DIB Scenario

What mnemonics can you use to help with the history of pain?

The patients’ observations are 105 HR, 26 RR, 93% Sp02, 148/82 BP, 5.2 BM, 36.6 Temp. You have also gained a brief history from your mnemonic: 

Onset – 30 minutes ago, Provocation – Deep inhalation, Quality – Sharp, tightening pain, Radiating – Radiating around the chest but mainly left side, Severity – Gradual increase to 8/10 NPS, Time – Increasingly getting worse, Associated symptoms – Shortness of breath, nausea. 

You complete a 12 lead ECG and get this result: 

What is the rhythm presented? 

You are not overly concerned with the ECG presented but still consider the risks of an NSTEMI. Is aspirin still indicated in this scenario even though there is no ECG evidence of ACS?

You look to give the patient a thorough respiratory examination as you cover your differentials. On inspection you find on deep inhalation the chest moves symmetrically but causes a lot of pain. No deformities are present on palpation. On auscultation, the left side sounds quiet compared to the right especially on the upper base. You also find hyper resonance on the left side, again on the upper base. 

What diagnosis would these findings be more associated with? 

You find out the patient has pulmonary fibrosis and has been undergoing recent tests to determine the severity including a lung biopsy, making you more confident of your pneumothorax differential. The patient has no other past medical history. What treatment would you consider at this stage?

You apply 02 but how much and what adjuncts can you use to apply it, according to JRCALC? Observations are still the same as when you complete them on arrival.

You can use needle thoracocentesis on any patient whereby you suspect a pneumothorax developing?

You hold off your needle thoracocentesis as there are certain inclusion criteria. What additional or worsening symptoms could you potentially see when a simple pneumothorax develops into a tension pneumothorax? 

A simple pneumothorax does not shift the mediastinal structures unlike a tension pneumothorax?

What pain relief would be most appropriate in this scenario?

What other differential diagnoses could be similar to pneumothorax?

When assessing a patient’s chest with an advanced pneumothorax, you may find the effected side of the chest to either be not rising symmetrical and or hyper-inflated?

What risk factors are associated with spontaneous pneumothorax? 

Recurrence of pneumothorax can be seen in up to what percentage of cases? 

The rupture of what structures within the lungs cause most cases of spontaneous pneumothoraxes?