63 year old pensioner

presented to emergency department

left lateral stabbing chest pain while breathing

shortness of breath

63 year old pensioner

• immune system low

• prone to get disease

• pensioner - not active lifestyle

• less contact with another person

  
  

presented to emergency department

• patient in chronic condition

• need immediate treatment

left lateral stabbing chest pain while breathing

• sharp chest pain

• trauma

• rib fracture

• pneumothorax

• pleuritis

• MI

• pericarditis

• muscle strain

• pulmonary embolism

• costochondritis

• GERD

• angina

• anxiety attack

• viral pneumonia

• cytomegalovirus

• RSv

• covid

• tuberculosis

shortness of breath

• dyspnea

• check oxygen

• movement

• nose flaring

• reduced blood flow- emboli - insufficient oxygen

• smoking maybe?

• COPD- gas exchange

sharp chest pain

trauma

rib fracture

pneumothorax

pleuritis

MI

pericarditis

muscle strain

pulmonary embolism

costochondritis

GERD

angina

anxiety attack

viral pneumonia

cytomegalovirus

RSsharp chest pain

trauma

rib fracture

pneumothorax

pleuritis

MI

pericarditis

muscle strain

pulmonary embolism

costochondritis

GERD

angina

anxiety attack

viral pneumonia

cytomegalovirus

RSV

covid

tuberculosis

benign essential hypertension

• benign does not involve organ

• malignant involves organ damage

• persistently elevated blood pressure with no indentifiable underlying course

symptoms appeared soon after he fell on his chest

two days before.

The chest pain radiated to the shoulder of the same

side and increased with inspiration.

was agitated and disturbed emotionally

no leg swelling

no history of contact with patients with chronic cough

He has a history of benign essential hypertension.

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

His family history was unremarkable.

The patient did not smoke,No history of alcohol or drug abuse.

No history of recent long air travel

symptoms appeared soon after he fell on his chest two days before

• blunt trauma (sharp trauma causes bleeding)

• can be pneumothorax

• rib fracture- rib poking his lung

The chest pain radiated to the shoulder of the same

side and increased with inspiration

• can be CVS problem because heart is located at the left

• unstable angina

• costochondritits

• clavicular fracture

• pleuritis

was agitated and disturbed emotionally

• very painful/ feeling restless

no leg swelling

• no edema, no heart failure

no history of contact with patients with chronic cough

• no tb, covid

He has a history of benign essential hypertension

• high bp with non inditifiable medical course

• increase PR, that s why bp high, will have headache ,dizziness,nose bleeding

• can form thrombus, embolim and chest pain

• stasis, hypercoagulating state and inflammation

• immobility- cannot move

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

• normal blood flow

• no chronic respiratory or cvs disease

His family history was unremarkable.

• family semua okay

The patient did not smoke,No history of alcohol or drug abuse.

• healthy and fit guy

• no risk , health compromisation

No history of recent long air travel

• no DVT stasis

• no pulmonary embolism

vital signs

• respiratory rate

• pulse rate

• temperature

• blood pressure

physical examination

• respiratory system

  • inspection

  • nasal flaring

  • accessory muscle

  • tracheal deviation

  • percusion

  • auscaltation

• CVS

• GIT

CXR

check BMI

Crepitus = crackling or popping sounds or sensation that can be heard when certain structures in the body moves.

hyper-resonance = presence of air in pleural space

Normal temperature

normal heart rate

High respiratory rate

High BP

Borderline normal oxygen saturation

patient was found alert and in mild respiratory distress. There

was no cyanosis or pallor. His upper airways were clear.

no tracheal deviation

was found.

Reduced chest wall movement on the left side of the chest

localised tenderness over

the patient left lateral chest wall

crepitus over the 2nd to 6th left

ribs at the midaxillary line

hyper-resonance on

percussion over the left chest wall with decreased breath sounds.

BMI normal

no palpable lymphadenopathy.

The rest of the examination was unremarkable.

trauma (rib fracture)

pneumothorax

pleuritis

MI

pericarditis

costochondritis

angina

anxiety attack

pulmonary embolism

GERD

viral pneumonia

cytomegalovirus

RSV

covid

tuberculosis

CXR

FBC (to confirm the blood count,WBC)

Arterial Blood Gas (CAN dydx TYPE 1/TYPE 2 respiratory failure)

haemodynamically stable - Everything blood normal

encompassing - only 25% pneumothorax

chest tube - flexible tube inserted into pleural space to remove air/fluid/pus