Diseases Flashcards
Coronary Artery Disease (CAD) (Etiology)
Narrowing of the coronary arteries causing reduced blood flow to the heart muscle (A patient has CAD if they have a PMHx of Angina, MI, CABG, Cardiac stents, or Angioplasty)
Coronary Artery Disease (CAD) (risk factors)
HTN,HLD, DM, Smoking, Family history of CAD/MI <55 y/o
Coronary Artery Disease (CAD) (Chief Complaint)
Angina: Exertional chest pain or chest pressure
Modifying Factors: Worse with exertion, improved with rest and/or nitroglycerin
Coronary Artery Disease (CAD) (Associated Sx)
Shortness of breath
Coronary Artery Disease (CAD) (Medications)
Nitroglycerin (NTG) to manage angina, Acetylsalicylic Acid (ASA) to decrease the chance of a blockage
Coronary Artery Disease (CAD) (Diagnosed by)
Cardiac catheterization (CAD cannot be diagnosed in the ED)
Myocardial Infarction (MI) (Etiology)
Acute blockage the coronary arteries causing ischemia or infarct to the heart muscle (Document ED arrival time, EKG time, ASA time, cath lab departure time. STEMI patients must get to Cath-lab within 90 minutes of arrival)
Myocardial Infarction (MI) (risk factors)
CAD, Hypertension, Hyperlipidemia, Diabetes Mellitus, Smoker, FHx of CAD <55 y.o.
Myocardial Infarction (MI) (Chief Complaint)
Chest pain or chest pressure
Modifying Factors: Worse with exertion, improved with rest and/or nitroglycerin
Myocardial Infarction (MI) (Associated Sx)
Diaphoresis, Nausea/Vomiting, and Shortness of breath
Myocardial Infarction (MI) (Medication)
Acetylsalicylic Acid (aspirin or ASA) , Nitroglycerin (NTG ), Thrombolytic (Heparin)
Myocardial Infarction (MI) (Diagnosed by)
STEMI: diagnosed by EKG (may also have an elevated troponin) Non-STEMI: diagnosed by elevated troponin
Congestive Heart Failure (CHF) (Etiology)
The heart becomes enlarged, inefficient, and congested with excess fluid.(If patient has CHF history, document their current dosage of Lasix. Search echocardiograms and document the cardiac output (EF or ejection fraction) and cardiac valve function.)
Congestive Heart Failure (CHF) (Risk Factors)
History of CHF, Hypertension, Hyperlipidemia, Diabetes Mellitus, Kidney Disease, Smoking
Congestive Heart Failure (CHF) (Chief Complaint)
Shortness of Breath - Modifying Factors: Worse with lying flat (Orthopnea), Worse with exertion (Dyspnea on Exertion), and Episodically worse at night - Paroxysmal Nocturnal Dyspnea (PND)
Congestive Heart Failure (CHF) (Associated Sx)
Bilateral lower extremity swelling, fatigue, cough
Congestive Heart Failure (CHF) (Medications)
Diuretics (Lasix/Furosemide) → Urinate extra fluid
Congestive Heart Failure (CHF) (Physical Exam)
Rales (Crackles) in lungs, Jugular Vein Distension (JVD), Pedal edema
Congestive Heart Failure (CHF) (Diagnosed by)
CXR and elevated BNP (B-type Natriuretic Peptide)
Atrial Fibrillation (A Fib) (Etiology)
Electrical abnormalities in the “wiring” of the heart causes the top of the heart (atria) to quiver abnormally (ED concern is Rapid Ventricular Response RVR which is Afib with a rate greater than 100 bpm). Patients who have AFib are at increased risk for developing blood clots and often take a blood thinner.)
Atrial Fibrillation (A Fib) (Risk Factors)
Paroxysmal A Fib, Chronic A Fib, Alcoholism
Atrial Fibrillation (A Fib) (Chief Complaint)
Palpitations (Fast, Pounding, Irregular)
Atrial Fibrillation (A Fib) (Associated Sx)
Global Weakness, Fatigue, Lightheadedness
Atrial Fibrillation (A Fib) (Medication)
Coumadin/Warfarin (Blood thinner) and Digoxin (Slows down heart rate)
Atrial Fibrillation (A Fib) (Physical Exam)
Irregularly irregular rhythm
Atrial Fibrillation (A Fib) (Diagnosed by)
Electrocardiogram (ECG/EKG)
Pulmonary Embolism (PE) (Etiology)
A blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs (A Deep Vein Thrombosis (DVT) is a blood clot in an extremity (not in the lungs). Symptoms of a
DVT include extremity pain and swelling and has the same risk factors as a PE. A DVT is diagnosed by and ultrasound of that extremity)
Pulmonary Embolism (PE) (Risk Factors)
Known DVT, PMHx of DVT or PE, FHx, Recent surgery, Cancer, A-Fib, Immobility, Pregnancy, BCP (birth control pills), Smoking
Pulmonary Embolism (PE) (Chief Complaint)
Chest Pain
Modifying Factor: Worse with deep breaths (pleuritic)
Pulmonary Embolism (PE) (Associated Sx)
Shortness of breath. Patients often are hypoxic (low oxygen saturation), tachycardic (elevated heart rate)
Pulmonary Embolism (PE) (Diagnosed by)
Screening tool: D-Dimer
Diagnostic tool: CTA Chest (CT Chest w/ IV Contrast)
Pneumonia (PNA) (Etiology)
Infiltrate (bacterial infection) and inflammation inside the lung (Community Acquired Pneumonia (CAP) protocol requires documenting Antibiotics (Abx), Vital Signs, SaO2, Mental status, and Blood cultures)
Pneumonia (PNA) (Risk Factors)
Elderly, Bedridden, Immunocompromised, Recent chest injury, Recent surgery
Pneumonia (PNA) (Chief Complaint)
Productive Cough
Pneumonia (PNA) (Associated Sx)
Shortness of breath, fever, chest pain
Pneumonia (PNA) (Medications)
Rocephin and Zithromax (Antibiotics)
Pneumonia (PNA) (Physical Exam )
Rhonchi
Pneumonia (PNA) (Diagnosed by)
Chest X-Ray (CXR)
Chronic Obstructive Pulmonary Disease (COPD) (Etiology)
Long-term damage to the lungʼs alveoli (emphysema) along with inflammation and mucus production (chronic bronchitis) (Document the patientʼs baseline O2 requirement)
Chronic Obstructive Pulmonary Disease (COPD) (Risk Factors)
Single greatest risk factor is Smoking (80-90% of all cases)
Chronic Obstructive Pulmonary Disease (COPD) (Chief Complaint)
Shortness of breath
Chronic Obstructive Pulmonary Disease (COPD) (Associated Sx)
Wheezing, Cough, Chest tightness
Chronic Obstructive Pulmonary Disease (COPD) (Treatment)
Bronchodilators, Supplemental oxygen, Corticosteroids, Ventilatory support
Chronic Obstructive Pulmonary Disease (COPD) (Physical Exam)
Decreased breath sounds, wheezes
Chronic Obstructive Pulmonary Disease (COPD) (Diagnosed by)
Acute infections are a very common cause for a COPD Exacerbation. For this reason, a CXR may be ordered to rule out PNA. Otherwise COPD is not diagnosed in the ED.
Asthma (Etiology)
Constricting of the airway due to inflammation and muscular contraction of the bronchioles, known as a “bronchospasm” (Be sure to document the patientʼs oxygen saturation. If the patient becomes hypoxic, they may require supplemental oxygen or additional interventions.)
Asthma (Risk Factors)
Personal or familial history of asthma, smoking, occupational exposures, obesity, allergies
Asthma (Chief Complaint)
Shortness of breath
Modifying factors: Improved with “breathing treatments”, exacerbated by certain triggers
Asthma (Associated Sx)
Wheezing
Asthma (Treatment)
Bronchodilators, Corticosteroids, Inhalers (inhaled corticosteroids) or nebulizers
Asthma (Physical Exam)
Wheezes (Inspiratory or Expiratory)
Ischemic Cerebrovascular Accident (CVA) (Etiology) (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. Also, document tPA considered and if it was not indicated due to:
● Onset greater than 3 hours or Unknown/Unreliable time of onset
● Symptoms are rapidly improving)
Blockage of the arteries supplying blood to the brain resulting in permanent brain damage
Ischemic Cerebrovascular Accident (CVA) (Risk Factors)
HTN, HLD, DM, hx TIA/CVA, Smoking, FHx CVA, AFIB
Ischemic Cerebrovascular Accident (CVA) (Chief Complaint)
Unilateral focal neurological deficits: One-sided weakness/numbness or changes in speech/vision
Ischemic Cerebrovascular Accident (CVA) (Medications)
tPA (thrombolytic) will be administered if the patient meets the criteria
Ischemic Cerebrovascular Accident (CVA) (Physical Exam)
Unilateral neurological deficits
Ischemic Cerebrovascular Accident (CVA) (Diagnosed by)
Clinically, following a CT Head in order to rule out Hemorrhagic CVA.
Hemorrhagic (CVA) (Etiology)(Document “tPA not indicated due to hemorrhage”)
Traumatic or spontaneous rupture of blood vessels in the head leads to bleeding in the brain
Hemorrhagic (CVA) (Risk Factors)
HTN, anticoagulant use, recent head trauma
Hemorrhagic (CVA) (Chief Complaint)
Severe, sudden onset (“Thunderclap”) Headache
Hemorrhagic (CVA) (Associated Symptoms)
Nausea, AMS, Focal neurological deficits (Unilateral weakness, numbness, or tingling, changes in speech/vision)
Hemorrhagic (CVA) (Physical Exam)
Unilateral neurological deficits
Hemorrhagic (CVA) (Diagnosed by)
CT Head is the preferred method of speedy diagnosis. However, imaging is not 100% reliable in detecting a brain bleed. Therefore the patientʼs clinical presentation will also play a role in the diagnostic process. In rare cases, a Lumbar Puncture (LP) may be performed for further diagnostic purposes.
Transient Ischemic Attack (TIA) (Etiology) (TIAʼs are also known as “Mini Strokes” because symptoms usually last < 1 hour and there is no permanent brain damage. Document tPA considered and not indicated due to the fact that symptoms are resolved)
Vascular changes temporarily deprive a part of the brain of oxygen (Symptoms usually last less than 1 hour)
Transient Ischemic Attack (TIA) (Risk Factors)
HTN, HLD, DM, hx TIA/CVA, Smoking, FHx CVA, AFIB
Transient Ischemic Attack (TIA) (Chief Complaint)
Transient focal neurological deficit (changes in speech, vision, strength, or sensation)
Transient Ischemic Attack (TIA) (Clinically)
Clinically
Meningitis (Etiology) (Meningitis is notoriously hard to diagnosis. Any person with a headache or fever will likely be asked if they have headache, neck pain or fever) Be sure to document all of the patientʼs symptoms they have and symptoms they do not have.)
Inflammation and infection of the meninges; the sac surrounding the brain and spinal cord
Meningitis (risk factors)
Recent international travel, recent exposure to a sick contact
Meningitis (Chief Complaint)
Headache, neck pain or stiffness, fever, altered mental status
Meningitis (Physical Exam)
Meningismus, Nuchal Rigidity
Meningitis (Lumbar Puncture)
Lumbar Puncture (LP)
Altered Mental Status (Etiology)
(AMS is very different compared to a focal neurological deficit (FND). AMS is generalized and is typically caused by things that affect the whole brain (drugs, low blood sugar).
Focal neuro deficits are localized weakness/numbness in one specific area, corresponding with damage at one specific site in the brain.)
Globalized confusion, caused by things that affect the entire brain. Most common are hypoglycemia, infection, intoxication, and neurological
Altered Mental Status (Risk Factors)
Known infection (commonly UTI in elderly patients), Diabetic, Elderly, Dementia, EtOH use, Drug use
Altered Mental Status (Chief Complaint)
Confusion, Decreased responsiveness, Unresponsive
Altered Mental Status (Diagnosed by)
Case Dependent
Syncope (Passing Out) (Etiology)
Temporary loss of blood supply to the brain resulting in loss of consciousness. There are a variety of causes; most common are vasovagal and low blood volume (dehydration/hypovolemia). Occasionally syncope occurs due to cardiac/neurologic causes.
Syncope (Passing Out) (Chief Complaint)
Loss of Consciousness (LOC), Fainting or Passing out
Appendicitis (etiology)
Infection of the appendix causes inflammation and blockage, possibly leading to rupture
Appendicitis (Chief Complaint)
Abdominal Pain Location: RLQ
Modifying Factor: Worse with movement
Appendicitis (Associated Sx)
Nausea, vomiting, fever, decreased appetite
Appendicitis (Physical Exam)
RLQ tenderness, McBurneyʼs point tenderness
Appendicitis (Diagnosed by)
CT Abdomen/Pelvis with PO Contrast
Urinary Tract Infection (UTI) (etiology)
Infection of the urinary tract (bladder or urethra)
Urinary Tract Infection (UTI) (risk factors)
female
Urinary Tract Infection (UTI) (chief complaint)
Painful urination (dysuria)
Urinary Tract Infection (UTI) (associated Sx)
Urinary frequency, urgency, malodorous urine, AMS (elderly)
Urinary Tract Infection (UTI) (Physical exam)
Suprapubic tenderness
Urinary Tract Infection (UTI) (Diagnosed by)
Urine dip or Urinalysis (UA)
Kidney Stones (etiology)
A kidney stone dislodged from the kidney and begins traveling down the ureter. The stone scrapes and irritates the ureter, causing severe flank pain and bloody urine
Kidney Stones (chief complaint)
flank pain
Kidney Stones (Associated Sx)
Blood in the urine (hematuria), Nausea/Vomiting, Unable to void
