-someone already retired from work

• 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

Pneumothorax

Pulmonary embolism

Pleurisy

Infection

• COVID-19

• Tuberculosis

• pneumonia

Rheumatic heart disease

Emphysema

Lung cancer

• 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

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

• 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

Pneumothorax

Pulmonary embolism

Pleurisy

Infection

• COVID-19

• Tuberculosis

• pneumonia

Rheumatic heart disease

Emphysema

Lung cancer

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

crepitus - crackles sounds

percussion - to asses the sound produce by tapping

tenderness - feeling pain when pressure is applied

• 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

Pneumothorax

Pulmonary embolism

Pleurisy

Infection

• COVID-19

• Tuberculosis

• pneumonia

Rheumatic heart disease

Emphysema

Lung cancer