Dr. William Harris: A 49-year-old man apparently had been crushed between an elevator and the sidewall of the elevator shaft while doing some repair work. When he was brought to the emergency ward shortly after the accident, he was awake but not fully responsive. His blood pressure was 130/70 mm Hg. A large ecchymotic area was noted on the left side of the neck and the left shoulder. There were paradoxical rib movements bilaterally. The chest had been so badly crushed that the cardiac impulse made the sternum and anterior chest wall thrust forward with each beat. Examination of the abdomen revealed a mass in the left upper quadrant. Aspirations of the abdomen in all four quadrants were negative. Sensation, including the perianal region, was completely absent below the dermatome level of T-11. He had total motor paralysis of the lower limbs. No reflexes were present in the lower extremities.