Week 5 - Back/Flank Pain & Genital Urinary Flashcards
ETCO2 in Cardiac Arrest
What does a spike AND drop in ETCO2 mean?
Spike - 1st sign of a ROSC
Drop - 1st sign it (life) is lost
Back Pain
Show me the lower back muscles
Back Pain
Show me the pocket assessments for back pain
What BLS to study for Test #2
General Pediatric
General Geriatric
Child in need of protection
Sexual Assult
Vaginal Bleeding Standard
Non-Traumatic:
- Abdominal Pain
- Chest Pain
- Back Pain
What ALS to study for test #2
Analgesia Medical Directive
Low Back pain
What are the common cheif complaints?
What should you obtain?
Spinal origins
Non-spinal origins
OPQRST
SAMPLE
Physical Assessment - Hands On
Low Back Pain
What are the spinal origins?
Musculoligamentous (common)
Discogenic
Fractures
Spondylolisthesis
Ankylosing Spondylitis
Osteomyelitis
Epidural Abscess/Hematoma
Cauda Equina Syndrome (nerve root)
Neoplasm
Show me the different types of spinal curvature
What are the types of trauma that can cause incomplete spinal cord syndrome?
Gunshot
Stabbing
Fractures
Motor Vehicle Collision
Incomplete Spinal Cord Syndromes
Brown-Sequard Syndrome
Central Cord Syndrome
Anterior Cord Syndrome
Explain
Myelitis
Transverse Myelitis
Acute Flaccid Myelitis (AFM)
What are the causes of AFM?
Inflammation of the spinal cord
Inflammtion of myelin ACROSS a section of spinal cord
AFM - the sudden onset of weakness (due to inflammation of the spinal cord) in one or more limbs
autoimmune diseases
or
exposure to environmental toxins
or
viruses (enteroviruse/west nile virus)
Cauda Equina Syndrome
What is it? What are the complications?
A protruding disc applies pressure to the nerve
- the patient may loose motor & sensory function
- alters bladder and bowel control
- causes leg syndromes
- leads (may) to serious & permanent irreversible diability
Sciatica - back pain
What happens when the sciatic area hurts?
There’s compression of the L4 nerve that results in pain radiating from the lower back down to the knee
There’s compression of the S1 nerve that results in pain radiating down to the foot
Lower-Back Pain
What about tight hamstrings?
Tight hamstrings i.e. if you don’t stretch them then it could cause radiating pain in the buttocks and back of the leg (sciatic pain)
Low-Back Pain
What are the Non-Spinal Origins?
Abdominal Aortic Aneurysm (pulsatile mass ?)
Renal Colic
Prostatitis
Ascending Urinary Tract Infection
Cystitis (Bladder Inflammation)
Pyelonephritis (Kidney Inflammation)
Neoplasm
Infection
Abdominal Aortic Aneurysm
Show & tell me the basics?
May have radiating pain to the back
Described at a tearing sensation
Pulsatile mass possible
Low Blood Pressure
Leaking blood follows gravity / pooling
Hematuria
Blood in the urine
Show me the causes
Nocturia
The need to get up at night to urinate regularly
What’s this associated with?
significant morbidity and marker of poor health
Show me the Bristol Stool Chart
Show me the Urine Properties
Show me the female antomy
Show me the Male anatomy
What’s a Pap Smear?
Show me the stages for cervical cancer
When the physican takes a sample of cells that are scraped from the cervix and examined under a microscope
Prostate Cancer
What’s the common age/gender?
Men over 70y/o
What is Trans-urethral resection of the prosate (TURP)?
A surgery that treats urinary problems that are caused by an enlarged prostate
Urine Output
Normal -
Oliguria -
Anuria -
urinates at least every 6h (35-105c/hr for 70kg)
Decreased output - 40-120cc/hr for 80kg usually less than 500cc/day adu
No/minimal urine output - 14-135cc/hr usually less than 100ml/day in adults
Urinary Tract Infection
What will the patient present as?
