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Scribe America ED > Day 2: Pathophysiology > Flashcards

Day 2: Pathophysiology Flashcards

1
Q

The diseases being considered are known as the _____.

A

Differential Diagnoses

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2
Q

Physician’s thought process

A
  1. Subjective complaints and risk factors
  2. Differential diagnoses
  3. Objective evaluation
  4. Final diagnosis
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3
Q

All the questions asked by the physician during the HPI are designed to ______.

A

Investigate specific subjective complaints that may help point towards or away from a particular differential diagnosis.

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4
Q

Pertinent positives

A

Specific symptoms that raise the physician’s suspicions for that disease

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5
Q

Pertinent negatives

A

Symptoms NOT present that cause the physician to doubt certain diagnoses

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6
Q

CAD (Coronary Artery Disease)

A

Etiology: Narrowing of the coronary arteries limits blood supply to the heart muscle causing angina (CP specifically due to heart-muscle ischemia).

  1. Catchphrase:“chest pain with physical exertion”
  2. CC: CP or chest pressure (worse with exertion, improved with rest or NTG)
  3. Associated Meds: ASA 324 mg PO (Per Os = by mouth), NTG 0.4 mg SL (Sublingual = under the tongue).
  4. Dx by: Cardiac catheterization (Not Dx in the ED).

NOTES:

  • CAD greatest risk factor for an MI.
  • Stress test or cardiac cath assesses the severity of CAD.
  • A pt has CAD if they have PMHx of Angina, MI, CABG, Cardiac stents, or Angioplasty
  • EVERY patient complaining of CP should receive ASA 324 mg PO, unless given PTA (prior to arrival) or contraindicated (should not be used) due to bleeding or allergy.
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7
Q

Myocardial Infarction (MI) STEMI, NON-STEMI

A

Etiology: Acute blockage of coronary arteries results in ischemia and infarct (area of dead tissue following prolonged ischemia) of the heart muscle.

  1. Catchphrase: Chest pressure with diaphoresis (sweating), N/V, and SOB
  2. Risk factors: CAD, HTN, HLD, DM, Smoker, FHx of CAD < 55 y.o.
  3. CC: CP or chest pressure
  4. Dx by: EKG (STEMI) or elevated Troponin (non-STEMI).
  5. Assoc. Meds: ASA, NTG, B-blocker, Thrombolytic (Heparin). Thrombo = Clot, Lysis = Destroy

NOTE:

  • Acute MI pts must receive ASA 325 mg ASAP.
  • STEMI pts must get to Cath-lab w/in 90 mins of arrival.
  • Document ED arrival and depart times!
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8
Q

Congestive Heart Failure (CHF)

A

Etiology: The heart becomes enlarged, inefficient, and congested with excess fluid.

  1. Catchphrase: SOB w/pedal edema and orthopnea.
  2. CC: SOB: Worse with lying flat (Orthopnea), Paroxysmal Nocturnal Dyspnea (PND), Dyspnea on Exertion (DOE).
  3. PE: rales (Crackles) in lungs, Jugular Vein Distention (JVD) in the neck, Pitting pedal edema.
  4. Assoc Meds: Diuretics (Lasix, Furosemide) –> Urinate extra fluid
  5. Dx by: CXR or elevated BNP (B-type Natriuretic Peptide).

NOTES:

  • 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).
  • Paroxysmal nocturnal dyspnea (PND) — is a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position.
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9
Q

Atrial Fibrillation (A-Fib)

A

Etiology: Electrical abnormalities in the “wiring” of the heart causes the top of the heart (atria) to quiver abnormally.

  1. CC: Palpitations (Fast, Pounding, Irregular).
  2. Risk Factors: Paroxysmal A-Fib, Chronic A-Fib
  3. PE: Irregularly irregular rhythm, Tachycardia
  4. Dx by: EKG (ECG)
  5. Assoc Meds: Coumadin (Warfarin), Blood thinner –> prevents blood clots in atria. Digoxin: Slows down the heart rate.

NOTES:

  • ED concern is Rapid Ventricular Response (RVR). These pts will often be “cardioverted”, put back into NSR.
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10
Q

Non-cardiac causes of CP

A
  1. Pericarditis: Inflammation of the sac surrounding the heart.
  2. Pleurisy: Inflammation of the sac surrounding the lungs.
  3. Costochondritis: Irritation of the ribs causing CP, worsened by pressing on the sternum.
  4. Chest Wall Pain: Irritation of the chest wall causing pain with palpation of the chest.
  5. Pleural Effusion: Fluid collecting around the lungs causing SOB or CP.
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11
Q

Pulmonary Embolism (PE)

A

Etiology: Blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs.

  1. Catchphrase: Pleuritic (sudden and intensely sharp, stabbing, or burning pain) CP w/Tachycardia and hypoxia
  2. Risk Factors: Known DVT, PMHx of DVT or PE, FHx, Recent surgery, Cancer, A-fib, Immobility, Pregnancy, BCP (birth control pills), Smoking.
  3. CC: SOB or Pleuritic CP (CP worse w/ deep breaths).
  4. Dx by: CTA chest (CT chest w/ IV contrast) or VQ scan. D-dimer aids in detecting clots, but cannot diagnose a PE.

Normal D-Dimer –– No possible abnormal clotting.

Elevated D-Dimer –– Possible abnormal clotting.

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12
Q

Pneumonia (PNA)

A

Etiology: Infiltrate (bacterial infection) and inflammation inside the lung.

  1. Catchphrase: Productive cough with fever.
  2. Risk Factors: Elderly, Bedridden, Recent chest injury, Recent surgery
  3. CC: SOB or Productive cough
  4. Assoc. Sx: Cough with sputum, Fever, Chest pain
  5. Assoc. Meds: Rocephin and Zithromax (Abx)
  6. PE: Rhonchi
  7. Dx by: CXR

NOTES:

  • Community-Acquired Pneumonia (CAP) protocol applies to pts with PNA. CAP protocol requires documenting Antibiotics (Abx), Vital Signs, SaO2 (oxygen saturation as measured by blood analysis), Mental Status, and Blood cultures.
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13
Q

Pneumothorax (PTX)

A

Etiology: Collapsed lung due to trauma or spontaneous small rupture of the lung.

  1. CC: SOB and one-sided CP (sudden onset, often trauma pts).
  2. PE: Absent breath sounds unilaterally
  3. Dx by: CXR

NOTES:

Document % lung collapsed (e.g. 20% PTX)

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14
Q

Chronic Obstructive Pulmonary Disease (COPD)

A

Etiology: Long-term damage to the lung’s alveoli (emphysema) along with inflammation and mucus production (chronic bronchitis).

  1. Risk factors: Smoking
  2. CC: SOB
  3. PE: Decreased breath sounds, Wheezes, Rales
  4. Assoc Meds: Home O2 (Document how much O2 they use @ baseline) –– Usually, 2 liters of home O2 via nasal cannula.
  5. Dx by: CXR and Hx of smoking.
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15
Q

Asthma (Reactive Airway Disease)

A

Etiology: Constricting of the airway due to inflammation and muscular contraction of the bronchioles, known as a “bronchospasm.”

  1. CC: SOB/Wheezing –– Improved with nebulizer “breathing treatments” (bronchodilators)
  2. PE: Wheezes (Inspiratory or Expiratory)
  3. Assoc. Meds: Inhalers, Nebulizers, Corticosteroids.
  4. Dx by: Clinically

NOTES:

The physician will ask asthma pt:

  1. Do you have a home nebulizer (machine)?
  2. Have you been on steroids recently?
  3. Hx of hospitalization for asthma?
  4. Hx of intubation (breathing tube)?
  5. Asthma triggers?
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16
Q

Pulmonary Summary

A
  • *PE** –– Pleuritic CP w/ tachycardia and hypoxia –– Dx by CTA (CT Chest w/ IV Contrast)
  • *PTX, Hemothorax** –– Unilateral CP and SOB –– Dx by CXR
  • *PNA** –– SOB w/ productive cough –– Dx by CXR
  • *COPD** –– SOB with Hx smoking –– Dx by CXR w/ Hx of Smoking
  • *Asthma** –– Wheezing with Hx of Asthma –– Dx clinically
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17
Q

Ischemic Cerebrovascular Accident (CVA)

A

Etiology: Blockage of the arteries supplying blood to the brain resulting in permanent brain damage.

