Course 2: Pathophysiology Scribe Alert

Question 1

Coronary Artery Disease (CAD): Scribe Alert? (4)

Answer 1

1. CAD is the single greatest risk factor for an MI.
2. Stress tests or cardiac catheterization assess the severity of CAD.
3. A patient has CAD if they have a PMHx of angina, MI, CABG, cardiac stents, or angioplasty.
4. Every patient complaining of chest pain should always receive aspirin PO, unless it was given PTA or if it is contra-indicated due to bleeding or allergy.

Question 2

Myocardial Infarction (MI) STEMI/non-STEMI: Scribe Alert? (2)

Answer 2

1. Acute MI patients must receive aspirin as soon as possible.
2. STEMI patients must get to Cath-lab within 90 min of arrival. Document ED arrival and depart time.

Question 3

Congestive Heart Failure (CHF): Scribe Alert?

Answer 3

You can think of CHF as a fluid traffic jam in the heart; fluid gets backed up in the neck (JVD) and down the legs (pedal edema)

Question 4

Atrial Fibrillation (A-Fib): Scribe Alert?

Answer 4

ED concern is Rapid Ventricular Response (RVR), which can cause blood clots. These patients will often be “cardioverted” which means they are put back into a regular rhythm, known as normal sinus rhythm (NSR).

Question 5

Pneumonia (PNA): Scribe Alert?

Answer 5

Community Acquired Pneumonia (CAP) protocol applies to pt’s with PNA. CAP protocol requires documenting Abx, vital signs – check for low oxygen, SaO2, mental status- disoriented, and blood cultures.

Question 6

Pneumothorax (PTX): Scribe Alert?

Answer 6

Document the percentage of lung collapsed (i.e. 20% PTX)

Question 7

Reactive Airway Disease (RAD): Scribe Alert? (5)

Answer 7

The physician will ask the asthma patient…

1. Do they have home nebulizer (machine)?
2. Have they been on steroids recently?
3. Hx of hospitalization for asthma?
4. Hx of intubation (breathing tube)?
5. Asthma triggers?

Question 8

Ischemic CVA: Scribe Alert? (2)

Answer 8

For any stroke patient, ALWAYS document the date and time they were “last known well” (at baseline) as well as the source of this information. This is used to assess eligibility for tPA (

Question 9

Hemorrhagic CVA (Brain Bleed): Scribe Alert?

Answer 9

Document tPA not indicated due to hemorrhage (because tPA is a blood thinner).

Question 10

Transient Ischemic Attack (TIA): Scribe Alert?

Answer 10

Document tPA considered and not indicated due to the fact that symptoms are resolved.

Question 11

Spinal Cord Injury: Scribe Alert?

Answer 11

Remember that during the initial physical exam the spine is often immobilized with a C-collar and backboard; document accordingly.

Question 12

Seizure (Sz): Scribe Alert? (5)

Answer 12

The physician will ask…

1. Has the patient had a similar Sz in the past?
2. Does the patient have a Hx of Sz?
3. What was the date of their last sz?
4. What sz medication do they take?
5. Have they missed med doses?

Question 13

Bells Palsy: Scribe Alert?

Answer 13

Most common cause of facial droop in young patients who do not have CVA risk factors. Remember to document the absence of other FND.

Question 14

Headache (HA) – Cephalgia: Scribe Alert?

Answer 14

Always remember to document if the HA is similar or dissimilar to any prior HA. Never document “worst headache of life” or “thunderclap” onset unless specifically instructed by physician.

Question 15

Altered Mental Status (AMS): Scribe Alert?

Answer 15

AMS is very different than a focal neurological deficit. It is generalized and typically caused by things that affect the whole brain (drugs, low sugar). Focal neuro deficits are localized weakness/numbness in one specific area, corresponding with damage at one specific site in the brain.

Question 16

Syncope (Fainting): Scribe Alert?

Answer 16

Document what happened prior, during, and after syncopal episode, as well as how the patient currently feels.

Question 17

Gastroesophageal Reflux Disease (GERD): Scribe Alert?

Answer 17

Due to the proximity of the stomach to the heart, patients with cardiac risk factors and epigastric pain always get a cardiac workup.

Question 18

Ectopic Pregnancy: Scribe Alert?

Answer 18

Any female with a positive pregnancy test who is complaining of lower abdominal pain or vaginal bleeding will always receive a US Pelvis to rule out a possible ectopic pregnancy.

Question 19

Ovarian Torsion: Scribe Alert?

Answer 19

Ovarian and testicular torsion are very time sensitive due to the risk of losing an ovary or testicle. Be sure to document accurate times for the pt arrival, US results, and any physician (surgical) consultations

Question 20

Upper Respiratory Infection (URI): Scribe Alert?

Answer 20

Pay special attention to any complaints of CP or SOB for URI patients; always be careful to describe the CP or SOB accurately so as not to accidentally create the impression of symptoms consistent with an MI or PE.

Question 21

Streptococcal Pharyngitis (Strep Throat): Scribe Alert? (2)

Answer 21

Most sore throats are viral, however strep is bacterial so Abx will help.
The biggest concern about a sore throat is the possibility of a peri-tonsillar abscess (PTA). Signs of PTA include uvular shift or tonsillar asymmetry.

Question 22

Epistaxis (Nosebleed): Scribe Alert?

Answer 22

Procedure epistaxis management: nose bleeds that do not stop spontaneously are often cauterized (burned) or stopped with pressure by a nasal tamponade, commonly called a “rhino-rocket”

Question 23

Musculoskeletal Back Pain: Scribe Alert?

Answer 23

Remember to document if there is any recent trauma related to the back pain; trauma increases the physician’s concern about possible spinal injury.

Question 24

Extremity Injury: Scribe Alert?

Answer 24

Remember the majority of extremity injuries will receive some type of splint; always remember to document a splint application procedure note.

Question 25

Abscess (Cellulitis with Fluctuance): Scribe Alert?

Answer 25

Abscesses must have the pus-pocket drained. Remember to always document incision and drainage (I&D) procedure notes for abscesses.

Question 26

Psychological Disorder: Scribe Alert?

Answer 26

Pay very careful attention to differentiating between medical (physical) and psychiatric complaints. As an emergency physician, the main concern is medical clearance; determining that the patient is not medically ill. After medical clearance, the patient is cleared to be evaluated from a psychiatric standpoint.

Question 27

Trauma: Scribe Alert?

Answer 27

Neurological Injury (Brain, Spine): LOC, confusion, numbness, weakness, HA, neck/back pain
Internal Organ Injury (Lungs, Spleen, Liver): SOB, Chest Pain, Abd Pain

Question 28

Allergic Reaction: Scribe Alert?

Answer 28

ED concern is anaphylaxis or respiratory failure.