Show me the upper and lower urinary tract presentations
With dementia
Confused
Altered
What are potential urinary catheter complications?
Infection
Catheter blockage/inability to flush
Retention balloon is not deflating
Kidney Stones
What’s the ER presentation of the patient?
Is there a comfortable position for the patient?
What are they presenting with that’s concering?
Fever Greater/Equal to 38 degrees celcius
A burning feeling/pain with peeing everytime
Repeated vomiting
Unable to Fully pee
No - let them ove around to figure it out
Kidney Stones
What/where is colicky pain?
Urinary Obstruction/Retention
What are the differntials?
Renal Calculi - Kidney Stones
Acute Kidney Injury
Benign Prostatic Hypertrophy (BPH) – Rx: Options
Urethral Obstructions
Blocked Foley Catheter
Urinary Tract Infections
Nerve Damage
Micturition Syncope/Nocturia
The vagus nerve stimulus causes slowing down of the HR and a drop in BP
Sometimes related to a very rare tumor called a paraprostatic pheochromocytoma within the urinary bladder
Urinary Incontinance
Show me the types of incontinance
Show me the kidney’s anatomy
What are kidney injury differentials?
Volume overload
Hyperkalemia
Uremia
Metabolic Acidosis
Acute Kindey Failure
What are the S+S?
Decreased urine output, although occasionally urine
output remains normal
Fluid retention, causing swelling in your legs, ankles or
feet
Shortness of breath
Fatigue
Confusion
Nausea
Weakness
Irregular heartbeat
Chest pain or pressure
Seizures or coma in severe cases
Failing Kidneys
What are the treatments?
Peritoneal Dialysis
Hemodialysis
Pyelonephritis
Inflammation of the kidney - usually bacterial infection
What are the complications?
What are the S+S?
pus around the kidney
Sepsis
Kindey failure
fever
flank tenderness
nausea
buring with urination
frequent urination
Rhabdomyolysis
What is it?
Kidneys are responsible for removing myoglobin from the blood so that urine can flush it out of the body
a life-threatening condition caused by muscle breakdown and muscle death. This dangerous muscle damage can result from overexertion, trauma, toxic substances or disease.
Rhabdomyolysis
Who does it affect?
What are the causes?
Endurance athletes - HIIT people
Firefighters - the overheating
Service members - intense training
Older people - people who fall and aren’t discovered for a longtime
High-intensity exercise - not enough time for the muscles to heal
Severe dehydration and overheating - faster muscle breakdown
Trauma - rapid disintigration of muscles in burns, electrocutions, and crushing injures
Medications - antipsychotic, antidepressant, and antiviral drugs. Also statin drugs for diabetics or liver diseased patients
Illegal Drugs and Alcohol - Heroine, LSD, Cocaine, and excessive alcohol
Long periods of inactivity - the falls, can’t get up (people)
Renal Infarct
Caused by vascular occlusion, usually affecting the renal cortex
Chronic Kidney Disease (CKD)
What are the potential differentials?
Show me the S+S
Diabetes
Undiagnosed diabetes
Hyperinsulinemia
Insulin Resistance
NSAIDS
Poorly treated diabetes
Poorly treated hypertension
Renal Atery Stenosis
The narrowing of 1 or more (renal) arteries that carry blood to your kidneys.
What happens as a result?
leads to lack of normal amounts of oxygen-rich blood from reaching your kidneys
this can injury kidney tissue and increase BP throughout the whole body
End-Stage Renal Disease (ESRD)
Consider dialysis and/or a kidney transplant
PCOS - Polycystic Ovary Syndrome
What is it?
Disorder involving infrequent, irregular or prolonged
menstrual periods, and often excess male hormone (androgen) levels.
The ovaries develop numerous small collections of fluid — called follicles — and may fail to regularly release eggs
Ovarian Cysts
What are they/What do they do?
What’s the pain like?
When does it become a problem?
Ovarian cysts are solid or fluid-filled pockets in or on your ovary.
Common in women who are pregnant or who haven’t gone through menopause
painless and harmless - go away on their own without treatment
When the cyst doesn’t go away or it gets bigger or it does get painful
Endometriosis
What is it?