Kidney Stones (Physical Exam)
Costovertebral angle (CVA) tenderness
Kidney Stones (Diagnosed by)
CT Abdomen/Pelvis; Red blood cells in the UA may be a clue
Ectopic Pregnancy (etiology)
Fertilized egg develops outside the uterus, usually in the fallopian tube. High risk for rupture and death
Ectopic Pregnancy (risk factors)
Pregnant female (HCG positive), STD (PID)
Ectopic Pregnancy (chief complaint)
Lower abdominal pain or Vaginal Bleeding while pregnant
Ectopic Pregnancy (diagnosed by)
Ultrasound Pelvis (Determine location of fetus. Intrauterine is a normal finding)
Spinal Cord Injury (description)
Bruise, partial tear, or complete tear of the spinal cord
Spinal Cord Injury (chief complaint)
Neck or back pain, Bilateral extremity weakness
Spinal Cord Injury (diagnosed by)
CT C-spine, T -Spine and/or L-spine
Pneumothorax (description)
Collapsed lung
Pneumothorax (chief complaint)
Shortness of breath, one-sided chest pain
Pneumothorax (diagnosed by)
CXR
Internal Organ Injury (Spleen, Liver) (description)
Rupture leading to hemorrhage/bleeding
Internal Organ Injury (Spleen, Liver)(chief complaint)
Abdominal pain, abdominal distention
Internal Organ Injury (Spleen, Liver)(diagnosed by)
CT Abdomen
Fracture (description)
Trauma creates pain/swelling
Fracture (chief complaint)
Pain, swelling, bruising, use limitation
Fracture (diagnosed by)
X-ray
Abdominal Aortic Aneurysm (AAA)(etiology)
Widened and weakened arterial wall at risk of rupture
Abdominal Aortic Aneurysm (AAA)(risk factors)
Age, HTN, smoking, CAD
Abdominal Aortic Aneurysm (AAA)(Chief complaint)
Midline Abdominal Pain
Abdominal Aortic Aneurysm (AAA)(physical exam)
Midline pulsatile abdominal mass, Abdominal bruit, Unequal femoral pulses, Hypotension
Abdominal Aortic Aneurysm (AAA)(diagnosed by)
CT Abdomen/Pelvis with IV contrast dye
Aortic Dissection (etiology)
Separation of the muscular wall from the membrane of the artery, putting the pt at risk of aortic rupture and death
Aortic Dissection (risk factors)
Age, HTN, connective tissue disorder
Aortic Dissection (chief complaint)
Ripping or Tearing chest pain radiating to the back
Aortic Dissection (physical exam)
Unequal brachial or radial pulses, Hypotension
Aortic Dissection (diagnosed by)
CT Chest with IV contrast dye
Sepsis (etiology)
An infection that gets into the bloodstream. In response to a systemic infection, chemicals released from the immune system cause inflammation throughout the entire body, potentially leading to shock and death.
Sepsis (risk factor)
Current infection: viral, bacterial, or fungal. Compromised immune system. Open wounds. Chronically ill. Young and old populations. Having an invasive device such as IVC or breathing tube
Sepsis (chief complaint)
Fever and AMS
Sepsis (Associated Sx)
Symptoms vary, dependent on the source of the infection
Diabetes (etiology)
The inadequacy of insulin in controlling the blood glucose level (insulin resistance)
Diabetes (risk factor)
FHx of DM, obesity, high carb diet, lack of exercise
Diabetes (chief complaint)
Unusual weight loss or gain
Polyuria, polydipsia, blurred vision, N/V
Diabetes (medications)
Insulin Dependent: humalog, lantus
Non-Insulin Dependent: Oral meds like metformin, glyburide
Diabetes (diagnosed by)
Fasting blood glucose / hemoglobin A1c
Hypertension (etiology)
Higher than normal pressure of blood pushing against the walls of your arteries.
Hypertension (risk factors)
Diabetes, Obesity, Age, Smoking, Alcohol Use, Family History of HTN
Hypertension(chief complaints)
Usually has no warning signs or symptoms
hypertension (medication)
Different blood pressure medicines can work in different ways to keep blood pressure at a healthy level
● Causing your body to get rid of water, which decreases the amount of water and salt in your body
to a healthy level
● Relaxing your blood vessels
● Making your heart beat with less force
● Blocking nerve activity that can restrict your blood vessels
hypertension (diagnosed by)
Having blood pressure measures consistently above normal may result in a diagnosis of high blood pressure (or hypertension).
Hyperlipidemia (etiology)
An elevated level of lipid in the blood causes plaque build-up along arterial walls
Hyperlipidemia (risk factors)
FHx of HLD, obesity, high lipid diet (high in saturated fats), ETOH, physical inactivity
Hyperlipidemia (chief complaint)
Usually has no warning signs or symptoms
Medications
Statins
Hyperlipidemia (diagnosed by)
Not often done in the ED, more relevant in the setting of being a risk factor for other emergent diseases.
