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Fracture rib

Pneumothorax

Pulmonary embolism

Pleurisy

Infection

COVID-19

Tuberculosis

pneumonia

Rheumatic heart disease

Emphysema

Lung cancer

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Pensioner

-someone already retired from work

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63 year old

highest risk to get health problem

l ow immune system

pensioner

passive lifestyle

presented to Emergency Department

need immediate treament

left lateral stabbing chest pain

due to inflammation

heart problem

could be beacause of heart attack/angina/COPD

left side of the lung

stabbing chest pain

sharp and sudden pain

pain while breathing

feel the pain during normal activity

patient might have heart problem

hypoxia - also can lead to SOB

injury to the rib (fracrture rib)

shortness of breath

could be cause by pulmonary embolism

cause blockage

loss oxygen - body stimulate compensatory mechanism

hypoxia

collapsed of lung might due to emphysema

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Socrates

onset - from when/on and off

characteristic - dry/wet cough & color of sputum/ haemoptysis

radiation - radiated to where

associated symptomp - fever/night sweat/loss of weight/loss of appetite

time - when feeling pain

Family history

any of family member have cvd

infection covid-19

have any cancer

hyperlipidaemia

social history

past trauma

smoking/drinking

medical history

have been hospitalised or not

hypercoagubility

any vaccination

check for leg edema

undergoes surgery before

have any past infection

travel history

any prolonged immobility

go to the country with high risk of infection

general question

bedridden

Vital sign

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agitated - nervous or feeling disturbed, restlessness which lead to physical discomfort

benign essential hypertension - a type of hypertension, chronic vascular damage, not identified cause, primary hypertension

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after he fell on his chest

can cause pleurisy

fractured ribs

can cause pneumothorax

two days before

acute

chest pain radiated to the shoulder of the same side

has cranial nerve, overlap with lung, ribs and shoulder, so it can radiate to shoulder

increased with inspiration

lung problem, lung cannot inflate properly

due to fracture ribs

agitated and disturbed emotionally

chronic pain

less oxygen supply due to fast breathing(tachypnea)

panic attack

no leg swelling

exclude PE

no history of contact with patients with chronic cough

exclude disease by infection

COVID-19

a history of benign essential hypertension

reduced blood flow, inadequate oxygen supply

No history of asthma, COPD, heart disease or history of previous

hospitalisations

have no chronic disease

might due to trauma

His family history was unremarkable

no genetic disease

no cancer

no spontaneous pneumothorax

The patient did not smoke

rule out lung cancer

rule out emphysema

No history of alcohol or drug abuse

no sharing of needle

no HIV, less likely TB

No history of recent long air travel

low risk of infection

less likely pulmonary embolism

no DVT that lead to PE

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Fracture rib

Pneumothorax

Pulmonary embolism

Pleurisy

Infection

COVID-19

Tuberculosis

pneumonia

Rheumatic heart disease

Emphysema

Lung cancer

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Vital signs

Chest X-ray

Associated symptoms for fell related trauma (intrinsic or extrinsic)

dizziness

sleep deprived

sarcopenia

osteoporosis

syncope

visual disability

neurological disorder

Medication history

diuretic - cause to go to toilet frequently

Physical examination

tracheal inspection - deviation

chest examination - bruise on chest

palpation - for any internal bleeding

auscultation - lung sound,

percussion - hyper-resonance for chest to check

Lymph node inspection

relate to infection

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tracheal deviation - move to one side of the neck

crepitus - crackles sounds

percussion - to asses the sound produce by tapping

tenderness - feeling pain when pressure is applied

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normal -

temperature - no infection

heart rate - no cvs problem

oxygen saturation - no hypoxia

elevated respiratory rate

compensatory mechanism due to sob

pt was found alert

no problem in nervous system problem

no cyanosis or pallor

rule out hypoxia

upper respiratory is clear

no blockage in the upper respy part

no tracheal deviation

mild pneumothorax

Reduced chest wall movement on the left side of the chest

due to fractured of ribs

localised tenderness over the patient left lateral chest wall

due to fractured of ribs

due to cavity (pneumothorax)

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

can be due to fractured of ribs

can be differentiate into subcutaneous and bone (different sound)

can also be due to fluid accumulation

hyper-resonance on percussion over the left chest wall

indicate pneumothorax

decreased breath sounds

due to low breath volume

due accumulation of air or fluid around the lungs

no movement of air in and out

Body mass index (BMI): 24 kg/m2

normal

no palpable lymphadenopathy

rule out malignancy and infection

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Fracture rib

Pneumothorax

Pulmonary embolism

Pleurisy

Infection

COVID-19

Tuberculosis

pneumonia

Rheumatic heart disease

Emphysema

Lung cancer

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1. A chest x-ray demonstrating the left thoracic cavity

partly filled with air occupying the pleural space (arrowhead) in the left

hemithorax

2. CT scan of the chest showed pneumothorax

encompassing about 25% of the left hemithorax with multiple left ribs

fractures (2nd to 6th ribs)

3. pneumothorax due to blunt chest

trauma with multiple left ribs fractures

4. patient refused insertion

of a chest tube

fear of pain

5. Supplemental oxygen and analgesics were

administered

6. Pulse oximeter oxygen saturation was maintained

above 95%. Follow up chest x-ray showed a slight reduction in the

size of the pneumothorax. The patient was discharged six days after

admission. He was followed up in the Surgical Clinic, and he

remained asymptomatic. After three months, repeated CT scan of

the chest showed complete resolution of the pneumothorax.

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pneumothorax due to blunt chest trauma