Case 3-Chest paiN Abdul Fattah & Isfa Rizal Faculty of medicine, UiTM,Malaysia
<ul><li>Mr. MS, 36 yo malay gentleman </li></ul><ul><li>c/o - sudden left chest pain and SOB </li></ul><ul><li>asso/w feve...
<ul><li>PE </li></ul><ul><ul><li>Alert, pink, in pain, can complete sentence in one breath </li></ul></ul><ul><ul><li>Vita...
Provisional Dx <ul><li>Tension Pneumothorax </li></ul><ul><ul><li>It’s more clinical diagnosis than radiological </li></ul...
DIFFERENTIAL DX <ul><li>Acute MI </li></ul><ul><li>Angina/acute coronary syndrome </li></ul><ul><li>Pulmonary embolism </l...
INVESTIGATION <ul><li>It’s more  clinical diagnosis  than radiological </li></ul><ul><li>ABG analysis to evaluate  </li></...
<ul><li>Sharp thin line (visceral pleura) with no lung markings. </li></ul><ul><li>Beware of skin folds/apical bullae </li...
 
FINAL DX <ul><li>Tension pneumothorax </li></ul>
MANAGEMENT <ul><li>Treatment of tension pneumothorax should commence immediately after diagnosis, without waiting for furt...
<ul><li>Immediately administer 100% oxygen </li></ul><ul><li>Evaluate for evidence of respiratory compromise and hemodynam...
Chest tube
THANK YOU 
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chest pain-case 3

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common case scenario @ emergency department about chest pain.presented by my colleague.

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chest pain-case 3

  1. 1. Case 3-Chest paiN Abdul Fattah & Isfa Rizal Faculty of medicine, UiTM,Malaysia
  2. 2. <ul><li>Mr. MS, 36 yo malay gentleman </li></ul><ul><li>c/o - sudden left chest pain and SOB </li></ul><ul><li>asso/w fever and cough </li></ul><ul><li>Chest pain ~ sudden in onset </li></ul><ul><li> ~ severe pain, stabbing in nature </li></ul><ul><li> ~ radiating to ipsilateral shoulder </li></ul><ul><li> ~ increasing with inspiration (pleuritic) </li></ul><ul><li>went to GP and was given subL GTN </li></ul><ul><li>had SOB since onset of pain </li></ul><ul><li>GP refer pts to HS </li></ul><ul><li>In ED was given GTN and Aspirin stat </li></ul>
  3. 3. <ul><li>PE </li></ul><ul><ul><li>Alert, pink, in pain, can complete sentence in one breath </li></ul></ul><ul><ul><li>Vital </li></ul></ul><ul><ul><ul><li>BP – 129/79 </li></ul></ul></ul><ul><ul><ul><li>Temp – 36.8 </li></ul></ul></ul><ul><ul><ul><li>Pulse – 75 </li></ul></ul></ul><ul><li>Respi examination </li></ul><ul><li>Inspection </li></ul><ul><li>- asymmetry chest wall expansion </li></ul><ul><li>- breathlessness (respiratory distress) </li></ul><ul><li>- distended neck vein </li></ul><ul><li>- cyanosis </li></ul><ul><li>Palpation </li></ul><ul><li>- tracheal deviation to the right </li></ul><ul><li>Percussion </li></ul><ul><li>- hyperresonance at the left side </li></ul><ul><li>Auscultation </li></ul><ul><li>- decreased breath sound at the left side </li></ul>
  4. 4. Provisional Dx <ul><li>Tension Pneumothorax </li></ul><ul><ul><li>It’s more clinical diagnosis than radiological </li></ul></ul><ul><ul><ul><li>Chest pain, dyspnea, asymmetry chest wall expansion, respiratory distress, tracheal deviation to the right, hyperresonance at the left side, decreased breath sound at the left side. </li></ul></ul></ul>
  5. 5. DIFFERENTIAL DX <ul><li>Acute MI </li></ul><ul><li>Angina/acute coronary syndrome </li></ul><ul><li>Pulmonary embolism </li></ul>
  6. 6. INVESTIGATION <ul><li>It’s more clinical diagnosis than radiological </li></ul><ul><li>ABG analysis to evaluate </li></ul><ul><li>- hypoxia </li></ul><ul><li>- hypercapnia </li></ul><ul><li>- respiratory acidosis </li></ul><ul><li>Chest x-ray </li></ul>
  7. 7. <ul><li>Sharp thin line (visceral pleura) with no lung markings. </li></ul><ul><li>Beware of skin folds/apical bullae </li></ul><ul><li>Deep sulcus sign </li></ul>
  8. 9. FINAL DX <ul><li>Tension pneumothorax </li></ul>
  9. 10. MANAGEMENT <ul><li>Treatment of tension pneumothorax should commence immediately after diagnosis, without waiting for further consultation and/or evaluation. </li></ul><ul><li>Do not wait for CXR confirmation because patient may die if delay the treatment </li></ul>
  10. 11. <ul><li>Immediately administer 100% oxygen </li></ul><ul><li>Evaluate for evidence of respiratory compromise and hemodynamic instability </li></ul><ul><li>Immediate needle thoracostomy (14-16G) at 2 nd intercostal space at midclavicular line of affected side </li></ul><ul><li>Follow with chest tube insertion </li></ul>
  11. 12. Chest tube
  12. 13. THANK YOU 
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