  1. CC: Unilateral focal neurological deficits: 1-sided weakness/numbness or changes in speech/vision
  2. Risk Factors: HTN, HLD, DM, Hx TIA/CVA, Smoking, FHx CVA, Afib.
  3. PE: Neurological deficits: hemiparesis, unilateral paresthesias, aphasia, visual field deficits
  4. Dx by: Clinically, CT Head is often done to rule out any other acute abnormality.
  • Hemiparesis – weakness or the inability to move on one side of the body.
  • Paresthesias – Tingling or prickling, “pins-and-needles” sensation; usually temporary, often occurs in the arms, hands, legs, or feet.
  • Aphasia – Loss of ability to understand or express speech, caused by brain damage.

NOTES:

Always document pt’s “last time known well,” as well as the source of this information –– Used to assess eligibility for tPA – a blood thinner that can reverse CVA.

Document tPA considered and not indicated due to: onset greater than 3 hours or unknown, unreliable time of onset; symptoms are rapidly improving.

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18
Q

Hemorrhagic Stroke (CVA)

A

Etiology:“Brain bleed” –– Often a traumatic or spontaneous rupture of blood vessels in the head leads to bleeding in the brain.

  1. CC: Severe HA (sudden onset, “worst of life”)
  2. Risk Factors: Recent head trauma, HTN, anticoagulant therapy.
  3. Assoc. Sx: Changes in speech, Vision, Sensation, or Motor Strength, AMS, Sz
  4. PE: Unilateral Neurological Deficits
  5. Dx by: CT Head or LP

NOTES:

  • Document –– tPA is not indicated due to hemorrhage.
  • tPA Contraindicated
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19
Q

Transient Ischemic Attack (TIA)

A

Etiology: Vascular changes temporarily deprive a part of the brain of O2, Sxs usually last less than <1 hour (mini-stroke) and there is no permanent brain damage.

  1. CC: transient focal neurological deficit (change in speech, vision, strength, or sensation)
  2. Dx: clinically

NOTES:

  • Document tPA considered but not indicated due to resolved symptoms.
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20
Q

Only ________ patients can qualify for tPA.

A

Ischemic CVA

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21
Q

Meningitis: (Bacterial vs. Viral)

A

Etiology: Inflammation and infection of the meninges; the sac surrounding the brain and spinal cord.

  1. CC: HA and neck pain.
  2. Assoc Sx: Fever, Neck pain, Neck stiffness, AMS, Photophobia.
  3. PE: Meningismus, Nuchal rigidity
  4. Dx by: Lumbar Puncture (LP)

AMS –– Altered Mental Status

Photophobia –– Sensitivity to light

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22
Q

Spinal Cord Injury

A

Etiology: Injury to the spinal cord may create weakness or numbness in the extremities past the site of the injury.

  1. CC: Neck pain or Back pain, Bilateral extremity weakness.
  2. PE: Midline bony tenderness, Deformities, or step-offs, Bilateral extremity weakness, Numbness, Decreased rectal tone
  3. Dx by:
  • CT Cervical Spine (C-spine) –– Neck
  • CT Thoracic Spine (T-spine) –– Upper back
  • CT Lumbar Spine (L-spine) –– Lower back

NOTES:

  • Remember that during the initial physical exam, the spine is often immobilized with a C-collar and
    backboard; document accordingly.
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23
Q

Seizure (Sz)

A

Etiology: Abnormal electrical activity in the brain leading to abnormal physical manifestations. Often caused by epilepsy, EtOH withdrawals, or febrile Sz in pediatric pts.

  • *CC:** Sz activity, syncope (passing out)
  • *Assoc Sx:** Injuries (tongue bite), Confusion, Headache, Incontinence – the inability of the body to control the evacuative functions of urinary or defecation.
  • *PE:** Somnolent (drowsy, sleepy), Confused (postictal – the period of time immediately following a seizure).

Assoc. Meds: Dilantin, Tegretol, Keppra, Depakote, Neurontin.

NOTES:

The physician will ask:

  • Has the patient had a similar Sz in the past?
  • Does the patient have a Hx of seizures?
  • What was the date of their last seizure?
  • What seizure medication do they take?
  • Have they missed any medication doses?
  • How did you feel before, during, after, now?
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24
Q

A fever is the number one cause of seizure in _____.

A

Pediatrics

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25
Q

Bell’s Palsy

A

Etiology: Inflammation or viral infection of the facial nerve causes one-sided weakness of the face.