Where does it occur?
Painful disorder in which tissue similar to the tissue that
normally lines the inside of your uterus — the endometrium — grows outside your uterus.
Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis
ovaries, fallopian tubes, and the tissue linning you pelvis
Pelvic Inflammatory Disease
What is it?
What are the common S+S?
an infection of a woman’s reproductive organs
It is a complication often caused by some STD’s like chlamydia and gonorrhea.
Other infections that are not sexually transmitted can cause this
Pain in your lower abdomen
Fever
An unusual discharge with a bad odor from your vagina
Pain and/or bleeding when you have sex
Burning sensation when you urinate
Bleeding between periods
Prostatits
What is it?
Acute Bacterial Prostatitis
Chronic Prostatitis
Chronic Pelvic Pain Syndrome
Asymptomatic Inflammatory Prostatitis
Testicular Issues
What are the top 6 DDX?
Testicular Torsion
Testicular Masses
Testicular Trauma
Orchitis
Epididymitis
Fournier’s Gangrene
- Risk Sepsis
Orchiectomy - removal of 1 or both testicles
Why/When is it performed?
Prostate cancer (procedure prevents it from spreading)
Testicular cancer and breast cancer in men
A medical condition of the male reproductive
organs (such as testicular torsion)
Cancer prevention
Treatment of an undescended testicle after
puberty
Severe trauma (to the testicle)
Male-to-female gender reassignment surgery
Phismosis - Paraphimosis
What is it?
What is phumosis?
Paraphimosis is a condition that only affects uncircumcised males. It develops when the foreskin can no longer be pulled forward over the tip of the penis.
This causes the foreskin to become swollen and stuck, which may slow or stop the flow of blood to the tip of the penis.
Paraphimosis shouldn’t be confused with phimosis.
a condition in which the foreskin can no longer be pulled back from the tip of the penis - usually occuring in younger children
Priapism
What’s the max amount of time until it’s ER? What are the causes?
4h
Spinal Chord Injury
Erectile Dysfunction Rx
Antidepressants
Antipsychotics
Anticoagulants
Antihypertensives
Cocaine, Marijuana
Sickle Cell Disease
Leukemia
Renal Trauma
What is it?
When the kidney is damaged from an outside source
Shiv/Shank
Where is the target location?
Lower back/kidney area
Liver
Ruptured Bladder
Tell me what you know
Blunt force trauma most
common
Mechanism usually MVC
Full Bladder increases injury
rates
80% associated with pelvic
fracture
Common in pediatrics due to
height of seatbelt/area
compressed
Abuse
What should you consider/look out for?
Living Conditions
History that does not make sense
Person refusing to let the patient answer questions
Sexual Assault
Sex Trafficking
Children’s Aid Society Notification
Notification of Police to attend
scene (be discrete)
Show me differentials for all 9 quadrants of the abdominal cavity
Show me the organs than lie in the abdominal cavity
Show me sites of pain on the body that relate to abdominal pain - suspected issue/disease
Bowel Sounds
What’s the pitch and frequency of NORMAL BOWEL sounds?
What’s the pitch and frequency for ileus?
What’s the pitch and frequency of an obstruction?
Low-pitched gurgling
Every 5-10sec (veries per person)
None
None
High-pitched increased volume
Increased frequency (so more than every 5-10sec)
Food Poisoning
What are the common signs and symptoms?
Bloody Diarrhea and/or diarrhea that lasts more than 3 days
High Fever
Frequent vomiting that prevents keeping liquids in
Signs of dehydration - little to no urination, dry mouth/throat, and feeling dizzy when standing up
Lectins
What are they? What do they contribute to?
What food have the highest content of lectins?
Sugar-binding proteins (can agglutinate becoming problematic for health)
The development of diseases such as celiac disease, autoimmune disease, rheumatoid arthritis, obesity, cardiovascular disease, and type 2 diabetes
Grain
Legumes
Nightshades
Vegtables - tomatoes, potatoes, goji berries
FOOD MAP (what does it stand for/what does it mean)?
