Table 6

Findings from secondary survey suggesting need for hospital admission

ConditionKey findings
Pleural effusionHistory 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
    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