  1. CC: Facial droop, Sudden onset
  2. Assoc. Sx: Jaw or ear pain, increased tear flow of one eye.
  3. Pert. Neg: No extremity weakness, no changes in speech or vision
  4. PE: Unilateral weakness of the upper and lower face.
  5. Dx: Clinically

NOTES:

  • Remember to document the absence of other FND (Focal Neurological Deficit).
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26
Q

Headache (HA), Cephalalgia

A

Etiology: Various causes including hypertensive HA, recurrent dx migraines, sinusitis, etc

  1. CC: HA (gradual onset), pressure, throbbing (strong regular rhythm, pulsating).
  2. Pert. Neg: No fever, No neck stiffness, No numbness/weakness, No change in speech or vision.

NOTES:

  • 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 a physician.
27
Q

Altered Mental Status ( AMS)

A

Etiology: Multiple causes: most common are hypoglycemia, infection, intoxication, and neurological.

  1. Risk Factors: Diabetic, Elderly, Demented, EtOH use, Drug use.
  2. CC: Confusion, Decreased responsiveness, Unresponsive.
  3. Dx by: Case dependent

NOTES:

  • AMS is generalized and usually caused by things that affect the whole brain (drugs, low blood sugar), very different than a focal neurological deficit.
  • Focal neuro deficits are localized weakness/numbness in one specific area, corresponding with damage at one specific site in the brain.
  • The most common cause of AMS for patients with a Hx of dementia is an infection, most often caused by a UTI.
28
Q

Syncope

A

Etiology: Temporary loss of blood supply to the brain resulting in LOC (loss of consciousness). Many causes: most common are vasovagal and low blood volume (dehydration/hypovolemia). Occasionally syncope occurs due to cardiac/neurologic causes.

  1. CC: Passing-out vs. About to pass-out (near-syncope).

NOTES:

  • Document what happened prior, during, and after the syncopal episode, and how the pt currently feels.
29
Q

Vertigo

A

Etiology: Caused by two etiologies: vertigo may be from a harmless problem of the inner ear (benign positional vertigo) or it may be caused due to damage in a specific center of the brain (possible CVA).

  1. CC: Room-spinning, Feeling off-balance (disequilibrium), worsened w/ head movement.
  2. Assoc Sx: N/V, Tinnitus (ringing in ears).
  3. PE: Horizontal Nystagmus, + Romberg, + Dix-Hallpike Test
  4. Assoc Meds: Meclizine (Antivert)
  5. Dx: Clinically

Nystagmus –– involuntary rhythmic side-to-side, up and down, or circular motion of the eyes.

Romberg Test –– a test that measures your sense of balance.

Hallpike Test –– a test that doctors use to diagnose a particular kind of vertigo called benign paroxysmal positional vertigo (BPPV).

30
Q

Neurological Summary

A

Diagnosis –––––––– Important things to document

  • *Hemorrhagic CVA** –– tPA Ineligibility
  • *Ischemic CVA** –– tPA Eligibility, Last known normal
  • *Meningitis** –– HA, Fever, Neck pain
  • *Spinal Cord Injury** –– Bilateral extremity weakness
  • *TIA** –– When did Sx resolve?
  • *Seizure** –– Post-Ictal state, Missed Sz meds?
  • *Bell’s Palsy** –– Absence of other FND
  • *HA/Migraine** –– Similar Sx in past? Gradual onset
  • *AMS** –– Infection? DM? Drugs? Baseline?
  • *Syncope** –– Before, during, after, current status
  • *Vertigo** –– N/V, Nystagmus
31
Q

Abdominal Quadrants Summary

  • Epigastric
  • RUQ
  • LUQ
  • Periumbilical
  • LLQ
  • RLQ
  • Suprapubic
  • Flanks
A
  • *Epigastric:** GERD, MI
  • *RUQ:** Cholecystitis, Cholelithiasis
  • *LUQ:** Pancreatitis
  • *Periumbilical:** SBO – Small Bowel Obstruction
  • *RLQ:** Appendicitis
  • *LLQ:** Diverticulitis
  • *Suprapubic:** Ovarian Torsion, Ovarian Cyst, UTI
  • *Flanks:** Pyelonephritis, Renal Calculi
32
Q

Appendicitis (Appy)

A

Etiology: Infection of the appendix causes inflammation and blockage, possibly leading to rupture.

  1. CC: RLQ pain –– Gradual Onset, Constant, Worsened w/ Movement.
  2. Assoc Sx: Decreased appetite (anorexia), Fever, N/V
  3. PE: McBurney’s point tenderness, RLQ tenderness, Peritoneal signs: guarding, rebound, rigidity.
  4. Dx by: CT A/P w/ PO Contrast (CT Abdomen/Pelvis with PO Contrast)
33
Q

Small Bowel Obstruction (SBO)

A

Etiology: Physical blockage of the small intestine.

  1. Risk Factors: Elderly, Infants, Abdominal surgery, Narcotic pain medication
  2. CC: Abdominal pain, Vomiting, Constipation
  3. Assoc Sx: Abd Distension, Bloating, No BMs
  4. PE: Abd tenderness, Guarding, Rebound, Abnormal bowel sounds, Abdominal distension, Tympany.
  5. Dx by: CT A/P w/ PO contrast, Acute Abdominal Series (AAS) (an Xray)
34
Q

Gallstones (Cholelithiasis, Cholecystitis)

A

Etiology: Minerals from the liver’s bile condense to form gallstones that can irritate, inflame, or obstruct the gallbladder.

  1. Catchphrase: RUQ Abd pain after eating fatty foods.
  2. CC: RUQ pain –– Sharp, Worse w/ eating, Deep breaths, and Palpation
  3. PE: RUQ tenderness, Murphy’s sign
  4. Dx by: Abd US (Ultrasound), RUQ
35
Q

Gastrointestinal Bleed (GI Bleed)

A

Etiology: Hemorrhage in the upper or lower gastrointestinal tract can lead to anemia.

  1. CC: Hematemesis (bright) (upper), Coffee-ground emesis (dark) (lower), Hematochezia (bright) (lower), Melena (dark) (upper).
  2. Assoc Sx: Generalized weakness, lightheadedness, SOB, Abd pain, Rectal pain.
  3. PE: Pale conjunctiva, Pallor, Tachycardia
  • Rectal Exam: Melena, Grossly (obvious) bloody stool.
    4. Dx by: Heme positive stool (Guaiac positive) during a rectal exam.
  • Hematemesis –– The vomiting of blood.
  • Coffee-ground emesis –– The presence of coagulated blood in the vomit (looks like coffee-ground).
  • Hematochezia –– the passage of fresh blood per anus, usually in or with stools.
  • Melena –– dark sticky feces containing partly digested blood.

NOTES:

  • ED concern is the need for a possible blood transfusion due to significant blood loss.
36
Q

Diverticulitis

A

Etiology: Acute inflammation and infection of abnormal pockets of the large intestine known as diverticula.

  1. Risk Factors: diverticulosis, Advanced age
  2. CC: LLQ pain
  3. Assoc. Sx: Nausea, Fever, Diarrhea
  4. Dx by: CT A/P w/ PO Contrast

Diverticulosis –– small pouches or pockets in the wall or lining of any portion of the digestive tract.

37
Q

Pancreatitis

A

Etiology: Inflammation of the pancreas.

  1. Risk Factors: EtOH abuse, Cholecystitis, Specific medications
  2. CC: LUQ, epigastric pain
  3. Assoc Sx: N/V
  4. PE: LUQ tenderness, Epigastric tenderness
  5. Dx by: Elevated Lipase lab test (sometimes elevated Amylase)

Elevated lipase usually indicates a problem in the pancreas, same for an elevated amylase.

38
Q

Gastroesophageal Reflux Disease (GERD)

A

Etiology: Stomach acid regurgitating into the esophagus.

  1. CC: Epigastric pain – Burning, Improved w/ Antacids
  2. PE: Epigastric tenderness
  3. Assoc Med: GI cocktail (numbs and soothes the esophagus and stomach).

NOTES:

  • Due to the proximity of the stomach to the heart, pts w/ cardiac risk factors and epigastric pain will always get a cardiac workup
39
Q

Other causes of Abd pain

A
  • *Gastroenteritis** –– Vomiting and diarrhea, GI bug, often viral or bacterial.
  • *Crohn’s Disease:** –– Immune disorder causing diarrhea/Abd pain.
  • *IBS:** –– Chronically sensitive bowels prone to diarrhea
  • *Gastritis:** –– Irritated stomach w/ vomiting “stomach ache.”
40
Q

Gastrointestinal Summary

A

Diagnosis** ––––– **Abdominal Region** ––––– **Diagnosed by:

  • *Appendicitis** –– RLQ –– CT A/P with PO
  • *SBO** –– Periumbilical –– CT A/P with PO, AAS
  • *Cholecystitis** –– RUQ –– US RUQ
  • *GI Bleed** –– Any –– Guaiac (Heme) Positive
  • *Diverticulitis** –– LLQ –– CT A/P with PO
  • *Pancreatitis** –– Epigastric, LUQ –– Elevated Lipase
  • *GERD** –– Epigastric –– Endoscopy (not in ED)
41
Q

Urinary Tract Infection (UTI)

A

Etiology: Infection in the urinary tract.

