PTX

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of sudden onset of ‍rightleft ‍chest painshortness of breath

Symptoms include:

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍shortness of breath

‍rapid heart rate

‍rapid breathing

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills



Worsening factors: ‍nonephysical activitymovementdeep breathing

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍smoking

‍tall and thin stature

‍mechanical ventilation

no history of: ‍pneumothorax, ‍COPD, ‍chest injury, ‍chest surgery





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Chest: ‍tenderness on ‍rightleft ‍

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Pneumothorax ‍likelysuspectedpossible

DDx: pneumothorax, COPD exacerbation, asthma exacerbation, pulmonary embolism, pleural effusion, rib fracture, chest wall contusion, pneumonia, lung cancer, heart failure, pulmonary contusion, myocardial contusion, traumatic aortic disruption, esophageal injury, diaphragmatic injury, anxiety/panic disorder related to trauma, tuberculosis, ARDS





PLAN:

Investigations:

- Chest X-ray

- CT scan of the chest

Treatments:

- Immediate ‍needlefinger decompression

- Chest tube insertion

- Oxygen 2L

- ‍Acetaminophen

- ‍Ibuprofen

- ‍Opioids

- Hydration and rest

- Smoking cessation counseling

Further care:

- Referral to surgeon

- Repeat chest X-ray in ‍ ‍daysweeks

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop