Quiz #2

Past Hx

Results/ED course

ED course

Diagnoses and Disposition

HPI focuses on the details related to their chief complaint, ROS is a head to toe checklist of Sx including the CC, associated Sx, and other

Cholecystectomy

Erythema

Ecchymosis

Differential diagnosis: diseases under consideration

specific Sx that raise or lower suspicions for a particular disease

ordered by the physician if they have strong suspicions about a certain disease so that they can diagnose or rule out (PE findings also r/o)

subjective complaint, DDx, physical exam and orders, final Dx

phrase: CP with physical exertion Dx by cardiac catheterization-not in ED)

greatest risk factor for MI, stress tests/cardiac catheterization asses severity, CAD=Hx of angina, MI, CABG, always give aspirin

phrase: Chest pressure with diaphoresis, n/v and SOB CC: cp/pressure Risk: CAD, Dx by EKG or elevated troponin

acute MI patients must receive aspirin asap, STEMI patients must get to cath-lab within 90 mins. Doc arrival/depart time

phrase: SOB w. pedal edema and orthopnea CC: SOB, worse lying flat, paroxysmal nocturnal dyspnea PND, dyspnea on exertion DOE

think of CHF as a fluid traffic jam in the heart-fluid gets backed up in the neck (JVD) and downthe legs (pedal edema)

CC: palpitations PE: irregular rhythm, tachycardia Dx: EKG Meds: blood thinner

ED concern is rapid ventricular response (RVR) PT will often by cardioverted aka put back into regular rhythm known as Normal sinus rhythm

inflammation of the sac surrounding the heart causing CP

inflammation of the sac surrounding the lungs causing pleuritic CP

irritation of the ribs causing CP worsened by pressing on the sternum

irritation of the chest wall causing pain with palpation of the chest

fluid collecting around the lungs causing SOB or CP

phrase: pleuritic cp with tachycardia/hypoxia CC: SOB or pleuritic cp (CP worsens with deep breaths) Dx: CTA chest, VQ scan, d-dimer)

phrase: productive cough with fever CC: SOB or productive cough PE: rhonchi Dx: CXR

CAP protocol applies to PNA, document Abx, vital signs, Sao2, mental status, blood cultures

CC: SOB and one-sided CP Dx: CXR

document the percentage lung collapsed (ex. 20% PTX) PTs will have a chest tube placed to reinflate the lung

CC: SOB PE: decreased breath sounds, wheezes, rales Dx: CXR and hx of smoking

CC: SOB/Wheezing PE: wheezing Dx: clinically

physician will ask: nebulizer? steroids? hospitalized for asthma? hx of intubation? asthma triggers?

CC: one-sided weakness/numbness/changes in speech/vision PE: hemiparesis,paresthesias, aphasia, visual deficits Dx: clinically

always document the date/time they were "last known well"-used to assess the eligibility for IPA-blood thinner reverse CVA

CC: extreme HA Sx: changes in speech, vision, sensation, motor strength, ams, seizure, HA PE: unilateral neuro deficits Dx: CT head/LP

document "tPA not indicated due to hemorrhage"

CC: transient focal neuro deficit, changes in speech vision strength or sensation Dx: clinically

Also known as mini-strokes because Sx last < 1 grand no permanent brain damage. doc tPA considered and not indicated due to sx resolved

CC: HA and neck pain Sx: fever, neck pain, neck stiffness, AMS PE: meningismus, nuchal rigidity Dx: lumbar puncture

CC: neck/back pain, bilateral extremity weakness Dx: CT cervical spine CT thoracic spine CT lumbar spine

remember that during the initial PE the spine is often immobilized with a C-collar and backboard, doc accordingly

CC: seizure activity, syncope Sx: injuries, confusion, HA, incontinence PE: somnolent, confused postictal

Physician will ask: hx of seizures? date of last seizure? what seizure med.? missed med. doses? how do they feel before, during, after, now?