  1. Risk Factors: Female
  2. CC: Dysuria
  3. Assoc Sx: Frequency, Urgency, Malodorous urine, AMS (Elderly)
  4. PE: Suprapubic tenderness
  5. Dx by: Urine dip or UA (Urinalysis) Nitrite, WBC, and Bacteria in urine.

Dysuria –– painful urination.

Urinalysis –– can detect the presence of nitrites in the urine. Normal urine contains chemicals called nitrates. If bacteria enter the urinary tract, nitrates can turn into different, similarly named chemicals called “nitrites.” Nitrites in urine may be a sign of a urinary tract infection (UTI).

42
Q

Pyelonephritis (Pyelo)

A

Etiology: Infection of the tissue in the kidneys, usually spread from a UTI.

  1. Risk Factors: Female, Frequent UTIs.
  2. CC: Flank pain w/ dysuria
  3. Assoc Sx: Fever, N/V
  4. PE: CVA tenderness (costovertebral angle)
  5. Dx by: CT Abd/Pel w/o Contrast or confirmed UTI w/ CVA tenderness on exam.

Flank pain –– Flank pain affects the area on either side of the lower back, between the pelvis and the ribs.

43
Q

Kidney Stone (Urolithiasis, Nephrolithiasis, Renal Calculi, Renal Colic)

A

Etiology: Stone dislodges from kidney, travels down the ureter. stone scrapes and irritates the ureter, causing severe flank pain and bloody urine.

  1. CC: Flank pain, sudden onset, radiating to the groin.
  2. Assoc Sx: Hematuria, N/V, Unable to void (Urinary retention is the inability to voluntarily urinate.)
  3. PE: CVA (Costovertebral angle) tenderness
  4. Dx: CT Abd/Pelvis, RBC in UA may be a clue.
44
Q

Ectopic Pregnancy

A

Etiology: Tubal pregnancy, when a fertilized egg develops outside the uterus (usually in the fallopian tube). High risk for rupture and death.

  1. Risk Factors: Pregnant female, (HCG +) STD, PID.
  2. CC: lower Abd pain or vaginal bleeding while pregnant.
  3. Dx by: US pelvis –– to determine the location of the fetus.

HCG + –– A pregnancy test measures a hormone in the body called human chorionic gonadotropin.

PID –– Pelvic inflammatory disease, an infection of one or more of the upper reproductive organs, including the uterus, fallopian tubes, and ovaries.

NOTES:

  • Any female w/ Abd pain and pregnant will get US pelvis to rule out ectopic pregnancy.
45
Q

Ovarian Torsion

A

Etiology: Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting in an infarct of the ovary.

  1. CC: Lower Abd pain (RLQ or LLQ)
  2. PE: Adnexal tenderness (R or L), Tenderness in the RLQ or LLQ
  3. Dx by US pelvis –– assesses blood flow to ovaries.

Adnexal tenderness –– A technical term for pain in the area of a woman’s uterus.

NOTES:

  • Time-sensitive, document all times.
46
Q

Testicular torsion

A

Etiology: Twisting of the spermatic cord resulting in loss of blood flow and nerve function to the testicle.

  1. CC: Testicular pain.
  2. PE: Testicular tenderness and swelling R or L.
  3. Dx by US scrotum.
47
Q

Upper Respiratory Infection (URI)

A

Etiology: Most often viral infection causes congestion, cough, and inflammation of the upper airway.

  1. CC: Cough/congestion
  2. Assoc Sx: Fever, Sore throat, HA, Myalgias
  3. PE: Rhinorrhea, Boggy turbinates, Pharyngeal erythema
  4. Dx: Clinically

Rhinorrhea –– a thin, mostly clear nasal discharge.

Myalgias –– describe muscle aches and pain, which can involve ligaments, tendons, and fascia, the soft tissues that connect muscles, bones, and organs.

