ok, here are some ideas. i hesitate to say everything without you revealing what you're thinking. why? because if any student i had went away with a problem and got it all answered by someone else i'd not so much be annoyed that they hadn't done the work themselves but be disappointed that they hadn't really gotten the best out of the assignment. you can't improve your clinical reasoning more than the slowest, slowest speed by getting someone else to do it for you. you probably think i sound like a real bastard clinical educator you hopefully never meet, but it's very true. i'm not too mean though......

priority is to correct his collapse which will resolve his hypoxaemia issue and reduce his RR and put a smile back on his face.

i'm guessing they've put in the raised temperature bit to make you think that a new chest infection is the source of his deterioration, and he has clogged up his right lower lobe with sputum, it has collapsed and hence all the other signs/symptoms.

first and foremost with any respiratory patient is ensuring adequate oxygenation before you start anything. no good making an unnecessarily hypoxic patient get active. next comes positioning. possible even more important with this particular fellow, however, will be his pain.

1. up his oxygen so his sats are more acceptable than 85%
2. ensure adequate analgesia - discuss with medical staff, pain team etc
3. position. for RLL collapse left side-lying bed flat would be nice and this is ok because his rib fractures are not on the left

3. now i stop helping. what do you think about ACBT, manual techniques, IPPB, saline nebs...... ???

post your ideas and i'll discuss further