ED 2 Flashcards
1
Q
Pathophysiology
A
The study of abnormal changes in body functions that are the causes, consequences, or concomitants of disease processes
2
Q
Associated Symptoms
A
Specific symptoms that raise the physician’s suspicion for a particular DDx
3
Q
Pertinent Negatives
A
Specific symptoms that are not present which lower physicians suspicion for a particular DDx
4
Q
Diabetic Retinopathy
A
Damages small vessels of the eyes and can cause hemorrhaging leading to blurred vision, nearsightedness, or vision loss.
5
Q
Renal Failure
A
Damage to glomeruli of the kidneys.
6
Q
Neuropathy
A
Peripheral nervous system damage causes distal paresthesias and extremity pain.
7
Q
Cerebrovascular Accident
A
Overtime high glucose levels can damage the body’s blood vessels, increasing chance of stroke.
8
Q
Cardiac Disease
A
Damages blood vessels therefore increasing the risk factor for CAD, CHF, and diabetic cardiomyopathy.
9
Q
Peripheral Vascular Disease
A
Damages blood vessels and decreases blood flow to extremities results in infections, ulcers, and potential amputations.
10
Q
Effects of Chronically High Blood Pressure
A
CVA
Cardiac Disease
CHF
Retinopathy
Renal Failure
11
Q
CVA
A
Damages and narrows arterial vessels and limits blood flow and increases risk of artery rupture.
12
Q
Effects of Chronically High Blood Glucose
A
Diabetic Retinopathy
Cardiovascular Accident
Cardiac Disease
Peripheral Vascular Disease
Renal Failure
Neuropathy
13
Q
Effects of Chronically High Cholesterol
A
CVA
Cardiac Disease
Pancreatitis
14
Q
CHF
A
15
Q
Pancreatitis
A
16
Q
Coronary Artery Disease
A
Narrowing of the coronary arteries causing reduced blood flow to the heart muscle.
17
Q
CAD Risk Factors
A
HTN, HLD, DM, Smoking, Family history of CAD/MI <55y/o
18
Q
CAD Chief Complaint
A
Angina
Modifying factors
19
Q
CAD Associated Sx
A
Shortness of breath
20
Q
CAD Medications
A
NItroglycerin to manage angina, Acetysalacylic Acid to decrease the chance of blockage
21
Q
CAD Diagnosed by
A
Cardiac catheterization
*cannot be diagnosed in ED
22
Q
CAD Scribe Alert
A
A patient has CAD if they have a PMHx of Angina, MI, CABG, Cardiac stents, or Angioplasty.
23
Q
Myocardial Infraction
A
Acute blockage the coronary arteries causing ischemia or infaction to the heart muscle.
24
Q
MI Risk Factors
A
CAD, Hypertension, Hyperlipidemia, Diabetes Melitus, Smoker, FHx of CAD < 55 yo
25
MI Assoc. Sx
Diaphoresis, Nausea/Vomiting, and Shortness of breath
26
MI Chief Complaints
Chest pain or chest pressure.
Modifying Factors: Worse with exertion, improved with rest and/or nitroglycerin
27
MI Medications
Acetylsalicylic Acid, Nitroglycerin, Thrombolytic
28
MI Diagnosed by
29
MI Scribe Alert
Document ED arrival time, EKG time, ASA time, cath lab departure time. STEMI patients must get to Cath-lab within 90 minutes of arrival
30
Congestive Heart Failure
The heart becomes enlarged, inefficient, anc congested with excess fluid.
31
CHF Risk Factors
History of CHF, Hypertension, Hyperlipidemia, Diabetes Mellitus, Kidney Disease, SMoking
32
CHF Chief Complaint
Shortness of Breath
MOdifying Factors: Orthopnea, Dyspnea on Exertion, and Paroxysmal Nocturnal Dyspnea
33
CHF Assoc Sx
Bilateral lower extremity swelling, fatigue, cough
34
CHF Medications
Diuretics -> urinate ectra fluid
35
CHF Physical Exam
Rales in lungs, Jugular Vein Distention, Pedal Edema
36
CHF Diagnosed by
CXR and elevated BNP
37
CHF Scribe Alert
If the patient has a CHF history, document their current dosage of Lasix. Search echocardiograms and document the cardiac output and cardiac valve function.
38
Atrial Fibrillation
Electrical abnormalities in the wiring of the heart causeing the atria to quiver abnormally
39
A Fib Risk Factors
Paroxysma A FIB, Chronic A Fib, Alcaholism
40
A Fib Cheif Complaint
Palpitations (Fast, Pounding, Irregular)
41
A Fib Assoc. Sx
Global Weakness, Fatigue, Lightheadedness
42
A Fib Medications
Coumadin/Warfarin and Digoxin
43
A Fib Physical Exam
Iregularly irregular rhythm
44
A Fib Diagnosed by
ECG/EKG
45
A Fib Scribe Alert
ED concern is Rapid Ventricular Response, which is Afib with a greater than 100 bpm. Patients who have AFib are at an increased risk for developing blood clots and often take a blood thinner.
46
Pulmonary Embolism
A blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs
47
RE Risk Factors
Known DVT, PMHx of DVT or PE, FHx, Recent surgery, Cancer, A Fib, Immobility, Preganancy, BCP, Smoking
48
PE Cheif Complaint
Chest Pain
Modifying Factor: Worse with deep breaths
49
PE Assoc. Sx
Shortness of breath.
Patients often are hypoxic, techycardic
50
PE Diagnosed by
Screening tool: D-Dimer
Diagnostic tool: CTA Chest
51
PE Scribe Alert
A deep vein thrombosis is a blood clot in an extremity. Symptoms include extremity pain and swelling and have the same risk factors as a PE. A DVT is diagnosed by an ultrasound of that extremity.
52
Pneumonia
Infection and inflammation inside the lung
53
PNA Risk Factors
Elderly, Bedridden, Immunocompromised, Recent chest injury, Recent surgery
54
PNA Chief Complaint
Productive Cough
55
PNA Assoc. Sx
Shortness of breath, fever, chest pain
56
PNA Medications
Rocephin and Zithromax
57
PNA Physical Exam
Rhonchi
58
PNA Diagnosed by
Chest X-Ray
59
PNA Scribe Alert
Community-Acquired Pneumonia protocol requires documenting Abx, Vital Signs, SaO2, Mental Status, and Blood Cultures
60
Chronic Obstructive Pulmonary Disease
Long-term damage to the lungs alveoli along with inflammation and musuc production
61
COPD Risk Factors
Single greatest risk factor is Smoking (80-90% of all cases)
62
COPD Chief Complaint
Shortness of breath
63
COPD Assoc. Sx
Wheezing, cough, chest tightness
64
COPD Treatment
Bronchodilators, Supplemental oxygen, Corticosteroids, Ventilatory support
65
COPD Physical Exam
Decreased breath sounds, wheezes
66
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. Othersise COPD is not diagnosed in the ED.
67
COPD Scribe Alert
Document the paitents baseline O2 requierment
68
Asthma
Constricting of the airway due to inflammation and muscular contraction of the bronchioles, known as "bronchospasm"
69
Asthma Risk Factors
Personal or familial history of asthma, smoking, occupational exposures, obesity, allergies
70
Asthma Chief Complaint
Shortness of Breath
Modifying Factors: Improved with "breathing treatments", exacerbated by certian triggers
71
Asthma Assoc Sx
72
Asthma Treatment
73
Asthma Physical Exam
74
Asthma Scribe Alert
75
Ischemic Cerebrovascular Accident
Blockage of the arteries supplying blood to the brain resulting in permanent brain damage
76
CVA Risk Factors
HTN, HLD, DM, hx TIA/CVA, Smoking, FHx CVA, AFIB
77
CVA CHief Complaint
Unilateral focal neurological deficits: one sided weakness/numbness or changes in speech/vison
78
CVA Medications
tPA will be administered if the paitent meets the criteria
79
CVA Physical Exam
Unilateral neurological deficits
80
CVA Diagnosed by
Clinically following a CT Head in order to rule out Hemorragic CVA
81
CVA Scribe Alert
Document the date and time they were "last known well" as well as the source of this information. This is used to assess eligability 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
82
Hemorrhagic CVA
Traumatic or spontaneous rupture of blood vessels in the head leads to bleeding in the brain
83
Hemorrhagic CVA Risk Factors
HTN, anticoagulant use, recent head trauma
84
Hemorrhagic CVA Chief Complaint
Severe, sudden onset Headache
85
Hemorrhagic CVA Assoc. Sx
Nausea, AMS, Focal neurological deficits
86
Hemorrhagic CVA Physical Exam
Unilateral neurological deficits
87
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 paitents clinical presentation will also play a role in the diagnostic process. In rare cases, a LP may be performed for further diagnostic purposes
88
Hemorrhagic CVA Scribe Alert
Document "tPA not indicated due to hemorrahge"
89
90
Transient Ischemic Attack
91
TIA Risk Factors
92
TIA Chief Complaint
93
TIA Diagnosed by
94
TIA Scribe Alert
95
Meningitis
Inflammation and infection of the meninges; sac surrounding the brain and spinal cord
96
Meningitis Risk Factors
Recent international travel, recent exposure to a sick contact
97
Meningitis Chief Complaint
Headache, neck pain or stiffness, fever, altered mental status
98
Meningitis Physica Exam
99
Meningitis Diagnosed by
100
Meningitis Scribe Alert
101
Altered Mental Status
102
Altered Mental Status Risk Factors
103
Altered Mental Status Chief Complaint
104
Altered Mental Status Diagnosed by
105
Altered Mental Status Scribe Alert
106
Syncope
Temporary loss of blood supply to the brain resulting in loss of consciousness. There are a variety of causes: volume. Occasionally, syncope occurs due to cardiac/neurologic causes.
