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Confirm Pneumothorax secondary to blunt chest trauma w multiple left rib fractures !

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1. Normal hb, normal WBC, normal pH, normal PaCO2, normal HCO3, normal PO2, normal ECG:
Normal Hb = no anemia ,no injury to the blood vessel from the rib fracture

Wbc normal = no infection

Normal ECG = no heart abnormalities

ABG analysis normal = gases exchange is still normal

2. left thoracic cavity partly filled with air occupying the pleural space (arrowhead) in left hemithorax

air occupying pleural space in left hemithorax (half of thorax) = in line with prev hypothesis that the patient had pneumothorax

3. pneumothorax encompassing about 25% of the left hemithorax with multiple left ribs fracture

Pneumothorax encompassing about 25% of the left hemithorax - significant amount of air trapped between the left lung and the chest wall
Multiple left rib fractures trauma to the chest wall on the left side - traumatic pneumothorax due to rib fractures

4. The patient refused insertion of a chest tube
- Insertion of a chest tube (thoracostomy tube) - a hollow tube is inserted into the chest cavity to drain air, fluid, or blood and restore normal lung function
- Chest tube insertion - create negative pressure in the chest cavity & allow re-expansion of the lung
- Pt might refused insertion of chest tube due to pain and discomfort during insertion & also increase risk of infection and bleeding

5. supplemental oxygen and analgesics administered
Analgesic

Relieve chest pain

Prevents hypoventilation and enable deep breathing

Oxygen supplement

to relieve the dyspnea symptom

Normal air - breathe in 80% of nitrogen, 20% of oxygen

Oxygen supplement = 100%, pneumothorax = accumulation of air in pleural space = 79% of nitrogen, 21% of oxygen

Given oxygen supplement therapy, creates concentration gradient of nitrogen, which means the partial pressure of nitrogen in pleural cavity is higher than that in the alveoli, so nitrogen tends to diffuse into alveoli -> decrease the amount of air in pleural cavity -> accelerates resolution

6. slight reduction in pneumothorax size
small air in the pleural cavity is resorbed, even without chest tube

7. follow up in a clinic
make sure the diagnosis made is right & no further complications on the patients

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Blunt trauma - non-penetrating trauma - injury of the body by forceful impact, falls, or physical attack with a dull object

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1. Normal Hb

2. Normal WBC

3. Normal pH

4. Normal PaCO2

5. Normal HCO3

6. normal PO2

7. normal ECG

8. Left thoracic cavity partly filled with air

9. Ct scan of chest showed pneumothorax encompassing about 25% of the left hemithorax with multiple left ribs fracture

10. diagnosed to have pneumothorax due to blunt chest trauma with multiple left ribs fractures.

11. refused insertion of a chest tube,

12. supplemental oxygen and analgesics administered, hemodynamically stable throughout stay in hospital, pulse oxygen saturation maintained above 95%, slight reduction in pneumothorax size

13. pt discharge 6 days after admitted. follow up in the clinic. remain asymptomatic. after 3 months, repeat CT scan showed complete resolution of pneumothorax

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ct scan-detailed imaging of the chest structures
ABG-Measure O2, CO2 levels & blood pH
Chest xray-
ECG-further confirm
FBC- rbc and wbc level

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1. Pneumothorax-Reduced chest wall movement on the affected side
Rapid breathing
Decreased breath sounds on the affected side
Progressive lung collapse - increased intrapleural air accumulation pressure -, push the affected lung and other mediastinal structures away from the midline = localised tenderness over the patient left lateral chest wall
No cyanosis = not severe
No tracheal deviation = not tension pneumothorax

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1. normal temp = no infection

normal heart rate- cardiovascular related diseases

O2 saturation is normal - less likely hypoxia to occur

Increase respiratory rate = due to the SOB, compensatory mechanism to fulfil the oxygen demand

2. alert and in mild respiratory distress-patient aware & responding

3.No cyanosis or pallor- decrease O2- get enough O2

4. clear upper airways-  no obstruction or abnormalities present

in the upper portion of the respiratory system : nasal passages, pharynx, larynx

patient get proper oxygenation and efficient exchange of O2 and CO2

5.Tenderness - development of pain with the application of light palpation to a specific area.
Localised tenderness over left lateral chest wall - secondary to fibrosis, consolidation, collapse or pneumothorax

6.Crepitus  over the 2nd to 6th left ribs at the midaxillary line-may be due to fractured rib & accumulation of excess fluid and air in the lungs

7.No tracheal deviation-Not in critical condition due to pneumothorax

8.BMI: 24 kg/m2 -Healthy weight range-respiratory conditions that can affect individuals regardless of their BMI

9.No palpable lymphadenopathy

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1. normal temperature, normal heart rate, increase respiratory rate, increase blood pressure, normal oxygen saturation