NOTES:

  • Pay special attn to c/o CP or SOB for URI pts; always be careful to describe the CP or SOB accurately so as to not accidentally create the impression of symptoms consistent w/ MI or PE.
48
Q

Otitis Media (middle ear infection)

A

Etiology: Viral or bacterial infection of the TM causing ear pain and pressure.

  1. CC: Ear pain, ear pulling.
  2. Assoc Sx: Fever, sore throat, dry cough, congestion.
  3. PE: Erythema, effusion, dullness, or bulging of the TM (Tympanic Membrane).
  4. Dx: Clinically.
49
Q

Streptococcal Pharyngitis

A

Etiology: Bacterial infection of the tonsils and pharynx causing a sore throat and frequently swollen lymph nodes.

  1. CC: Sore throat
  2. PE: Pharyngeal erythema, Tonsillar hypertrophy, Tonsillar exudates (pus)
  3. Dx by Rapid strep – a quick throat swab,

NOTES:

  • Most sore throats are viral, however, strep is bacterial so Abx will help; concern of Peri-Tonsillar Abscess (PTA). Signs include uvular shift or tonsillar asymmetry.
50
Q

Conjunctivitis (Pink Eye)

A

Etiology: Infection of the outer lining of the eye.

  1. CC: Eye redness, irritation, or pain
  2. Assoc Sx: Eyelid matting
  3. PE: conjunctival injection, edema, and exudates
  4. Dx: Clinically
51
Q

Epistaxis (nose bleed)

A

Etiology: Rupture of a blood vessel inside the nose causes blood to flow out of the nose and into the throat.

  1. CC: Nose bleed
  2. Risk Factors: blood thinners (coumadin/warfarin, ASA, Plavix) or HTN
  3. PE: Anterior, posterior, or septal source of the bleeding
  4. Dx: Clinically

NOTES:

  • Nose bleeds can be cauterized or stopped w/ pressure from a nasal tamponade called a “rhino-rocket”
52
Q

Musculoskeletal Back Pain

A

Etiology: Deterioration or strain of the back creates pain that is worse with movement.

  1. CC: Back pain, lower usually
  2. Assoc Sx: Shooting posterior lower extremity pain
  3. Pert. Neg: No LE weakness, no incontinence
  4. PE: Paraspinal tenderness, positive straight leg raise (+ SLR diagnoses Sciatica, back pain that radiates down the legs).

NOTES:

  • Document any recent trauma-related to back pain as it increases concerns of spinal injury
53
Q

Extremity Injury

A

Etiology: Trauma creates pain/swelling in an extremity

  1. CC: Extremity pain
  2. Assoc Sx: Swelling, Bruising, Deformity, Use limitation.
  3. Pert. Neg: No motor weakness, No numbness tingling.
  4. PE: Distal CSMT intact (circulation, sensory, motor, tendon), no tendon or ligament laxity, ROM (range of motion) limited secondary to pain.

NOTES:

  • Document any splint with Splint Application Procedure Note
54
Q

Abdominal Aortic Aneurysm (AAA)

A

Etiology: Widened and weakened arterial wall at risk of rupture.

  1. CC: Midline Abd pain.
  2. PE: Midline pulsatile abdominal mass, abdominal bruit, unequal femoral pulses, hypotension.
  3. Dx by CT A/P w/ IV contrast.
55
Q

Aortic Dissection

A

Etiology: Separation of the muscular wall from the membrane of the artery, putting the pt at risk of aortic rupture and death.

  1. CC: CP radiating to back (ripping/tearing).
  2. PE: Unequal brachial or radial pulses, hypotension.
  3. Dx by CT Chest w/ IV Contrast.
56
Q

Deep Vein Thrombosis (DVT)

A

Etiology: Blood slows down while flowing through long straight veins in extremities, slow-flowing blood is more likely to clot. Once formed, the clot can continue to grow and eventually occlude/block the vein.

  1. Risk Factors: PMHx of DVT or PE, FHx, Recent surgery, Cancer, Immobility, Pregnancy, BCP (Birth Control Pill), smoking LE trauma, LE casts.
  2. CC: Extremity pain and swelling (atraumatic), usually a LE.
  3. PE: Calf tenderness, cords, Homan’s sign
  4. Dx by US/Doppler of the extremity
57
Q

Cellulitis

A

Etiology: Infection of the skin cells.

  1. CC: Red swollen painful and sometimes warm area of the skin
  2. PE: Erythema, edema, Increased warmth (calor – heat), Induration
  3. Assoc Meds: Abx
  4. Dx: Clinically

Erythema –– superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilation of the blood capillaries.