107
Syncope Chief Complaint
Loss of Consciousness, Fainting or Passing out
108
Syncope Scribe Alert
Document what happened:
1. Before the episode
2. During the episode
3. After the episode
4. How the patient is currently feeling
Were they near-syncopal? Did they almost pass out or have lightheadedness?
109
Appendicitis
Infection of the appendix causes inflamation and blockage, possibly leading to rupture
110
Appendicitis Chief Complaint
Abdominal Pain
Located RQL
Modifying Factor: Worse with mivement
111
Appendicitis Assoc. Sx
Nausea, vomiting, feer, decreased appetite
112
Appendicitis Physical Exam
RQL tenderness, McBurney's point tenderness
113
Appendicitis Diagnosed by
CT Abdomen/Pelvis with PO contrast
114
Cholelithiasis
Minerals from he liver's bile condense to form gallstones which can irritate, inflame, or obstruct the gallblader
115
Cholelithiasis Risk Factors
Females age 40 or older, Ppl of native american or Mexican decent, obesity, sedentary, pregnancy, high fat diet
116
Cholelithiasis Chief Complaint
Abdominal pain
Located RQL
Quality Typically Sharp
Modifying Factors: Worse with eating fatty foods, deep breaths, and palpitations
117
Cholelithiasis Physical Exam
RUQ tenderness, Murphy's sign
118
Cholelithiasis Diagnosed by
Abdominal Ultrasound
119
Urinary Tract Infection
Infection of the urinary tract (bladder or urethra)
120
Urinary Tract Infection Risk Factors
Female
121
Urinary Tract Infection Chief Complaint
Painful urination (dysuria)
122
Urinary Tract Infection Assoc. Sx
Urinary frequency, urgency, malodorous urine, AMS
123
Urinary Tract Infection Physical Exam
Suprapubic tenderness
124
Urinary Tract Infection Diagnosed by
Urine drip or urinalysis
125
Urinary Tract Infection Scribe Alert
126
Kidney Stones
A kidney stone disloged from the kidney and begins traveling down the ureter. The stone scrapes and irritates the ureter, causing severe flank pain and bloody urine.
127
Kidney Stones Chief Complaint
Flank pain
128
Kidney Stones Assoc. Sx
Blood in the urine, nausea/vomiting, unable to void
129
Kidney Stones Physical Exam
130
Kidney Stones Diagnosed by
131
Ectopic Pregnancy
A fertilized egg develops outside the uterus, usually in the fallopian tube. High risk for rupture and death.
132
Ectopic Pregnancy Risk Factors
133
Ectopic Pregnancy Chief Complaint
134
Ectopic Pregnancy Diagnosed by
135
Ectopic Pregnancy Scribe Alert
136
Acute Trauma Diagnoses
137
Trauma Documentation Requierments
Mechanism of Injury ?*HPI
Blood Thinners? *HPI
Glasgow Goma Scale? *PE
138
Back Pain
Deterioration or strain of the back creates pain that is worse with movement
139
Back Pain Risk Factors
Chronic back pain, age. physically demanding job
140
Back Pain Chief Complaint
Back pain
141
Back Pain Physical Exam
Paraspinal tenderness, positive straight leg raise
142
Back Pain Scribe Alert
Remember to document
143
Abdominal Aortic Aneurysm
Widened and weakened arterial wall at risk of rupture
144
AAA Risk Factors
Age, HTN, smoking, CAD
145
AAA Chief Complaint
Midline Abdominal Pain
146
AAA Physical Exam
MIdline Pulsatile abdominal mass, Abdoninal bruit, Unequal femoral pulses, Hypotension
147
AAA Diagnosed by
CT Abdomen/Pelvis with IV contrast dye
148
Aortic Dissection
Se
149
Aortic Dissection Risk Factors
150
Aortic Dissection Chief Complaint
151
Aortic Dissection Physical Exam
152
Aortic Dissection Diagnosed by
153
Sepsis
An infection that gets into the bloodstream. In respoonse to a systemic infection, chemicals released from the immune system cause inflammation throughout the entire body, potentially leading to shock and death
154
Sepsis Risk Factors
Curret infection, Compromised immune system, Open WOunds, chronically ill. young/old, invasive device
155
Sepsis Chief Complaint
Fever and AMS
156
Sepsis Assoc. Sx
Symptoms vary, dependant on the source of infection.
157
Sepsis Scribe Alert
158
Sepsis Protocal
1. Trending vital signs
2. Monitoring labs
3. Preliminary management
4. Finalized management
159
Cellulitis
160
Cellulitis Chief Complaint
161
Cellulitis Medications
162
Cellulitis Physical Exam
163
Cellulitis Diagnosed by
164
Cellulitis Scribe Alert
165
Abcess
