Pneumothorax

HISTORY:

Sudden onset of ‍rightleft ‍chest painshortness of breath for ‍ ‍hoursdays

‍chest pain, ‍retrosternal, ‍on exertionat restwith deep breath

‍shortness of breath

‍rapid heart rate

‍rapid breathing

‍cough, ‍non-productiveproductive

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

Worsening factors: ‍nonephysical activitymovementdeep breathing

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Chest: ‍tenderness on ‍rightleft ‍

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Pneumothorax ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Chest X-ray

- CT scan of the chest

- Immediate ‍needlefinger decompression

- Chest tube insertion

- Oxygen 2L

- ‍Acetaminophen

- ‍Ibuprofen

- ‍Opioids

- Hydration and rest

- Smoking cessation counseling

- Referral to surgeon

- Repeat chest X-ray in ‍ ‍daysweeks

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop