1. Medical History, Respiratory Symptoms and Signs Flashcards
First few things to do when a patient with signs and symptoms of dyspnea presents to the doctor
- ABCDE survey and place patient in comfortable position
- Blood Pressure measurement
- Pulse Oxymeter
- EKG measurement
- Basic Physical Exam [POCUS, Auscultation]
If pulse oxymeter shows below 90% saturation - Airway management, oxygen therapy, respiratory support
If blood pressure is below 120/80, give IV fluids
If suspected Tension PTX - needle thoracostomy
If suspected Anaphylaxis - epinephrine [although EMS do it too]
- Take blood for Blood-Gas analysis, CBC, D-dmier, Troponin, BNP
- If patient presents with signs of Cardiac arrest/Respiratory arrest/Physical Exhaustion/Altered Mental status –> consider NIPPV, prior to mechanical ventilation
ONLY start medical history taking and anamnezis AFTER patient is stablized and doesn’t show signs of discomfort which hampers ability to speak
Basic questions to ask about Medical History and Anamnesis
No details. that is another flashcard
- Current/Chief Complaints
- History of present complaint and Pain related questions [SOCRATES]
- Systemic/Constituitional Symptoms [Fever, night sweats, weight loss, fatigue]
- Past medical history [Preexisting illness, Surgical history, Immunizations, Allergies, Current medications]
- Family History [Malignancies, similar complaints or disease]
- Social History [Drinking, Smoking, Work place environment, Travel history, exposures]
What can constitute Past Medical History?
- Preexisting Illnesses especially TB, Malignancies, GERD, Cardiac diseases or comorbidities, DVT history, Asthma, COPD, Neuromuscular disease [like Myasthenia Gravis]
- Immunizations against relevant respiratory bugs [like TB, DTaP in Children, COVID-19, Flu shots, RSV, Pneumococcal pneumonia vaccine, Zooster]
- Medications like inhalers, ACE inhibitors [can cause cough], Diuretics, Herbal medicines, Oxygen therapy, Antiarrhythmics [amiodarone], Beta blockers, Diabetic medications [Stigaliptin]
- Allergies like pollen, pets, bee venom, aspirin, penicillin, dust
- Surgical history
State all the Respiratory Symptoms that a patient can present with to a Pulmonologist
1.Cough [main complaint]
- Acute/Subacute/Chronic
- Productive/Dry
- Sputum [odor, consistency, color]
- Associated symptoms [Gastric reflux, post exposure]
- Allergies aggrevatingfactor
2.Dyspnea
3.Chest pain [SOCRATES to know more]
4.Hemoptysis
5.Stridor/Wheezing
6.Central cyanosis and discolouration
7.Increased work of breathing [intercoastal retractions, nasal flaring, grunting, deep breathing without exertion, slouching/slunching]
8.Clubbing of fingers [due to heart and lung diseases]
Clinical Evaluation for Cough
1.Duration of cough [below 4 weeks, 4-8 weeks, more than 8 weeks]
2.Productive or Dry cough [generally only useful in children]
3.Onset [Sudden onset indicates foreign body aspirations; Gradual indicates URTIs]
4.Cough quality/type [classic presentation in children]
- Brassy/Barking [croup or tracheomalacia]
- Staccato [chlamydia pneumonia]
- Paroxysmal [Pertussis, adenovirus or mycoplasma]
- Inspiratory whoop [Whooping cough aka Pertussis]
5.Aggrevating factors [Symptom variation based on weather; Supine position in GERD, UCAS or CHF; Exercise induced in cough-variant asthma; Daytime or nighttime worsening]
6.Associated symptoms [Viral symptoms like rhinorrhea, myalgia, fever; Allergic symptoms like nasal congestion, rhinorrhea; Posttussive vomiting; Chest pain or heartburn]
Red Flags for Cough
Require more attention and quicker evaluation
- Smoking history [more than 30 pack-year for 55 and older; less than 45 years of age new or worsening cough with/without voice changes]
- Fever
- Weight loss
- Severe dyspnea
- Weight gain with peripheral edema
- Dysphagia, hoarseness, vomiting
- Hemoptysis
- Recurrent pneumonia
- Excessive sputum production
Bolded conditions in my opinion require more attention
