ED 2 Flashcards
Pathophysiology
The study of abnormal changes in body functions that are the causes, consequences, or concomitants of disease processes
Associated Symptoms
Specific symptoms that raise the physician’s suspicion for a particular DDx
Pertinent Negatives
Specific symptoms that are not present which lower physicians suspicion for a particular DDx
Diabetic Retinopathy
Damages small vessels of the eyes and can cause hemorrhaging leading to blurred vision, nearsightedness, or vision loss.
Renal Failure
Damage to glomeruli of the kidneys.
Neuropathy
Peripheral nervous system damage causes distal paresthesias and extremity pain.
Cerebrovascular Accident
Overtime high glucose levels can damage the body’s blood vessels, increasing chance of stroke.
Cardiac Disease
Damages blood vessels therefore increasing the risk factor for CAD, CHF, and diabetic cardiomyopathy.
Peripheral Vascular Disease
Damages blood vessels and decreases blood flow to extremities results in infections, ulcers, and potential amputations.
Effects of Chronically High Blood Pressure
CVA
Cardiac Disease
CHF
Retinopathy
Renal Failure
CVA
Damages and narrows arterial vessels and limits blood flow and increases risk of artery rupture.
Effects of Chronically High Blood Glucose
Diabetic Retinopathy
Cardiovascular Accident
Cardiac Disease
Peripheral Vascular Disease
Renal Failure
Neuropathy
Effects of Chronically High Cholesterol
CVA
Cardiac Disease
Pancreatitis
CHF
Pancreatitis
Coronary Artery Disease
Narrowing of the coronary arteries causing reduced blood flow to the heart muscle.
CAD Risk Factors
HTN, HLD, DM, Smoking, Family history of CAD/MI <55y/o
CAD Chief Complaint
Angina
Modifying factors
CAD Associated Sx
Shortness of breath
CAD Medications
NItroglycerin to manage angina, Acetysalacylic Acid to decrease the chance of blockage
CAD Diagnosed by
Cardiac catheterization
*cannot be diagnosed in ED
CAD Scribe Alert
A patient has CAD if they have a PMHx of Angina, MI, CABG, Cardiac stents, or Angioplasty.
Myocardial Infraction
Acute blockage the coronary arteries causing ischemia or infaction to the heart muscle.
MI Risk Factors
CAD, Hypertension, Hyperlipidemia, Diabetes Melitus, Smoker, FHx of CAD < 55 yo
MI Assoc. Sx
Diaphoresis, Nausea/Vomiting, and Shortness of breath
MI Chief Complaints
Chest pain or chest pressure.
Modifying Factors: Worse with exertion, improved with rest and/or nitroglycerin
MI Medications
Acetylsalicylic Acid, Nitroglycerin, Thrombolytic
MI Diagnosed by
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
Congestive Heart Failure
The heart becomes enlarged, inefficient, anc congested with excess fluid.
CHF Risk Factors
History of CHF, Hypertension, Hyperlipidemia, Diabetes Mellitus, Kidney Disease, SMoking
CHF Chief Complaint
Shortness of Breath
MOdifying Factors: Orthopnea, Dyspnea on Exertion, and Paroxysmal Nocturnal Dyspnea
CHF Assoc Sx
Bilateral lower extremity swelling, fatigue, cough
CHF Medications
Diuretics -> urinate ectra fluid
CHF Physical Exam
Rales in lungs, Jugular Vein Distention, Pedal Edema
CHF Diagnosed by
CXR and elevated BNP
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.
Atrial Fibrillation
Electrical abnormalities in the wiring of the heart causeing the atria to quiver abnormally
A Fib Risk Factors
Paroxysma A FIB, Chronic A Fib, Alcaholism
A Fib Cheif Complaint
Palpitations (Fast, Pounding, Irregular)
A Fib Assoc. Sx
Global Weakness, Fatigue, Lightheadedness
A Fib Medications
Coumadin/Warfarin and Digoxin
A Fib Physical Exam
Iregularly irregular rhythm
A Fib Diagnosed by
ECG/EKG
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.
Pulmonary Embolism
A blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs
RE Risk Factors
Known DVT, PMHx of DVT or PE, FHx, Recent surgery, Cancer, A Fib, Immobility, Preganancy, BCP, Smoking
PE Cheif Complaint
Chest Pain
Modifying Factor: Worse with deep breaths
PE Assoc. Sx
Shortness of breath.
Patients often are hypoxic, techycardic
PE Diagnosed by
Screening tool: D-Dimer
Diagnostic tool: CTA Chest
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.
Pneumonia
Infection and inflammation inside the lung
PNA Risk Factors
Elderly, Bedridden, Immunocompromised, Recent chest injury, Recent surgery
PNA Chief Complaint
Productive Cough
PNA Assoc. Sx
Shortness of breath, fever, chest pain
PNA Medications
Rocephin and Zithromax
PNA Physical Exam
Rhonchi
PNA Diagnosed by
Chest X-Ray
PNA Scribe Alert
Community-Acquired Pneumonia protocol requires documenting Abx, Vital Signs, SaO2, Mental Status, and Blood Cultures
Chronic Obstructive Pulmonary Disease
Long-term damage to the lungs alveoli along with inflammation and musuc production
COPD Risk Factors
Single greatest risk factor is Smoking (80-90% of all cases)
COPD Chief Complaint
Shortness of breath
COPD Assoc. Sx
Wheezing, cough, chest tightness
COPD Treatment
Bronchodilators, Supplemental oxygen, Corticosteroids, Ventilatory support
COPD Physical Exam
Decreased breath sounds, wheezes
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.