2. patient was found alert and in mild respiratory distress

3. No cyanosis or pallor

4. Upper respiratory clear

5. No tracheal deviation

6. Reduced chest wall movement on the left side of the chest

7. localised tenderness over the patient left lateral chest wall

8. crepitus over the 2nd to 6th left ribs at the midaxillary line

9. hyper-resonance on percussion

10.  decreased breath sounds

11. BMI: 24 kg/m2 (normal)

12.  no palpable lymphadenopathy

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1. tracheal deviation-trachea pushed to one side of your neck by abnormal pressure in chest cavity or neck
2. crepitus-it refers to a grating, crackling or popping sound or sensation that occurs when moving a joint

The term crepitus is sometimes also used to describe other conditions, such as lungs crackling from respiratory illnesses and bones grating after fractures.
3.percussion-A method of tapping body parts with fingers, hands or small instruments as part of physical examination.
hyper-resonace-Drum like sound Louder and lower pitch than resonance sound

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1. vital sign - Temp, heart rate, respiratory rate, blood pressure, o2 saturation
2. Physical examination - cynosis, clubbing, lymph node assessment (Lymphadenopathy - infection), chest examination (abnormalities at heart & lungs, cardiomegaly), percussion (oedema)
3. ascultation - duration, frequency, ampliude & quality of breath - detect abnormal lung sound
4. BMI - assess their body fatness and overall health status since the patient has a history of benign essential hypertension, obesity = risk factor of HTN

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1. ribs injuries - chest pain & SOB
2. rib fracture
3. pneumathorax - ribs injury lead to air in pleural space - allow air to enter the pleural space - pleuritic chest pain - pain durig breathing - SOB
4. pleurisy - conditontissue around lungs iinflammed - pain = sharp & stabbing natural - chest pain become worse during breathing & cough - might radiate to other site - fatigue , cough & fever

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1. fell on the chest - trauma - rib fracture - air enter pleural space - penumathorax - apply pressure to lungs - difficulties of breathing - dyspnoea
2. chest pain radiated to the shoulder of the same side and increased with inspiration - musculoskeleton movement, pleurisy (inflammation of pleura - mechanical injury on chest - force travel beyong rib cage to pleura - insult pleural tissue - inflammation) - pneumonia, PE, angina, MI. pain increase in inspiration - usually pleurisy
3. patient was agitated & disturbed emotionally - distress & unbale to relax - due to unbearable pain & afraid - agitated causing hyperventilation
4. absent leg swelling - exclude rhf & pe  - body is maintaining a normal fluid balance, with fluid being distributed and eliminated appropriately.

5. no history of contact with patients with chronic cough. - exclude urti & lti
6. benign essential hypertension - early stage,  asymptomatic, predispose themselves with to more dangerous and organ damaging
7. No history of asthma, COPD, heart disease or history of previous hospitalisations. - acute, exclude emphysema cuz no hhistory of COPD & asthma. not immunocompromised - less risk to get disease like immunocompromised pt is
8. family history unremarkable - exclude genetic disease
9. did not smoke - decrease risk of copd lung ca pe asthma
10. no history of drug abuse - not susceptible to infection via contamination by sharing needle
11. no hisotry of recent long air travel - no alteration in sleeping pattern, less risk to anxiety that may develop the same symptoms

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1. presenting symptoms appeared soon after he fell on his chest at home two day
2. chest pain radiated to the shoulder of the same side and increased with inspiration.
3. patient was agitated and disturbed emotionally.
4. no leg swelling
5. no history of contact with patients with chronic cough.
6. history of benign essential hypertension. 7. No history of asthma, COPD, heart disease or history of previous hospitalisations.
8. His family history was unremarkable.
9. did not smoke
10. No history of alcohol or drug abuse
11. No history of recent long air travel

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1. agitated - feeling troubled, nervous or disturbed (afraid / nervous)
2. benign essential hypertension - hypertension that doesn't know secondary cause

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1. SOCRATES- cough (sputum)- duration(how long occurs)-severity of chest pain)
2. Past medical history- asthma-disease related to lung-prescription of medicine-history of hospitalization
3. Family history-diabetes-HTN-cancer
4.Social history-smoking-taking drugs-chemical exposure-tb exposure

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1.COPD-asthma- pulmonary HTN
2.cardiomyopathy
3emphysema
4.pulmonary embolism
5. Pneumothorax-rib injuries
6.Cardiovascular disease- valvular HD-RHD

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1. 63 years old - immunosenescence

2. Pensioner -less active-prone to getting CVS disease

3. Presented to the Emergency Department -serious illness/injury-need treatment immediately

4. complaining of left lateral stabbing chest pain while breathing(pleuritic chest pain)-include left side area-inflammation(SLE)-fracture rib-trauma-intense exercise-pleural injury( pneumothorax)

5. shortness of breath(Acute/Chronic)-dyspnea-respiratory/ cvs problem-pneumonia- impaired inspiration-air accumulation in the pleural cavity-pneumothorax- reduced lung perfusion ( pulmonary effusion)- CVS ( impaired blood flow)- reduced gas exchange-Heart Attack-cardiac tamponade-cardiac myopathy

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1. 63 years old

2. Pensioner

3. Presented to the Emergency Department

4. complaining of left lateral stabbing chest pain while breathing

5. shortness of breath

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SOB- dyspnea