Chest Wall Injury
- If a mechanism or pattern:
- When did it happen?
- What happened exactly? Try to understand the mechanism and forces involved (if present)
- What symptoms initially?
- Where were the symptoms initially?
- Describe pain – sharp / superficial / deep / ache / burning etc
- What aggravates and what eases?
- Pain on breathing / coughing?
- Haemoptysis?
- What symptoms now?
- Have the symptoms changed? Better / Worse? Location?
- If no mechanism
- How long has it been there?
- Is there anything that they believe may have contributed to the development of the problem? Recent activity / inactivity
- What symptoms are present?
- Are they there all the time?
- What treatment has been sought so far?
- Assessment
- Investigations
- If imaging, do they have it with them?
- If not, can we view it?
- Private providers use online applications
- If in another public hospital in Victoria, then can use the “Synapse Mix” service to get the images temporarily put on local network diagnostic imaging servers.
- What management has been undertaken? Has it been effective
- Ice
- Medications
- History of problems in that area before
- When?
- How was it managed?
- Assessment undertaken?
- Investigations
- Medications
- Any ongoing problems?
- Any associated symptoms (if a non mechanical cause or if at all suspicious)
- Recent illness / fevers / sweats
- Recent overseas / long haul travel / immobilisation (eg for suspected DVT)
- Loss of appetite / loss of weight, etc
- If potentially needing procedural sedation or surgery (and consider this for anyone you are contemplating an x-ray for)
- Fasting status (and tell them not to eat and drink until you tell them it is ok to do so
- Observations
- SaO2, HR, BP
- Auscultation
- Thoracic Movement
- Flexion / Extension
- Rotation
- Lateral Flexion
- Breathing
- Palpation
- Thoracic spine
- Ribs
- Costovertebral joints
- Costochondral joints
- Sternum
- Special Tests
- Chest wall springing / compression
- Imaging
- If substantial chest wall pain, consider Chest inspiratory / expiratory x-ray to:
- Exclude Pneuomothorax / Haemothorax
- Examine the ribs (although rib fractures are often radiologically occult)
- Also consider thoracic spine involvement
- May need thoracic spine x-ray as well
- If substantial chest wall pain, consider Chest inspiratory / expiratory x-ray to: