archetype (adl_version=1.4)
    openEHR-EHR-CLUSTER.exam-chest.v1
specialize
    openEHR-EHR-CLUSTER.exam.v1

concept
    [at0000.1]    -- Examination of the chest
language
    original_language = <[ISO_639-1::en]>
description
    original_author = <
        ["name"] = <"Sam Heard">
        ["organisation"] = <"Ocean Informatics">
        ["date"] = <"9/04/2007">
        ["email"] = <"Sam.Heard@OceanInformatics.biz">
    >
    details = <
        ["en"] = <
            language = <[ISO_639-1::en]>
            purpose = <"A cluster for recording findings on physical examination of the chest">
            use = <"">
            keywords = <"examination", "physical", "chest", "thorax", "lungs">
            misuse = <"">
        >
    >
    lifecycle_state = <"Initial">
    other_contributors = <>

definition
    CLUSTER[at0000.1]  {    -- Examination of the chest
        items cardinality  {0..*; unordered}  {
            CLUSTER[at0004] occurrences  {0..1}  {    -- Normal statements
                items cardinality  {0..*; unordered}  {
                    ELEMENT[at0005] occurrences  {0..*}  {    -- Normal statement
                        value  {
                            DV_TEXT  {*}
                        }
                    }
                }
            }
            ELEMENT[at0002] occurrences  {0..1}  {    -- Clinical description
                value  {
                    DV_TEXT  {*}
                }
            }
            CLUSTER[at0008] occurrences  {0..1}  {    -- Findings
                items cardinality  {0..*; unordered}  {
                    CLUSTER[at0.1] occurrences  {0..1}  {    -- Chest wall
                        items cardinality  {0..*; unordered}  {
                            ELEMENT[at0.2] occurrences  {0..1}  {    -- Description
                                value  {
                                    DV_CODED_TEXT  {
                                        defining_code  {[local::]}
                                    }
                                }
                            }
                            ELEMENT[at0.28] occurrences  {0..1}  {    -- Shape
                                value  {
                                    DV_TEXT  {*}
                                }
                            }
                            CLUSTER[at0.30] occurrences  {0..1}  {    -- Heart - Apex beat
                                items cardinality  {0..*; unordered}  {
                                    ELEMENT[at0.31] occurrences  {0..1}  {    -- Visible
                                        value  {
                                            DV_BOOLEAN  {
                                                value  {True, False}
                                            }
                                        }
                                    }
                                    CLUSTER[at0.32] occurrences  {0..1}  {    -- Palpation
                                        items cardinality  {0..*; unordered}  {
                                            ELEMENT[at0.33] occurrences  {0..1}  {    -- Palpable
                                                value  {
                                                    DV_BOOLEAN  {
                                                        value  {True, False}
                                                    }
                                                }
                                            }
                                            ELEMENT[at0.34] occurrences  {0..1}  {    -- Maximal location
                                                value  {
                                                    DV_TEXT  {*}
                                                }
                                            }
                                        }
                                    }
                                }
                            }
                            allow_archetype CLUSTER occurrences  {0..1}  {
                                include
                                    archetype_id/value matches {/palpation\.v1draft/}
                                    archetype_id/value matches {/inspection\.v1draft/}
                                    archetype_id/value matches {/auscultation-chest\.v1/}
                            }
                        }
                    }
                    CLUSTER[at0.3] occurrences  {0..1}  {    -- Respiratory system
                        items cardinality  {0..*; unordered}  {
                            ELEMENT[at0.4] occurrences  {0..1}  {    -- Trachea
                                value  {
                                    DV_CODED_TEXT  {
                                        defining_code  {
                                            [local::
                                            at0.5,     -- Midline
                                            at0.6,     -- Deviated to the left
                                            at0.7]    -- Deviated to the right
                                        }
                                    }
                                }
                            }
                            CLUSTER[at0.8] occurrences  {0..1}  {    -- Breathing
                                items cardinality  {0..*; unordered}  {
                                    ELEMENT[at0.19] occurrences  {0..1}  {    -- Description
                                        value  {
                                            DV_TEXT  {*}
                                        }
                                    }
                                    ELEMENT[at0.9] occurrences  {0..1}  {    -- Type
                                        value  {
                                            DV_CODED_TEXT  {
                                                defining_code  {
