A breathless patient
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A 27-year-old male smoker presented with chest pain, shortness of breath, and a productive cough, experiencing worsening symptoms while working. He underwent a successful VATS bullectomy with subsequent clinical improvement and was advised against flying for six weeks and to quit smoking. The document also discusses the effectiveness of ultrasound versus chest radiographs in detecting pneumothorax, highlighting the superior sensitivity of ultrasound.
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A breathless patient
- 1. Dr. Avijit Barai MBBS, MRCS, MSc (Crit care), PGCertCPU, CCPU, MRNZCUC
- 2. 27-year-old male Smoker Inconsistent history Told triage that he had chest pain since yesterday Told me that he is having shortness of breath for a week Productive cough for a week Symptoms got worse at work as he was putting fire out
- 3. Appearance: Looked tired, anxious. Sitting upright on bed. A: Clear. B: RR= 26/min, sats= 93% RA. Reduced air entry right side. Percussion note hyper-resonance right side. C: Pulse= 107/min, BP 122/76mmHg D: Temp 37 deg C, GCS 15/15 Remaining exam unremarkable.
- 10. Cardiothoracic team took him to theatre VATS Bullectomy was done Chest drain removed Clinical and radiological improvement
- 11. Home No diving EVER! Not to fly for 6 weeks Advised to quit smoking
- 12. American guidelines BTS 2003 guidelines
- 15. Needle thoracostomy Aspiration Bedside ultrasound Time critical emergency
- 17. Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from 86% to 98% and 97% to 100%, respectively. The sensitivity of supine AP chest radiographs for the detection of pneumothorax ranged from 28% to 75%. The specificity of supine AP chest radiographs was 100% in all included studies.
- 18. Gentry Wilkerson R, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Academic Emergency Medicine. 2010 Jan 1;17(1):11-7. Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax. 2003 May;58(Suppl 2):ii39.