A 16-year-old male with presents with a gunshot wound to his chest.  The patient states he was in a house when he heard gunshots.  As he ran from the house he developed pain to his right upper back.  He presented to the ED via a private vehicle complaining of back pain & mild shortness of breath.  His vital signs  were a blood pressure of 110 / 60.  His pulse was 118.  His RR was 20.  And his room air pulse ox was 98.%.   You perform a focused ultrasound and note the following...

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