Approach to the Undifferentiated Patient Flashcards
Most common triage coding system
Emergency Severity Index (ESI)
Red-Critical Orange- Emergent Yellow- Urgent Green- Minor Blue- Very minor
Does the patient appear to be unstable or in any distress? Determine this with a basic assessment of
the ‘ABCs’ (airway, breathing, circulation).
For unresponsive adults w/ cardiovascular emergency, approach the patient using
“CAB” (circulation, airway, breathing
If patient is “sick”, the following events should always occur in parallel
Vital signs asap
vascular access
cardiac monitor
O2 prn
think “IV-O2-Monitor”.
Spectrum bias is
test characteristic wherein the test becomes increasingly reliable as the disease progresses
Well’s Criteria is for
pulmonary embolism
Well’s Criteria
- s/s of DVT
- PE is #1 diagnosis
- HR > 100 bmp
- Immobilization 3+ days
- Surgery in last 4 weeks
- Hx of PE of DVT
- Hemoptysis
- Malignancy within 6 months -palliative care
Indications for emergency airway management may include
- hypoxia
- hypercarbia
- AMS
- failure to tolerate oral secretions
- anticipation of a worsening clinical condition.
Pain-related complaints are the most common reason for emergency department visits, with _____ & ____ being the two most frequent cc
abdominal pain and chest pain
“premature closure
potential pitfall of honing in on a particular diagnosis before all of the information is available
At a minimum, all AMS patients deserve:
ABCDE Cardiac monitoring pulse oximetry glucose testing IV access Eval for trauma Consider naloxone
AMS = AEIOU TIPS
Alcohol Electrolytes Insulin Opiates/ Oxygen Uremia Trauma/ Temp Infection Poison/ Psych Shock/ Stroke
Three common broad classifications of AMS include
delirium- emergency
dementia
psychosis.
Arousal is mediated primarily by ________
brainstem nuclei- reticular activating system
Many medical conditions manifest as AMS when decompensated. Look for a history of:
Meds DKA/ HHNK HTN endocrine disease renal failure cancer dementia CVD seizure psychiatric issues
Glasgow Coma Scale compantants
Eyes, Verbal, Motor
Glasgow Coma Scale
Eyes
4 – Spont
3 – Loud voice
2 – To Pain
1- None
Glasgow Coma Scale
Verbal
5 – Oriented 4 – Confused 3 – Inapprop words 2 – Incomprehensible sounds 1 – No Sounds
Glasgow Coma Scale
Motor
6 – Obeys 5 – Localizes to pain 4 – Withdraws to pain 3 – Abnormal flexion posturing 2 – Abnormal extension posturing 1 – None
Glasgow Coma Scale and airway
less that eight, intubate!
Metabolic or Endocrine AMS labs
Rapid glucose Serum electrolytes ABG or VBG BUN/Creatinine Thyroid function Ammonia Serum cortisol level Toxic or medication causes
Levels of medications AMS labs
- Drug screen- Benzo, opioids, barbiturates
- Alcohol level
- Serum osmolality (toxic alcohols)
Hemodynamic instability causes of AMS labs
ECG
Cardiac enzymes
Echo
Carotid/vertebral artery ultrasound
AMS diagnosis is never assured until ?
abnormalities recognized and remedied
patient has returned to their normal mental status.
AMS rx
________ for agitated withdrawal states
Supportive care and sedation
AMS rx
Intravenous fluids for __________
- dehydration
- hypovolemia
- hypotension
- hyperosmolar states (HHNS or hypernatremia)
AMS rx
Empiric antibiotics for _____
suspected meningitis
urosepsis
pneumonia, etc.
AMS rx
_________ for temperature extremes
Rewarming or aggressive cooling
AMS rx
__________ for specific toxins
Fomepazole
pyridoxine
digoxin-fab fragments other antidotes
AMS rx
_______ for opioid toxicity
Naloxone
AMS rx
____________ for hypertensive encephalopathy
Controlled reduction of BP with
- nitroprusside
- labetolol
- fenoldepam
AMS rx
_________ for hypoglycemia
Dextrose
AMS rx
_______ for profound hyponatremia with seizures or AMS
Hypertonic saline
AMS rx
_______ for metastatic CNS lesions with vasogenic edema
Glucocorticoids
AMS rx
_______ for suspected Wernicke’s encephalopathy
thiamine
AMS pts who can discharge home
sz
hypoglycemia from DM
Narcotic OD
AMS pt asking to leave can if?
patient can demonstrate they understand both the risk of leaving against advice vs benefit of staying
