Download Assessment Based Management

Assessment Based
Management
(WHAT?)
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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)
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Information
• History, history, history
• Exam
– Physical
– Emotional
– Environmental
• Diagnosis (working/field)
• Re-examine
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Complications
• Environment
• Preconceived ideas
• Prejudice
• Others opinions
• Distracting injuries/issues
• Safety considerations
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Count off by 4s
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1. Shortness of Breath
2. Altered Mental Status
3. Abdominal Pain
4. Chest Pain
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Asthma
COPD Pneumonia
Emphysema
Bronchitis
Pneumothorax
Hemothorax
Pulmonary Embolism
MI
Congestive Heart Failure
Pulmonary Edema
Anaphylaxis
SOB
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Cystic Fibrosis
Bronchiolitis
Adenocarcinoma of the lung
Amyotrophic Lateral sclerosis
Pulmonary Hamartoma
Mesothelioma
Myasthenia Gravis
Pulmonary Arterial Hypertension
Sucking Chest Injury
Flail Chest
SOB
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• Pulmonary Contusion
• Influenza viruses
• ARDS (Acute Respiratory Distress
Syndrome)
• Croup
• Epiglottis
• RSV (Respiratory Syncytial Virus)
• Tuberculosis
• Respiratory Distress Syndrome
• Adenoviruses
• Atelectasis
SOB
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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
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• Trauma
• Decreased O2
SOB
• Running
• Scared
• Hurt (pain)
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Drug toxicity/Overdose
Metabolic
Structural
Infectious
Psychiatric
Endocrine
Pulmonary
Oncologic
Cardiovascular
GI
Renal
AMS
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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
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• 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
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• 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)
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• 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
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CHEST PAIN
• Acute coronary syndrome
– Angina
– Myocardial infarction
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Aortic dissection
Pulmonary embolism
Pneumonia
Hemothorax
Pneumothorax
Tension pneumothorax
Arrhythmia
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Carbon Monoxide
Sarcoidosis
Lead Poisoning
Upper gastrointestinal ailments, for example:
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Problems of outer chest structures
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Costochondritis
Spinal nerve problem
Fibromyalgia
Chest wall problems and breast conditions
Herpes zoster (shingles)
Psychological
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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
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