                                                    [local::
                                                    at0.10,     -- Diaphragmatic breathing
                                                    at0.11]    -- Thoracic breathing
                                                }
                                            }
                                        }
                                    }
                                    ELEMENT[at0.12] occurrences  {0..1}  {    -- Effort
                                        value  {
                                            5|[local::at0.13],     -- Normal breathing effort
                                            6|[local::at0.14],     -- Mild increase in effort
                                            8|[local::at0.15],     -- Moderate increased effort
                                            10|[local::at0.16]      -- Major increased effort
                                        }
                                    }
                                    CLUSTER[at0.17] occurrences  {0..1}  {    -- Signs of increased effort
                                        items cardinality  {0..*; unordered}  {
                                            ELEMENT[at0.18] occurrences  {0..*}  {    -- Sign
                                                value  {
                                                    DV_CODED_TEXT  {
                                                        defining_code  {
                                                            [local::
                                                            at0.25,     -- Using accessory muscles
                                                            at0.20,     -- Intercostal recession
                                                            at0.24,     -- Subcostal recession
                                                            at0.23,     -- Suprasternal recession
                                                            at0.21,     -- Sternal recession
                                                            at0.22]    -- Rib retraction
                                                        }
                                                    }
                                                }
                                            }
                                        }
                                    }
                                    ELEMENT[at0.26] occurrences  {0..1}  {    -- Paradoxical movement (flail chest)
                                        value  {
                                            DV_BOOLEAN  {
                                                value  {True, False}
                                            }
                                        }
                                    }
                                }
                            }
                        }
                    }
                    CLUSTER[at0003] occurrences  {0..1}  {    -- Detail
                        items cardinality  {0..*; unordered}  {
                            allow_archetype CLUSTER occurrences  {0..1}  {
                                include
                                    archetype_id/value matches {/exam-generic\.v1/}
                                    archetype_id/value matches {/auscultation-chest\.v1/}
                                    archetype_id/value matches {/palpation\.v1/}
                                    archetype_id/value matches {/inspection\.v1draft/}
                                    archetype_id/value matches {/percussion\.v1/}
                            }
                        }
                    }
                }
            }
            CLUSTER[at0.27] occurrences  {0..1}  {    -- Lymph nodes
                items cardinality  {0..*; unordered}  {
                    allow_archetype CLUSTER occurrences  {0..1}  {
                        include
                            archetype_id/value matches {/exam-generic-lympnode\.v1/}
                    }
                }
            }
            ELEMENT[at0006] occurrences  {0..*}  {    -- Image
                value  {
                    DV_MULTIMEDIA  {
                        media_type  {
                            [openEHR::
                            426, 
                            427, 
                            429]
                        }
                    }
                }
            }
        }
    }

ontology
    term_definitions = <
        ["en"] = <
            items = <
                ["at0.1"] = <
                    description = <"Findings about the chest wall">
                    text = <"Chest wall">
                >
                ["at0.10"] = <
                    description = <"Breathing using the diaphragm and not the chest wall">
                    text = <"Diaphragmatic breathing">
                >
                ["at0.11"] = <
                    description = <"Breathing using expansion of the chest wall">
                    text = <"Thoracic breathing">
                >
                ["at0.12"] = <
                    description = <"Effort required for breathing">
                    text = <"Effort">
                >
                ["at0.13"] = <
                    description = <"Diaphragmatic breathing as at rest">
                    text = <"Normal breathing effort">
                >
                ["at0.14"] = <
                    description = <"Breathing using obvious chest expansion">
                    text = <"Mild increase in effort">
                >
                ["at0.15"] = <
                    description = <"Breathing with signs of abnormal breathing">
                    text = <"Moderate increased effort">
                >
                ["at0.16"] = <
                    description = <"Many signs of increased breathing effort">