What are the symptoms/side affects?
Fermentable oligosaccharides
Disaccharides
Monosccharides
Polyols
(all are short-chain carbohdrates i.e. food you might eat)
Cramping
Diarrhea
Constipation
Stomach bloating
Gas and flatulence
Lactose Intolerant / Lactose Malabsorption
What’s (patho) wrong with these people?
What are the symptoms? When do they occur?
They are unable to fully digest the sugar (lactose) in dairy products. It’s usually harmless but do come with uncomfartable symptoms.
30min - 2h from the ingestion of said dairy prodcut
Diarrhea
Nausea, and sometimes, vomiting
Stomach cramps
Bloating
Gas
SIBO - Small intestinal bacterial overgrowth
What is it? What happens?
Symptoms?
When does it occur?
Also called BLIND LOOP SYNDROME - it’s when there is an abnormal increase in the overall bacterial population in the small intestine — particularly types of bacteria not commonly found in that part of the digestive tract
when something slows the passage of food and waste prodcuts in the digestive tract - a breeding ground for bacteria
SIBO
What are the most common sings and symptoms?
Loss of appetite
Abdominal pain
Nausea
Bloating
An uncomfortable feeling of fullness after eating
Diarrhea
Unintentional weight loss
Malnutrition
What are the top differentials for diarrhea?
Dehydration
Electrolyte Imbalance
Shock
Hypovolemia
Sepsis
Gastroenteritis
What is it?
What are the common signs and symptoms?
inflammation of the stomach and intestines. A virus, bacterium, or parasite can cause gastroenteritis. When it’s caused by a type of bacteria, it’s called bacterial gastroenteritis
Fever
Vomiting
Decreased appetite
Diarrhea
Chills
Nausea
C.Difficile (CDI)
What is it? What does it do?
It’s a germ that causes diarrhea and colitis
What’s the TOP 9 DDX for the life threats of abdominal pain?
Cardiac Event – Epigastric region
Ruptured / Dissecting AAA
Ruptured Ectopic Pregnancy (age and body parts)
Mesenteric Ischemia (10% mortality)
Mesenteric Infarction (85% mortality)
Bowel Obstruction
Bowel Perforation
Pancreatitis
Cholangitis
Perforated Diverticulitis
Upper Gastrointestinal Bleeding
Describe the following words?
Hematemsis
Hematochezia
Melena
Coffee Grounds Emesis
Hematemsis - vomiting blood
Hematochezia - fresh blood via the anus
Melena - black/tary stool
Coffee Grounds Emesis - vomit that looks like coffee grounds
Upper GI Bleeding
What are the top differentials?
Peptic Ulcer Disease
Gastric lining erosion (NSAID use / Alcohol)
Esophageal Varices
Mallory-Weiss tears
Esophagitis
Duodenitis
Show me Mallory-Weiss Tear / Boerhaave Syndrome
What’s the most common cause of esophageal varices?
What are the symptoms?
Scarring of the liver
unusually pale skin
ongoing tiredness
shortness of breath
faintness or dizziness
black or tarry stools
dark or bright red blood in stool
bright red blood in vomit
Lower GI Bleeding
What’s the most common cause?
What are other differentials?
Diverticulitis/diverticulosis
Angiodysplasia (abnormal dilated sm blood vessel in GI)
Cancer / Polyps
Rectal Disease
Inflammatory Bowel Disease
Mesenteric infarction
Aortoenteric Fistula (Graft after repair AAA)
What is the #1 cause of peptic ulcer disease?
Helicobacter Pylori
What are the top differentials for liver disease?
Viral Hepatitis
Drug Induced Hepatitis
Cirrhosis
Sepsis
Billiary Obstruction (stone, tumour, infection)
Hepatitis
What are the types?
4
What are the types of viral hepatitis?
