Findings from secondary survey suggesting need for hospital admission
| Condition | Key findings |
|---|---|
| Pleural effusion | History of cancer, cardiac failure, or renal failure |
| Limited chest expansion on the affected side | |
| Dull percussion note over the affected area | |
| Reduced breath sounds, TVF, and vocal resonance over the affected area | |
| Possible crackles in the presence of LVF | |
| Possible pleuritic rub (infection) | |
| Tracheal shift away from the effusion (late sign) | |
| Pneumothorax (most spontaneous pneumothoracies occur in tall, thin, fit young adults and are ideopathic) | Sudden onset of dyspnoea and pleuritic chest pain (early sign) |
| Development of tension pnuemothorax may be identified by increasing dyspnoea, and: | |
| Reduced chest expansion on the affected side | |
| Hyper-inflated, fixed chest wall on the affected side | |
| Surgical emphysema (rare) | |
| Trachea deviated away from affected side | |
| Chest hyper-resonant to percussion | |
| Decreased or absent breath sounds on the affected side | |
| Raised JVP | |
| Deteriorating cardiovascular status (late sign) | |
| Lung collapse (bronchial obstruction) | Dyspnoea |
| Reduced chest expansion on affected side | |
| Tracheal deviation towards side of collapse | |
| Dull to percussion over non-inflated area | |
| Decreased TVF over affected area | |
| Breath sounds absent or decreased over affected area; increased bronchial breathing elsewhere | |
| Pulmonary embolism (PE) | A Clinical features compatible with PE |
| Dyspnoea and/or | |
| Tachypnoea (>20 breaths per minute) and | |
| Heamoptysis and/or | |
| Pleuritic chest pain | |
| B Major risk factors for PE | |
| Major abdominal or pelvic surgery | |
| Hip or knee replacement | |
| Postoperative intensive care | |
| Late pregnancy | |
| Caesarean section | |
| Pueperium | |
| Lower limb fracture | |
| Varicose veins | |
| Abdominal, pelvic, or metastatic malignancy | |
| Reduced mobility due to hospitalisation or institutional care | |
| Previous history of venous thromboembolism | |
| C The absence of another reasonable clinical explanation for the signs and symptoms | |
| If A, B, and C are all confirmed the likelihood of PE is high; | |
| If A and B or C are present the likelihood of PE is intermediate; | |
| If A is present but B and C are both absent the likelihood of PE is low, especially in cases of pleuritic chest pain or haemoptysis not accompanied by breathlessness |