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Assessment Based Management (WHAT?) 1 What's That Mean? • The approach/assessment of every patient. • Systematic. • Not necessarily “protocol” driven. • Open minded. • Looking at all reasonable possibilities. • Treatable possibilities. • Multitasking (treating as your thinking) 2 Information • History, history, history • Exam – Physical – Emotional – Environmental • Diagnosis (working/field) • Re-examine 3 Complications • Environment • Preconceived ideas • Prejudice • Others opinions • Distracting injuries/issues • Safety considerations 4 Count off by 4s 1. 2. 3. 4. 6 1. Shortness of Breath 2. Altered Mental Status 3. Abdominal Pain 4. Chest Pain 7 • • • • • • • • • • • Asthma COPD Pneumonia Emphysema Bronchitis Pneumothorax Hemothorax Pulmonary Embolism MI Congestive Heart Failure Pulmonary Edema Anaphylaxis SOB 8 • • • • • • • • • • Cystic Fibrosis Bronchiolitis Adenocarcinoma of the lung Amyotrophic Lateral sclerosis Pulmonary Hamartoma Mesothelioma Myasthenia Gravis Pulmonary Arterial Hypertension Sucking Chest Injury Flail Chest SOB 9 • Pulmonary Contusion • Influenza viruses • ARDS (Acute Respiratory Distress Syndrome) • Croup • Epiglottis • RSV (Respiratory Syncytial Virus) • Tuberculosis • Respiratory Distress Syndrome • Adenoviruses • Atelectasis SOB 10 • • • • • • • • • • Asbestosis Flavoring Related Lung Disease Goodpasture’s Syndrome Histoplasmosis Hot Tub Lung Interstitial lung disease Hantavirus Pulmonary Syndrome Silicosis Human Metapneumovirus (HMPV) Radiation Fibrosis SOB 11 • Trauma • Decreased O2 SOB • Running • Scared • Hurt (pain) 46 12 • • • • • • • • • • • Drug toxicity/Overdose Metabolic Structural Infectious Psychiatric Endocrine Pulmonary Oncologic Cardiovascular GI Renal AMS 13 14 Abdominal Pain • Gastrointestinal – Inflammatory: gastroenteritis, appendicitis, gastritis, esophagitis, diverticulitis, Crohn's disease, ulcerative colitis, microscopic colitis – Obstruction: hernia, intussusception, volvulus, post-surgical adhesions, tumours, superior mesenteric artery syndrome, severe constipation – Vascular: embolism, thrombosis, hemorrhage, sickle cell disease, abdominal angina, blood vessel compression (such as celiac artery compression syndrome) – Digestive: peptic ulcer, lactose intolerance, celiac sprue, Jasohnstritis • Bile system – Inflammatory: cholecystitis, cholangitis – Obstruction: cholelithiasis, tumours • Liver – Inflammatory: hepatitis, liver abscess • Pancreatic – Inflammatory: pancreatitis 15 • Renal and urological – Inflammation: pyelonephritis, bladder infection – Obstruction: kidney stones, urolithiasis, Urinary retention, tumours – Vascular: left renal vein entrapment • Gynecological or obstetric – Inflammatory: pelvic inflammatory disease – Mechanical: ovarian torsion – Endocrinological: menstruation, Mittelschmerz – Tumors: endometriosis, fibroids, ovarian cyst, ovarian cancer – Pregnancy: ruptured ectopic pregnancy, threatened abortion 16 • Abdominal wall – muscle strain or trauma – muscular infection – neurogenic pain: herpes zoster, radiculitis in Lyme disease, abdominal cutaneous nerve entrapment syndrome (ACNES), tabes dorsalis • Referred pain – from the thorax: pneumonia, pulmonary embolism, ischemic heart disease, pericarditis – from the spine: radiculitis – From the genitals: testicular torsion • Metabolic disturbance – uremia, diabetic ketoacidosis, porphyria, C1-esterase inhibitor deficiency, adrenal insufficiency,lead poisoning, black widow spider bite, narcotic withdrawal • Blood vessels – aortic dissection, abdominal aortic aneurysm • Immune system – sarcoidosis – vasculitis – familial Mediterranean fever • Idiopathic – irritable bowel syndrome (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent abdominal pain) 17 • Traumatic : – blunt or perforating trauma to the stomach, bowel, spleen, liver, or kidney • Inflammatory : – Infections such as appendicitis, cholecystitis, pancreatitis, pyelonephritis, pelvic inflammatory disease, hepatitis, mesenteric adenitis, or a subdiaphragmatic abscess – Perforation of a peptic ulcer, a diverticulum, or the caecum – Complications of inflammatory bowel disease such as Crohn's disease or ulcerative colitis • Mechanical : – Small bowel obstruction secondary to adhesions caused by previous surgeries, intussusception, hernias, benign or malignant neoplasms – Large bowel obstruction caused by colorectal cancer, inflammatory bowel disease, volvulus, fecal impaction or hernia • Vascular : – occlusive intestinal ischemia, usually caused by thromboembolism of the superior mesenteric artery 105 18 CHEST PAIN • Acute coronary syndrome – Angina – Myocardial infarction • • • • • • • Aortic dissection Pulmonary embolism Pneumonia Hemothorax Pneumothorax Tension pneumothorax Arrhythmia 19 • • • • Carbon Monoxide Sarcoidosis Lead Poisoning Upper gastrointestinal ailments, for example: – – – – • Problems of outer chest structures – – – – – • Costochondritis Spinal nerve problem Fibromyalgia Chest wall problems and breast conditions Herpes zoster (shingles) Psychological – – – – – • • • • • Gastroesophageal reflux disease (GERD) Hiatus hernia Disorders of the esophagus Functional Dyspepsia Panic attack Anxiety Clinical depression Somatization disorder Hypochondria Hyperventilation Da costa's syndrome Bornholm disease Precordial catch syndrome Pleurisy 31 20