                    text = <"Major increased effort">
                >
                ["at0.17"] = <
                    description = <"Signs of increased respiratory effort">
                    text = <"Signs of increased effort">
                >
                ["at0.18"] = <
                    description = <"Use of accessory respiratory muscles">
                    text = <"Sign">
                >
                ["at0.19"] = <
                    description = <"Description of breathing">
                    text = <"Description">
                >
                ["at0.2"] = <
                    description = <"The contour of the chest wall">
                    text = <"Description">
                >
                ["at0.20"] = <
                    description = <"Drawing in between the ribs on inspiration">
                    text = <"Intercostal recession">
                >
                ["at0.21"] = <
                    description = <"Drawing in of the sternum on inspiration">
                    text = <"Sternal recession">
                >
                ["at0.22"] = <
                    description = <"Indrawing of the chest wall on inspiration">
                    text = <"Rib retraction">
                >
                ["at0.23"] = <
                    description = <"Indrawing above the sternum on inspiration">
                    text = <"Suprasternal recession">
                >
                ["at0.24"] = <
                    description = <"Indrawing of the subcostal abdominal wall ">
                    text = <"Subcostal recession">
                >
                ["at0.25"] = <
                    description = <"Use of accessory respiratory muscles during inspiration">
                    text = <"Using accessory muscles">
                >
                ["at0.26"] = <
                    description = <"Any paradoxical movement of the chest wall during respiration">
                    text = <"Paradoxical movement (flail chest)">
                >
                ["at0.27"] = <
                    description = <"Lymphnodes">
                    text = <"Lymph nodes">
                >
                ["at0.28"] = <
                    description = <"The shape of the chest">
                    text = <"Shape">
                    comment = <"ChestShape SNOMED query">
                >
                ["at0.29"] = <
                    description = <"Pidgeon chest, with prominent lower sternum">
                    text = <"Pectus carinatum">
                >
                ["at0.3"] = <
                    description = <"Respiratory findings">
                    text = <"Respiratory system">
                >
                ["at0.30"] = <
                    description = <"*">
                    text = <"Heart - Apex beat">
                >
                ["at0.31"] = <
                    description = <"Apex beat is visible">
                    text = <"Visible">
                >
                ["at0.32"] = <
                    description = <"*">
                    text = <"Palpation">
                >
                ["at0.33"] = <
                    description = <"Apex beat is palpable">
                    text = <"Palpable">
                >
                ["at0.34"] = <
                    description = <"Site of maximal location of apex beat">
                    text = <"Maximal location">
                >
                ["at0.4"] = <
                    description = <"The position of the trachea">
                    text = <"Trachea">
                >
                ["at0.5"] = <
                    description = <"The trachea is in the midline position">
                    text = <"Midline">
                >
                ["at0.6"] = <
                    description = <"The trachea is deviated to the left">
                    text = <"Deviated to the left">
                >
                ["at0.7"] = <
                    description = <"The trachea is deviated to the right">
                    text = <"Deviated to the right">
                >
                ["at0.8"] = <
                    description = <"Findings about breathing">
                    text = <"Breathing">
                >
                ["at0.9"] = <
                    description = <"Type of breathing">
                    text = <"Type">
                >
                ["at0000"] = <
                    description = <"Basic examination cluster for describing findings on physical examination when there is no named focus of examination">
                    text = <"Examination">
                >
                ["at0000.1"] = <
                    description = <"For recording findings on physical examination of the chest wall and lungs">
                    text = <"Examination of the chest">
                >
                ["at0002"] = <
                    description = <"Textural description of the part examined">
                    text = <"Clinical description">
                >
                ["at0003"] = <
                    description = <"More focused examination findings">
                    text = <"Detail">
                >
                ["at0004"] = <
                    description = <"A group of statements about the normality of the examination">
                    text = <"Normal statements">
                >
                ["at0005"] = <
                    description = <"A specific statement of normality">
                    text = <"Normal statement">
                >
                ["at0006"] = <
                    description = <"Drawing or image of the area examined">
                    text = <"Image">
                >
                ["at0008"] = <
                    description = <"Clinical findings">
                    text = <"Findings">
                >
            >
        >
    >