Edema –– swelling caused by excess fluid trapped in your body’s tissues.

Induration –– An area of hardness in the skin.

58
Q

Abscess

A

Etiology: Skin infection w/ an underlying collection of pus.

  1. CC: Red swollen, and painful lump
  2. PE: Fluctuance (pus pocket) induration, purulent discharge
  3. Dx: Clinically

NOTES:

  • Must drain, document I&D (Incision and drainage) procedure notes for abscesses
59
Q

Rash

A

Etiology: Changes in the skin’s appearance due to systemic or localized reactions. May be caused by medication, virus, bacteria, fungus, insect, etc…

  1. CC: Rash, red, pruritic (the medical term for itchy skin), painful.
  2. PE: Urticaria (hives or wheals –), Macules (flat) Papules (raised bumps) Vesicles (small blisters), Blanching (not dangerous) Petechiae (dangerous rash) Purpura (dangerous rash)
  3. Dx: Clinically

Hives –– a rash of round/irregular shape.

Wheals –– an area of the skin that is temporarily raised, typically reddened and usually accompanied by itching.

60
Q

Allergic reaction

A

Etiology: Immune response causing an inflammatory reaction consisting of swelling, itching, and rash.

  1. Risk factors: Known drug or food allergy
  2. CC: Rash, swelling, itchy, or SOB
  3. PE: Edema, facial angioedema, Urticaria (hives, wheals)
  4. Dx: Clinically

NOTES:

  • ED’s concern is Anaphylaxis (a severe, potentially life-threatening allergic reaction) or Respiratory failure.
61
Q

Allergic vs. Adverse Reactions

A

Allergic –– Rash, Itching, Swelling, SOB due to airway swelling.

Adverse Reaction –– N/V, Abd Pain, Diarrhea, Dizziness.

62
Q

Diabetic Ketoacidosis (DKA)

A

Etiology: A shortage of insulin resulting in hyperglycemia and production of ketones.

  1. Risk Factors: Diabetes Mellitus (DM) type I and II (rare in type II).
  2. CC: Persistent vomiting with a Hx of DM.
  3. Assoc Sx: SOB, polydipsia (increased thirst), polyuria (increased urination).
  4. PE: Ketotic odor “fruity”, Dry Mucous Membranes, Dehydration, Tachypnea.
  5. Dx by: Arterial Blood Gas (ABG or VBG) showing low pH (acidosis) or Positive Serum ketones.

ABG –– measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery.

63
Q

Psychological Disorder

A

Etiology: Various types of psych diseases produce abnormal thoughts, behaviors, or actions.

  1. PMHx: Bipolar Disorder, Schizophrenia, PTSD, Depression, Anxiety, Alcoholism, Drug Abuse, Suicide Attempt
  2. Possible CC: Suicidal Ideation(SI), Homicidal Ideation (HI), Hallucinations, (Auditory or Visual), Substance Abuse, Self-injury, Overdose
  3. PE: Flat affect, SI, HI, Tangential, or pressured speech.

Flat affect –– A flat affect can be a negative symptom of schizophrenia, meaning that your emotional expressions don’t show.

Tangential –– A disturbance in the associative thought process in which one tends to digress readily from one topic under discussion to other topics that arise in the course of associations; observed in bipolar disorder, schizophrenia, and certain types of organic brain disorders.

NOTES:

  • Be careful to document MEDICAL (PHYSICAL) COMPLAINTS.
64
Q

Trauma

A

Etiology: Depending on the mechanism of injury (MOI) physical trauma may break bones, sever nerves, rupture blood vessels or damage internal organs.

  1. CC: MVA (motor vehicle accident), Fall, GSW (gunshot wound).
  2. PE: Glasgow Coma Scale (GCS) 3-15 –– Assesses LOC following a trauma.
  3. Assoc Med: Blood thinners?
  4. Dx by: Trauma protocol depending on MOI, CT, or XR

NOTES:

Trauma DDx:

  • Neurological Injuries (Hemorrhagic stroke, spinal cord injury).
    • Keywords: LOC, Confusion, Numbness, Weakness HA, Neck/Back Pain.
  • Internal Organ Injury (Pneumothorax, Hemothorax, Abdominal Organ injury.
    • Keywords: SOB, Chest Pain, Abd Pain.

Scribe America ED (13 decks)

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