COPD Scribe Alert
Document the paitents baseline O2 requierment
Asthma
Constricting of the airway due to inflammation and muscular contraction of the bronchioles, known as “bronchospasm”
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 certian triggers
Asthma Assoc Sx
Asthma Treatment
Asthma Physical Exam
Asthma Scribe Alert
Ischemic Cerebrovascular Accident
Blockage of the arteries supplying blood to the brain resulting in permanent brain damage
CVA Risk Factors
HTN, HLD, DM, hx TIA/CVA, Smoking, FHx CVA, AFIB
CVA CHief Complaint
Unilateral focal neurological deficits: one sided weakness/numbness or changes in speech/vison
CVA Medications
tPA will be administered if the paitent meets the criteria
CVA Physical Exam
Unilateral neurological deficits
CVA Diagnosed by
Clinically following a CT Head in order to rule out Hemorragic CVA
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
Hemorrhagic CVA
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 Headache
Hemorrhagic CVA Assoc. Sx
Nausea, AMS, Focal neurological deficits
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 paitents clinical presentation will also play a role in the diagnostic process. In rare cases, a LP may be performed for further diagnostic purposes
Hemorrhagic CVA Scribe Alert
Document “tPA not indicated due to hemorrahge”
Transient Ischemic Attack
TIA Risk Factors
TIA Chief Complaint
TIA Diagnosed by
TIA Scribe Alert
Meningitis
Inflammation and infection of the meninges; 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 Physica Exam
Meningitis Diagnosed by
Meningitis Scribe Alert
Altered Mental Status
Altered Mental Status Risk Factors
Altered Mental Status Chief Complaint
Altered Mental Status Diagnosed by
Altered Mental Status Scribe Alert
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.
Syncope Chief Complaint
Loss of Consciousness, Fainting or Passing out
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?
Appendicitis
Infection of the appendix causes inflamation and blockage, possibly leading to rupture
Appendicitis Chief Complaint
Abdominal Pain
Located RQL
Modifying Factor: Worse with mivement
Appendicitis Assoc. Sx
Nausea, vomiting, feer, decreased appetite
Appendicitis Physical Exam
RQL tenderness, McBurney’s point tenderness
Appendicitis Diagnosed by
CT Abdomen/Pelvis with PO contrast
Cholelithiasis
Minerals from he liver’s bile condense to form gallstones which can irritate, inflame, or obstruct the gallblader
Cholelithiasis Risk Factors
Females age 40 or older, Ppl of native american or Mexican decent, obesity, sedentary, pregnancy, high fat diet
Cholelithiasis Chief Complaint
Abdominal pain
Located RQL
Quality Typically Sharp
Modifying Factors: Worse with eating fatty foods, deep breaths, and palpitations
Cholelithiasis Physical Exam
RUQ tenderness, Murphy’s sign
Cholelithiasis Diagnosed by
Abdominal Ultrasound
Urinary Tract Infection
Infection of the urinary tract (bladder or urethra)
Urinary Tract Infection Risk Factors
Female
Urinary Tract Infection Chief Complaint
Painful urination (dysuria)
Urinary Tract Infection Assoc. Sx
Urinary frequency, urgency, malodorous urine, AMS
Urinary Tract Infection Physical Exam
Suprapubic tenderness
Urinary Tract Infection Diagnosed by
Urine drip or urinalysis
Urinary Tract Infection Scribe Alert
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.
Kidney Stones Chief Complaint
Flank pain
Kidney Stones Assoc. Sx
Blood in the urine, nausea/vomiting, unable to void
Kidney Stones Physical Exam
Kidney Stones Diagnosed by
Ectopic Pregnancy
A fertilized egg develops outside the uterus, usually in the fallopian tube. High risk for rupture and death.
Ectopic Pregnancy Risk Factors
Ectopic Pregnancy Chief Complaint
Ectopic Pregnancy Diagnosed by
Ectopic Pregnancy Scribe Alert
Acute Trauma Diagnoses
Trauma Documentation Requierments
Mechanism of Injury ?*HPI
Blood Thinners? *HPI
Glasgow Goma Scale? *PE
Back Pain
Deterioration or strain of the back creates pain that is worse with movement
Back Pain Risk Factors
Chronic back pain, age. physically demanding job
Back Pain Chief Complaint
Back pain
Back Pain Physical Exam
Paraspinal tenderness, positive straight leg raise
Back Pain Scribe Alert
Remember to document
Abdominal Aortic Aneurysm
Widened and weakened arterial wall at risk of rupture
AAA Risk Factors
Age, HTN, smoking, CAD
AAA Chief Complaint
Midline Abdominal Pain
AAA Physical Exam
MIdline Pulsatile abdominal mass, Abdoninal bruit, Unequal femoral pulses, Hypotension
AAA Diagnosed by
CT Abdomen/Pelvis with IV contrast dye
Aortic Dissection
Se
Aortic Dissection Risk Factors
Aortic Dissection Chief Complaint
Aortic Dissection Physical Exam
Aortic Dissection Diagnosed by
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
Sepsis Risk Factors
Curret infection, Compromised immune system, Open WOunds, chronically ill. young/old, invasive device
Sepsis Chief Complaint
Fever and AMS
Sepsis Assoc. Sx
Symptoms vary, dependant on the source of infection.
Sepsis Scribe Alert
Sepsis Protocal
- Trending vital signs
- Monitoring labs
- Preliminary management
- Finalized management
Cellulitis
Cellulitis Chief Complaint
Cellulitis Medications
Cellulitis Physical Exam
Cellulitis Diagnosed by
Cellulitis Scribe Alert
Abcess