This patient has been in your ED for over 24 hours waiting for a CCU bed. He presented with vomiting and syncope, but acquired left sided rib fractures during his collapse. He has been comfortable for most of the day on nasal-prong oxygen and a morphine PCA.
You are asked to see him as he has sudden worsening of his left-sided chest pain. He has become clammy and hypoxic.
This is what you see….
What’s going on ?
What are you going to do now ??