DDx Flashcards
DDx of chest pain
Cardiac (MI,angina, myopericarditis, tamponade), GI: (spasm, gerd, mallory wiess s, ulcer neoplasm in esophagus: gastritis, PUD, stomach, pancreatitis, Biliary colic), Pulmonary: PE, pneumonia, hemo/pneumo/tensionpneumothorax, empyema, neoplasm, TB), Mediastinal: lymphoma, thymoma) vascular: (dissecting, rupture of aorta), chostochondritis, ribfracture, herpes zoster, psychosomatic.
Shock: definition
underperfusion of tissues. Presenting with tachycardia, hypotension and malfunction of underperfused organ system (lactic acidosis, anuria/oliguria, altered mentation)
Types of shock
Cardiogenic: pump failure
Hypovolemic: decreased circulatory blood volumes
septic: hypotension due to vasodilatation
neurogenic: failure of sympathetic nervous system to maintain adequate vascular tone
anaphylactic shock
Cardiogenic shock
Heart cannot generate CO sufficient to maintain tissue perfusion. Can be defined as sBP 20 ml /hr. Causes: MI, tamponade, tension pneumothorax, arrythmia, massive PE. Clinical: hypotension, tachycardia, pale cool skin, distended neck veins, pulm congestion, Dx: ECG, ECHO, swan-Ganz catheter. Tx: ABC, treat underlying cause, vasopressors (dopamine).
Hypovolemic shock
dec circ blood volume leads to dec preload, and CO. Etiology: GI loss, bleeding, dehydration, burns, third spacing. Dx: vital signs, CVC/swan ganz cath,: dec PCWP, dec CO, INCREASED SVR. Tx: ABC, hydration, treat underlying cause
Septic shock
Etiology: pneumonia, pyelonephritis, meningitis, cholangitis, celullitis, peritonitis. Clinical: depend on underlying cause, fever, SIRS,. Dx: clinical. Decreased SVR and increased/normal CO. Tx: IV AB fluids +- vasopressors.
Neurogenic shock
failure of symp nervous system to maintain adequate vascular tone. Etiology: spinal cord injury, spinal anesthesia. clinical: warm and well perfused skin, normal urine output, bradycardia and hypotension. CO and SVR is dec. PCWP is low or normal. Tx: iv fluids, vasocontrictors, supine/trendelenburg position, maintain body temp.
Def of cyanosis
cysanosis is bluish discoloration of skin and mucous membranes, due to excessive concentration of deoxyhb in the blood. Central: coe, lips and tongue. Peipheral: extremities, fingers
cyanosis
DDx
CNS (imparin normal ventilation): respiratory, cardivascular, blood. Others: high altitude, hypotermia, obstructive sleep apnea.
Dx and Tx cyanosis
duration, clubbing, abnormal hb? Met? sickle cell?
Tx: oxygen and tx of underlying disease.
Septic shock definition
Septic shock is a type of vasodilatory or distributive shock. Septic shock is defined as sepsis that has circulatory, cellular, and metabolic abnormalities that are associated with a greater risk of mortality than sepsis alone. Clinically, this includes patients who fulfill the criteria for sepsis (SOFA) who, despite adequate fluid resuscitation, require vasopressors to maintain a mean arterial pressure (MAP) ≥65 mmHg and have a lactate >2 mmol/L (>18 mg/dL).
Sepsis def
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection; organ dysfunction is defined as an increase of two or more points in the SOFA score. The (quick) qSOFA only has three components that are each allocated one point: respiratory rate ≥22/minute, altered mentation, and systolic blood pressure ≤100 mmHg. A score ≥2 is associated with poor outcomes due to sepsis
Clinical picture of sepsis
fecer, tachypnea, tachycardia, ssx from primary source of infections (pulm, urinary, meningitis, cholangitis, peritonitis). altered mental status. Hypotension. leukocytosis or leukopenia, hyperglycemia,
Signs of shock
signs of shock (eg, cool skin and cyanosis) and organ dysfunction develop (eg, oliguria, acute kidney injury, altered mental status)
