Pneumothorax - Secondary Survey

Question 1

Pneumo - Secondary Intro

Answer 1

If no time critical features present, continue on to secondary.

If the patient was in too much distress I would begin my treatment (see section 2) and move on to the secondary survey where possible.

Help to rule out differential.
Whilst setting up an ECG to help create differential diagnosis for chest pain, ask questions on:

Question 2

Pneumo - PC

Answer 2

• Clearly identify why the ambulance has been called

Question 3

Pneumo - HPC

Answer 3

• What happened directly before it started?
• Has it happened before?
• SOCRATES (should really help with differential for ACS)

Question 4

Pneumo - SOCRATES

Answer 4

S (thorax, localised), 
O (sudden, or developing overtime), 
C (Sharp), 
R (no), 
A (DIB), 
T, 
E (inspiration), 
S (High)

Question 5

Pneumo - RMH

Answer 5

• Any episodes of this before? If yes, previous outcomes?
• Respiratory conditions?
• Cardiac condition (differential)
• Family history

Question 6

Pneumo - Meds

Answer 6

• Find out the patient’s current prescribed medications.
• Use the medications to confirm with the patient why they think they take them.
• Are they taking their medications? If not, why not?
• Have they tried any over the counter medications, if so, what?
• Have they taken any medications to relieve symptoms? If so, what and when? To ensure you do not over medicate.
• Actions – take the patients medications with you.

Question 7

Pneumo - Review of systems intro

Answer 7

Respiratory system assessment, though would consider cardiac if time permitted, or questioning and assessment indicated cardiac involvement.

Question 8

Pneumo - Inspection

Answer 8

o Hands/feet – colour, warmth,
o Face – pursed lip breathing, cyanosis
o Resp rate, rhythm, depth, effort
o Thorax – recession, eq rise (pneumo differential) , chest shape (COPD?), scars

Question 9

Pneumo - Palpation

Answer 9

o Bony structures – differential for trauma
o Tracheal deviation – differential for pneumo
o Tactile fremitus – (decreased)
o Respiratory excursion – (pneumo diff)

Question 10

Pneumo - Percussion

Answer 10

o Pneumothorax – hyper-resonance

Question 11

Pneumo - Ausculatation

Answer 11

o	Eq bi lat AE (reduced breath sounds)
o	Wheeze (differnatial)

Question 12

Pneumo - SHx

Answer 12

• Who lives in the address you have been called to? If out of normal abode, establish living circumstances.
• Any other help? Family, external agency for example.
• Are there any problems with activities around the house etc, shopping, dressing etc.