Author: Jonathan Neil Mackenney /Â Editor: Jason Kendall / Reviewer: Phil Delbridge / Codes: GP9, RP6, RP7, SLO1, SLO3, SuC15, SuP7, TP3 /Â Published: 05/10/2023
An 80-year-old woman presented to the Emergency Department (ED) at 2am with acute chest pain and shortness of breath. She had fallen against a stool 1 week previously injuring her left posterior chest wall. Earlier on the day of presentation she had seen her GP due to ongoing left sided chest pain and had been prescribed a painkiller. She had been unwell with nausea and repeated vomiting following the first dose and her husband called an ambulance when her chest pain significantly worsened.
She looked unwell and was in severe pain; her respiratory rate was 28, temperature 37.6oC, O2 saturations were 89% on air, pulse rate was 115, and her BP was 130/68. There was reduced expansion of her left hemithorax and hyper-resonance at its apex. Arterial blood gas revealed hypoxia and a metabolic acidosis.
Her Chest X-ray is shown.
Module Content
Pleural Effusion
This session looks at the assessment and management of the adult with a pleural effusion in the ED.
Spontaneous Pneumothorax
This session covers the assessment and management of primary, secondary and tension pneumothoraces.
Thoracic Trauma
For each life-threatening thoracic injury this session includes: a definition and context, Clinical assessment , treatment and Key learning points.
12 Comments
Good case
Excellent case. Really shows how important a thorough history is to correlate clinical findings.
always the history that gives you the most likely diagnosis
Good case
Very tricky question but very informative.
Good case
Brain turner
Very good case presentation and CXR has many findings
Good rare case
Good tricky case
tricky case
Interesting case.