Lung collapse
Signs
Trachea- displaced towards the collapsed lung
Chest expansion- reduced on the affected side with flattening of the chest wall on the same side
Tactile fremitus- reduced on affected side
Percussion- dull over the collapsed lung
Breath sound- reduced +/- bronchial breath sound above the area of collapse
Cuauses of lung collapse
Intraluminal- mucus (post-operative, asthma, cystic fibrosis)
Mural- lung cancer
Extramural- peribronchial adenopathy
CLASSIC CLINICAL PROBLEM SOLVING
There are typically five distinct steps that an emergency department clinician undertakes to systematically solve most clinical problems:
1. Addressing the ABCs and other life-threatening conditions
2. Making the diagnosis
3. Assessing the severity of the disease
4. Treating based on the stage of the disease
5. Following the patient’s response to the treatment
Aetiology
Common Cause metastatic breast, prostate, lung
May also be primary loke multiple myeloma, leukemia, lymphoma
Clinical Symptoms Analysis
Pain lasting longer than 1 month, worse at night, unrelieved by rest; unexplained
weight loss;
mild tomoderate spinal tenderness
Diagnostic tools
CBC, ESR,
plain x-ray, CT,
MRI
Treatment in Emergency Departement
intravenous dexamethasone
and refer for radiation therapy
Etiology
Most commonly due
to Staphylococcus.aureus
Risk Factors
intravenous drug use
elderly, immunocompromised, alcoholism, recent bacterial
Signs and Symptoms
infection or back trauma
Back pain (even at rest/
night), fever, midline
cultures, tenderness
along spine.
Focal neurologic deficits as late finding
Diagnostics
CBC, ESR,
plain x-ray
C.T
MRI - preferred
Treatment
Intravenous
antibiotics,
surgical drainage
and
decompression
Patients younger than 18 years old or older than 50 years
Significant trauma (or mild trauma in patients older than 50 years)
Chronic steroid use
Osteoporosis
History of cancer Recent infection
Immunocompromise
History of intravenous drug use
Pain worse at night,
lasting longer than 6 weeks,
or refractory to analgesics and rest
Associated systemic symptoms (fever, unexplained weight loss, malaise, night sweats, diaphoresis, nausea, syncope)
Acute onset Use of anticoagulants or coagulopathy
Abnormal vital signs (including unequal blood pressures or pulse deficits)
Neurologic deficits (including extremity weakness, numbness, paresthesias, loss of rectal sphincter tone, urinary retention)
A 57-year-old man
one month history of worsening low back pain
radiates down the back of both legs and suddenly increased yesterday.
For the past 2 days, have difficulty voiding
skin around his anus feels numb when he wipes with toilet tissue.
He denies prior trauma to or surgery on his back.
- Most likely diagnosis: Cauda equine syndrome
Aetiology Central disk herniation multiple, involving bilateral nerve roots
the next diagnostic step MRI
Why Cauda Equina and not other causes of LBP because cardinal signs of Cauda equina syndrome are
, urinary retention and overflow incontinence, decreased rectal tone, saddle anesthesia
Past surgical history: Date and type of procedure performed, indication, and
outcome. Laparoscopy versus laparotomy should be distinguished. Surgeon
and hospital name/location should be listed. This information should be correlated with the surgical scars on the patient’s body. Any complications should
be delineated including, for example, anesthetic complications and difficult
intubations.
Past medical history:
a. Major illnesses such as hypertension, diabetes, reactive airway disease,
congestive heart failure, angina, or stroke should be detailed.
i. Age of onset, severity, end-organ involvement.
ii. Medications taken for the particular illness including any recent changes
to medications and reason for the change(s).
iii. Last evaluation of the condition (example: when was the last stress test
or cardiac catheterization performed in the patient with angina?)
iv. Which physician or clinic is following the patient for the disorder?
b. Minor illnesses such as recent upper respiratory infections.
c. Hospitalizations no matter how trivial should be queried.
