A Previously Healthy, 25-Year-Old Man Is Brought to the Emergency

A previously healthy, 25-year-old man is brought to the emergency department after falling approximately 3 m (10 ft) from a treehouse, landing on his left side.  There was no loss of consciousness.  The patient has left shoulder and left-sided chest pain, as well as abdominal pain.  Blood pressure is 114/72 mm Hg and pulse is 116/min.  Physical examination shows bruising to the left side of the chest wall and abdomen.  Heart sounds are normal.  There is sharp, left-sided chest pain with deep inspiration but equal breath sounds on both sides.  The left costal margin and the left upper quadrant of the abdomen are tender to palpation.  Range of motion of the left shoulder is normal.  Portable chest x-ray is normal.  Focused Assessment with Sonography for Trauma shows no pericardial effusion or significant intraperitoneal free fluid.  Which of the following is the best next step in management of this patient?

A) Monitor with serial physical examinations
B) Obtain CT scan of the abdomen
C) Obtain dedicated radiographs of the ribs
D) Obtain plain radiographs of the left shoulder
E) Perform diagnostic peritoneal lavage
F) Perform exploratory laparotomy

Correct Answer:

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