CC: facial droop, sudden onset Sx: jaw/ear pain, increased tear flow PE: unilateral weakness of the face Dx: clinically

most common cause of facial droop in young PTs, who do not have CVA risk

CC: confusion, decreased responsiveness, unresponsive Dx: case dependent

ams is different than a focal euro. typically caused by things that affect the wholebrain (drugs, low BS) com. cause is infection

document what happened prior, during, and after the syncopal episode as well as how the PT currently feels

CC: RLQ pain, gradual onset, constant, worse with move. PE: mcburney's point tenderness, fever Dx: CT A/P with PO contrast

CC: ab. pain, vomiting, constipation PE: abd tenderness, guarding, rebound, etc Dx: CT A/P with PO contrast, Acute abdominal series AAS

Phrase: RUQ abd pain after eating fatty food CC: RUQ pain sharp, worse with eating/deep breath/palpation PE: RUQ tenderness DX: and US RUQ

CC: hematemesis, coffee ground emesis, hematochezia, melena PE: pallor, tachycardia, rectal exam, etc Dx: heme pos. stool

ED concern is the need for a possible blood transfusion due to significant blood loss

CC: LLQ pain Sx: nausea, fever, diarrhea Dx: CT A/P with PO contrast

CC: LLQ, epigastric pain PE: LUQ tenderness, epigastric tenderness Dx: elevated lipase lab test

CC: epigastric pain, burning PE: epigastric tenderness

due to the prox. of the stomach to the heart, PTs with cardiac risk factors/epigastric pain will always get cardiac workup

CC: dysuria PE: suprapubic tenderness Dx: urine drip or urinalysis

CC: flank pain with dysuria PE: costs-vertebral angle tenderness Dx: CT abd/pel without contrast of confirmed UTI with tenderness on exam

CC: flank pain, sudden onset, radiating to groin PE: tenderness Dx: CT abd/pelvis

CC: lower abd pain or vag. bleeding while pregnant Dx: US pelvis, determine location of fetus

any females with pos. pregnancy test who is complaint of lower abd pain/bleeding will always received an US pelvis to r/o possible ectopic

CC: lower abd pain RLQ/LLQ PE: adnexal tenderness Dx: US pelvis assess blood flow to ovaries

ovarian and testicular torsion are very time sensitive due to risk of losing an ovary or testicle. doc. accurate times

CC: testicular pain PE: testicular tenderness and swelling Dx: US scrotum

CC: cough/congestion PE: rhinorrhea, boggy turbinates, pharyngeal erythema Dx: clinically

pay attn to complaints of CP, SOB for uri patients. always be careful to describe the sx accurately so it doesn't seem like MI or PE

CC: ear pain PE: erythema, effusion, dullness, bulging of the tympanic membrane Dx: clinically

CC: sore throat PE: pharyngeal erythema, tonsillar hypertrophy, tonsillar exudates Dx: rapid strep

strep throat is bacterial so Abx, biggest concern is peri-tonsillar abscess (sign: uvular shift/tonsillar asymmetry)

cc: eye redness, irritation, pain PE: conjunctival injection, edema, exudates DX: clinically

CC: nose bled PE: anterior/posterior/ septal source of the bleeding dx: clinically

nose bleed that don't stop are often cauterized pt on blood thinners will have coagulation labs drawn to make sure their blood isn't too thi

CC: back pain PE: paraspinal tenderness, positive st. leg raise, sciatica

remember to doc if there is any recent trauma related to the back pain, trauma increases concern of spinal injury

remember to document a splint application procedure note

CC: midline abd pain PE: midline pulsatile abd mass, abd bruit, unequal femoral pulses, hypotension Dx: CT A/P w IV contrast dye

CC: CP radiating to the back, ripping/tearing PE: unequal brachial/radial pulses, hypotension DX: CT chest with IV contrast dye

C: extremity pain/ swelling PE: calf tenderness, cords DX: US/Doppler of the extremity

CC: red, swollen, painful, sometimes warm area of skin PE: erythema, edema, increased warmth, induration Dx: clinically

CC: red, swollen, painful lump PE: fluctuant, induration, purulent drainage Dx: clinically

must have the pus-pocket drained. remember to doc incision and drainage procedure notes

CC: rash, swelling, itching, SOB PE: edema, facial angloedema, urticaria (hives, wheals) Dx: clinically

ED concern is anaphylaxis or respiratory failure

cc: persistent vomiting with hx of DM PE: ketotic odor, dry mucous membranes, tachypnea Dx: positive serum keytones

pay attn to differentiating between medical and psychiatric complaints. ER scribe the main concern is medical clearance. then pt can go psyc

neuro injury: LOC confusion numbness weakness HA neck/back pain Internal organ injury: SOB CP ABD pain