A major sports injury

Last Saturday, after I completed a review for a scientific paper, I went out for what I planned as a relaxing mountain bike ride. The plan was to enjoy the Taunus highlands near my home in Frankfurt/Main for 90 min. However, 25 min into the ride, shortly after leaving the city and entering a wood I heard the siren of an ambulance as it approached from behind and passed by me. As I trailed the ambulance I wondered what might have happened and where. Another 5 min later, in a steep downhill trail the ambulance and I stopped and I leaned my mountain bike against a tree. In front of the ambulance (staffed with two paramedics), at the border of the trail in a curve, lay a cyclist prone against a tree stump with his right side. His friend had already removed his riding partner's helmet.

The patient was alert and conscious. However, he could not provide details of the accident or the injury mechanism. Initial examination was done without moving the patient. There were no obvious bleeding and head and spine were not tender. There was severe left shoulder pain as well as pain with inspiration. Meanwhile, an emergency physician arrived. While I manually fixed the patients shoulder region we (emergency physician, myself, two paramedics and the accompanying mountain biker) carefully put the patient in a (flexed) standing position. Then we sat and laid him down supine to a spine board. His clothes were cut and further examination revealed a clavicular fracture and a pneumothorax, both on the left side. His head and trunk were fixed to the spine board and the emergency physician initially inserted a cannula in the right cubital vein and provided him with analgesics and infusion. Then we put the patient inside the ambulance. He was intubated and …