Viral Hepatitis
Toxic Hepatitis
Alcoholic Hepatitis
Non-alcoholic Fatty Liver Disease
A = Fecal oral transmission, jaundice, diarrhea, recent travel
B = IV drug use, contaminated food / sharing, sexual transmission
C = IV drug use, blood transfusion, increased incidence with HIV patients
D, E,G
Ascities
What is it?
What’s difficult about having ascites?
accumulation of excess fluid in the abdomen, which is a key complication of liver cirrhosis (“liver ascites”) and is also caused by certain late-stage cancers (“malignant ascites”).
Eating, moving, breathing, and sleeping
Hepatic Encephalopathy
What is it?
Is it short or long term?
What happens?
an impairment of brain functions that occurs due to liver diseases.
Can be either
the liver fails to properly clear the toxins from the blood, which keeps accumulating, and the toxins in the bloodstream increase, ultimately reaching the brain.
This buildup of toxins damages the brain’s functioning, and if untreated, the person can slip into a coma as the brain becomes unresponsive.
What’s the #1 cause of liver failure worldwide AND in north america?
Hepatitis A & E
Acetaminophen Hepatotoxicity
What’s the Toxic single dose of acetaminophen in adults AND children?
What’s in a bottle?
Adults Toxic Single Dose = 7.5-10 grams
Children Toxic Single Dose = 150mg/kg
325 mg / 100 tablets in a bottle = 32,500 mg / 32.5 grams
Acute Cholecysitis - gallbladder
What are the top differentials?
Stones
Biliary colic - not inflammed but comes with pain and vomiting
Cholecystitis - comes with pain, vomiting, inflammation, and fever.
Hemorrhoids
Show me the internal grades
Perforated Bowel
Show me the common causes by section of the bowel
Toxic Megacolon
When does it occur/what is it?
What happens/the complications?
occurs when inflammatory bowel diseases cause the colon to expand, dilate, and distend.
the colon is unable to remove gas or feces from the body. If gas and feces build up in the colon, your large intestine may eventually rupture. Rupture of your colon is life-threatening.
Hernias
What are the 2 main types and how’s the blood supply?
Incarcerated - has blood supply, obstructs the intestinal flow, and CAN’T be reduced
Strangulated - blood supply is compromised and intestinal flow is obstructed
Bowel obstructions
What are the top causes for small bowel obstruction?
Large bowel obstruction
Precious surgery - adhesions
Incarcerated Hernias
Cancer
Intissusception
What are the sigs and symptoms?
part of the intestine slides into an adjacent part of the intestine
sudden loud crying caused by abdominal pain
Stool mixed with blood and mucus - jelly stool
Vomiting
A lump in the abdomen
Weakness or lack of energy
Diarrhea
Show me inflammatory bowel diseases vs a healthy bowel
Volvulus
What is it?
What can happen?
when a portion of the digestive system loops around and folds over itself.
may cut off blood supply causing extreme pain, discomfort, bloody stool, cramps, bloating, and obstruction of the bowel making it difficult to have a bowel movement, or necrosis of the bowel
Ascending Cholengitis
What is it?
What’s the charcot’s triad (for DDX)?
An infection thoughout the biliary tree
Jaundice
Fever
RUQ pain
Pancreatitis - epigastric pain
What are the top 5 DDX?
Alcohol
Gallstones
Tumors
Abdominal Trauma
Infections
Peritonitis
What is it?
What’s the cause? - life threatening?
redness and swelling (inflammation) of the lining of your belly or abdomen. This lining is called the peritoneum
Infection (bacteria or fungal) from a hole in the bowel or a burst appendix
If it gets into the blood it will cause sepsis
Spontaneous Bacterial Peritonitis
What is it? what’s the mortality rate?
What the triad differntial?
An acute infection of the ascitic fluid in a pt with liver disease
50%
Fever
Abdominal Pain
Increasing Ascities
What is Ileus?
What are the causes and complications?
Diagnosis is made by x-ray. it is a temporary lack of the normal muscle contractions of the intestines.
Abdominal surgery and drugs
Bloating, vomiting, constipation, cramps, and loss of appetite occur.
Show and explain to me the 3 signs of appendicitis
