1. Step 6
1.1. Review session 1
1.1.1. Summary of step 5
1.2. Report new knowledge
1.2.1. brief anatomy of thorax region
1.2.2. How to deal with traumatic difficult patient?
1.2.2.1. post-trauma stress syndrome
1.2.3. rib fracture and consequences
1.2.3.1. internal bleeding
1.2.3.1.1. hemothorax
1.2.3.2. muscle tear
1.2.3.3. pneumothorax
1.2.3.3.1. fluid intery to the pleura
1.2.3.3.2. symptoms
1.2.3.3.3. types
1.2.3.3.4. effects
1.2.3.4. pulmonary contusion
1.2.3.4.1. coughing blood
1.2.3.4.2. wheezing
1.2.3.4.3. bilateral acute respiratory distress syndrome
1.2.3.5. diphragm rupture
1.2.3.6. Mycardial rupture
1.2.3.6.1. usually they don't reach the ED
1.2.4. what causes shortness of breath, bruising, and pain after trauma?
1.2.4.1. bruising is superficial not a sever
1.3. 40 minutes
2. Step 8
2.1. Diagnostic decision
2.1.1. multiple rib fractures associated with pneumothorax
2.2. Mechanism
2.2.1. chest trauma
2.2.2. rib fracture
2.2.3. injury to the pleural membrane
2.3. Presentation
2.3.1. shortness of breath
2.3.2. right chest bruising
2.3.3. chest pain
2.3.4. noncooperation
2.3.5. tachypneia
2.3.6. low PB
2.3.7. high HR
2.3.8. trachea deviation
2.4. Supporting data
2.4.1. x-ray
2.4.2. hyperressonance of right lung
2.4.3. PCO2 and PH
2.5. 10 minutes
3. Step 7
3.1. Inquiry plan and info gathering
3.1.1. History of presenting complain
3.1.1.1. 38 yo
3.1.1.2. ill looking
3.1.1.3. trachiea deviated to the left side
3.1.2. Previous medical / surgical history
3.1.2.1. clear history
3.1.3. Drug history / allergy
3.1.3.1. no history of allergies
3.1.4. Family history
3.1.4.1. why were the family aggressive?
3.1.5. Social / occupational history
3.1.6. Systemic review
3.1.7. Physical examination
3.1.7.1. vital signs
3.1.7.1.1. pule 160
3.1.7.1.2. PB 60/0
3.1.7.1.3. tachypniea
3.1.7.2. he is cyanosed
3.1.7.3. no abdomen tenderness
3.1.7.4. hyperressunant right lung
3.1.7.4.1. pneumothorax
3.1.7.5. no alcohol smell
3.1.8. tests results
3.1.8.1. normal CBC
3.1.8.2. biochemistry
3.1.8.2.1. high pH (7.47)
3.1.8.2.2. low PCO2
3.1.8.2.3. PO2 (100)
3.1.8.3. x-ray
3.1.8.3.1. shows multiple fracture ribs with right collapsed lung