COMMON PROBLEMS SEEN IN THE ER Flashcards
What is on your differential for patient w/: SYNCOPE/DIZZINESS?
• Vasovagal (emotional stress, prodrome) • Orthostatic (after standing) • Arrhythmia • Cardiac ischemia • Cardiovascular Syncope (valve disease, PE, PHT..) siesure?
What diagnostics are appropriate for SYNCOPE/DIZZINESS?
• Hx, PE, carotid massage, orthostatic, Guiac, ECG.
What is on your differential for patient w/: CHEST PAIN ?
- Cardio: CAD, valve ds, endocarditis, pericarditis, vasospasm
- Ms/Sk/skin: costochondritis, frx, trauma, arthritis, neoplasm, shingles…
- GI: GERD, Achalasia, Esophagitis, rupt..
- Pulm: PE, PHT, CA, Pnmia, sarcoid, COPD, pnmthx, pleuritis
- Mediastinal: Asc. Aortic dissection., itis
What diagnostics are appropriate for CHEST PAIN?
• Hx, PE, ECG, Card markers, x-ray, and others as indicated.
What is on your differential for patient w/: ABDOMINAL PAIN?
- Upper: biliary ds, pancreatitis, dyspepsia, hiatal hernia, pnmnia, MI, splenic abcess/infarct.
- Lower: appendicitis, diverticular ds, kid stones, bladder distension, pelvic pain..
- Diffuse: mesenteric isch/infarct, ruptured aneurysm, peritonitis, bowel obst.
What diagnostics are appropriate for ABDOMINAL PAIN?
• CBC, Chem 7, GI panel, lipase, UA, HCG, X-ray, CT, US
What is on your differential for patient w/: DYSPNEA?
- Cardio: ACS, HF, Tamp.
- Resp: bronchospasm, PE, pnmtx, inf (bronch/pnmia), upper airway obst.
- Other: rib frx, acidosis, trauma, neoplasm, obese, prego.
What diagnostics are appropriate for DYSPNEA?
• Hx, PE, X-ray, PFT, TEE, cariodpulm stress test.
What is on your differential for patient w/: HYPOTENSION?
- Autonomic failure: Prknsn, Dim w/ lewy body, Shydrager, DM, B12 def, Sjgrns…
- Volume depletion: diuretics, vomiting, hemorrhage, hyperglycemia
- Drugs: vasodil, alpha blckers,BB, ETOH
- Cardiac: arryth, HF
What diagnostics are appropriate for HYPOTENSION?
• Hx, PE, Orthostatics (20s/10d),>30bpm stand, HCT, elec, BUN, creat, glucose, ECG.
What is on your differential for patient w/: GI BLEEDING?
• Upper: gastric/duod ulcer, esoph varices, esphgtis, Mlry weiss snd, neop.
• Lower:
●Anatomic (diverticulosis)
●Vascular (angiodysplasia, ischemic, radiation-induced)
●Inflammatory (inflammatory bowel disease, infectious/ischemic colitis)
●Neoplastic (polyp, carcinoma)
What diagnostics are appropriate for GI BLEEDING ?
• Hx, PE, Guiac, Endoscopy, Colonoscopy, CBC, CT
What is on your differential for patient w/: VOMITING?
- Drugs: chemo, abx, narcs, etc.
- Infectious gastroenteritis
- Gut disorder: bwl obst, gastroparesis, IBS, ischmia, organ itis. (gb, panc, lvr,..)
- CNS: ICP, psych, labyrinth ds.
- Endo/met: prego, DKA, uremia, thyroid
- Misc: radiation, post op, MI, CHF
What diagnostics are appropriate for VOMITING?
• Hx, PE, endoscopy, labs as indicated by Hx and PE.
What is on your differential for patient w/: DIARRHEA?
• Acute:
->viruses (norovirus, rotavirus, adenoviruses, astrovirus, and others), ->bacteria (salmonella, campylobacter, shigella, enterotoxigenic E. coli, C. difficile, and others),
->protozoa (cryptosporidium, giardia, cyclospora, entamoeba, and others)
• Chronic (>4w): IBS, Crohn’s, Ulc col, func. Diah,
What diagnostics are appropriate for DIARRHEA?
• Hx, PE Fecal leukocytes, stool culture + O&P, colonospcopy
What is on your differential for patient w/: ALTERED MS?
- Met: Hypoxia, Hypoglycemia, Wernicke’s encephalopathy (thiamine)
- Drugs/toxins
- Hypothermia
- Inf: Sepsis, meningitis, UTI, pneumonia
- Neuro:ICP, intracranial hem., Alz/dementia delirium.
- Psych: dep, schiz,bipolar
What diagnostics are appropriate for ALTERED MS?
• Hx, PE, SP02, blood glucose, MMSE, Neuro ex,…depends on cause: CBC, UA, TSH, Toxicology analysis, CT….
What is on your differential for patient w/: SEIZURES?
- <50% ID cause
- Genetic: epilepsy (recurrent)
- Provoked: metabolic (ETOH/drug w/draw, hypoglycemia), head trauma, brain tumor, stroke, intra cran, inf., congenital abn (brain/metab).
What diagnostics are appropriate for SEIZURES?
• CMP, Toxicology analysis, renal function, LFT, LP, ECG, EEG, MRI.
What is on your differential for patient w/: STROKE?
- Hemorrhagic: intracerebral, subarachnoid
* Ischemic: thrombosis, embolism: a-fib, etc., hypoperfusion (systemic,vessel ds: giant cell art, athero), TIA
What diagnostics are appropriate for STROKE?
• Hx, PE, Non-con CT to see hem (focal dense white lesions), LP if CT neg. If not hemorrhagic, then CTA/MRA may be used to find blocked vessels and guide therapy for those who are candidates for lytic therapy/recanalization, but is not absolutely necessary.
What is on your differential for patient w/: HEADACHE?
- Sinus HA
- Migraine, Tension, Cluster, NSAID
- Meningitis
- Trauma (concussion)
- Subarachnoid hemorrhage
- Brain tumor
- CVA
- Giant cell arteritis
- Intracranial aneurysm
- Low CSF
What diagnostics are appropriate for HEADACHE?
• Hx, PE, Non-con CT (if danger signs: meningeal signs, ICP signs, focal deficits/mass lesion signs), LP (if subacute hemorrhage or infection suspected).
