Fine fracture I'm putting my money in pulmonary contusion tell me the flow was the 5 year 5 days ago yeah sure can improve it and then the oxygen requirement is that he's not my other option is fatty emboli it's a long bone fracture and he does have a stigmata on the chest past medical history of lung cancer but there's an x-ray this is to me a catheter issue this is a history of just going to have to remember it this institution was done already I think he looks good ortho we're trying what's gonna happen now is that I'm told you sleeps on the beginning of that tablet he's gonna continue getting higher than yes every time more yeah this was the abg we did now on 80% of oxygen he was on yeah on non rebreathe of this compensating type 2 respiratory failure no no chest fractures no no retractions no no he got into fractures he showed a small no nerve okay history he's he's got 3 monthly surveillance ct scans okay funded up the marks and he received a radical chemoradiogram in '22 last so as I said he's been monitoring for still okay great but if you look at the ct ct yeah a lot of his hemorrhoids dropped quite significantly but he's now recovering about whether we just do a ct so yeah because that's why I more post sexual chest imaging yeah because it hasn't been mobilized since he's anuric major and we wanna give him some contrast yeah today he's only passed 40 mils urine so we're gonna put him on some iv fluids now so egf ratio and we're gonna go up to the next so long is that 20% blood today egf was 5 90 yeah 90 we 20 we have bladder scattering there's nothing in his bladder no but yeah he's just not producing any an investment in any I know that lungs are kind well know we're be easily we get another person right we'll tell if we a ct we're gonna and either there's pulmonary contusion or there's pulmonary embolism it's gonna happen so mike you're discussing if it's pulmonary contusion you're gonna go if the I to see if we can get a diagnosis going god bless you other than that we might as well give him a bit of prehydration yeah I'll be fine 500 before the contrast that mean I'm not sure I'll have a 500 after that that's the what have you found about the saturation so he's got 1 it is a little bit worse your oxygen levels have dropped down and they've failed the x-ray of your chest shows us some bruising on this side of your chest every time on your right side jack you inch after you fall you've already bruised your lung quite significantly so that can affect your breathing your blood gas shows that the levels of carbon dioxide are building up in your blood you're not breathing enough is breathing painful calm yeah think it is it is painful yeah yeah yeah no no worries painful in 1 particular area or is it painful all over it's painful all over all over right so we'll get you some more painkillers we'll try and help breathe if you're suddenly not breathing enough we can see that on your on your blood gas test yeah I suggest we try and get you through a scan again to make sure that there's no blood clots in the vessels around the heart or an embolus of fat in the vessels around the heart which can cause the oxygen to be worse I'll also speak to my colleague from intensive care because he's had quite significant traumatic injuries and it may be that being in that environment would be better than being in the ward is that alright yeah great I'll get all those bits of obsessive team here we'll keep it from your team and we'll we'll sort of get close eye on the ward is that alright arrows like difference yeah desaturation secondary to differential diagnosis of that embolism pulmonary embolism or trauma associated with pneumonia we're to talk about some of the things that we're to we're about to traumatic issues chest it's not like fighting or having pain it's going to be a lactam he's have be bit we're on top of the we're trying to do this but you know if that he passed you in a clinical contrast you wanna give him to the doctor he said I'll a refill thinks well I don't know why this potassium has it's good sociological stuff as if your kidney couldn't concentrate water like don't you trust your kidney to concentrate salt I don't understand I think water is okay it may also be forming contrast but at least maybe later could possibly be the thing I was going to tell you is that when he had his fracture and his trauma and he had a significant hematoma and a loss of ductus hemoglobin down to 88 which is now recovered in 102 today it's just been stopping him on trying to lose an extra because obviously he hasn't given anything given the fact he had some scan him decide oh so you that's what we're do I was gonna put him no didn't get the scan exactly oh I did give him nicky with a new patient in the water day in the summer and mid afternoon he was quite stable at that. And listening to him bedside it has had like audible like secretions as well so when we saw him he dropped so early today he dropped his stats but then I saw him examine examine his chest and I asked him to like deep breaths and that improved mhmm because we saw don't know if it's a degree yeah okay of like plugging as well atelectasis yeah yeah exactly very spectral pain and I think he's hyperventilating to tenderness in his chest wall you know because it's a bit impactful to the room in so my impression was that honestly then I spoke and I actually came back and then all of sudden I'm sitting in the same room all the time I'm like I'm like you but but yeah so that was my impression initially but I just you guys took this so okay yeah because he didn't tell me anything about the pain he had on the right side of his chest when he saw me this afternoon and he said I've had this since morning yeah anyway yeah but thank you so we I asked the nurses just to do a ecg as well for control of the patient is there anything else you I can help you with and prescribe anything right now no no we're gonna switch him from his his palatal inhalers and the 2 lymphs and all sorts of that vocal assist team you get any lesions in there then you can have chest pain it's like a thyroid yeah otherwise just need to yeah I didn't for my learning I didn't quite know how a pulmonary edema on a on a scan that would be just ards it is ards it's white it's potentially ards yeah okay so a piece of imaging looked like that so we can kinda like rule that can we then with having a test like I'm just asking because I'm I don't know that much about it no okay I just think I think this hospital's yeah clinically how you can yeah identify the signs for that like trying say things like oh it sounds crunchy like you've got problematic lesions but I don't know I don't I'm not a traumatologist like these people are I'm surgeons for instance for the time I've done it I said crazy all the time yeah a like a flow void when you've a cough drop so you won't see it till then yeah I think I thought you said a flow void flow void I get because it's void in the cough drop but I don't know whether you'll be able to tell whether it's pap or not but I'm going to the radiologist for some reason I'm just actually correct it's a 2 0 2 she had crutches or high fever which makes her yeah yeah yeah I don't know I just don't know exactly as it described why not you guys got it hey surely yeah should we if that's what they want should we get the ooiesis to do it probably a nice thing I mean I can do it but the if I take a the yeast test okay and then the family will do it and they do it in here too they're nice and modern they do it in the tolerance they're very good at it you know I'm not very good at it but it it's probably nice if I I have it done nicely have you tried this 1 is it good no it's fine yeah yeah I'm I'm happy to do it but I think it would probably be better for her at least just to discuss it in the future if they have a moment but if they say no and I need to do everything that's done for you is it hard and the reason I guess is that we just think it'll be nice for this lady who might have meningitis he might be pregnant is that okay yeah don't know it's we've got an obstetricianist but he might need to do that yeah