Quiz #2 detailed

narrowing of the coronary arteries limits blood supply to the heart muscle causing angina

Chest pain with physical exertion

chest pain/pressure worse with exertion, improved by rest of NTG

cardiac catheterization (not diagnosed in ED)

greatest risk factor for MI, stress tests/cardiac cauterization assess severity, PT has CAD if pmhx of angina, mi, cabg, stents, angioplasty

acute blockage of the coronary arteries results in ischemia and infarct of the heart

chest pressure with diaphoresis, n/v, and SOB

CAD, HTN, HLD, DM, Smoker, Fhx of CAD < 55 y/o

Chest pain/pressure

EKG or elevated troponin

acute MI PTs must receive aspirin asap, stemi PTs must get to cath-lab within 90 minutes of arrival. Doc arrival/depart times

the heart becomes enlarged, inefficient, and congested with excess fluid

SOB with pedal edema and orthopnea

SOB, worse with lying flat (orthopnea) paroxysmal nocturnal dyspnea (PND) dyspnea on exertion

rales, jugular vein distension in neck, pitting pedal edema

CXR or elevated BNP

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

electrical abnormalities in the writing of the heart causes the top of the heart to quiver abnormally

palpitations

paroxysmal AFIB, chronic AFIB

irregularly irregular rhythm, tachycardia

EKG

ED concern is rapid ventricular response RVR. PTS will often be cardioverted which means they are put back into regular sinus rhythm

a blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs

pleuritic chest pain with tachycardia and hypoxia

known DVT, pmhx of dvt or pe, fhx, recent surgery, CA, AFIB, immobility, pregnancy, BCP, smoking

SOB or pleuritic CP that worsens with deep breaths

CTA chest, or VQ scan (d-dimer aids in detecting clots but can't diagnose PE)

productive cough with a fever

elderly, ridden, recent chest injury, recent surgery

SOB or productive cough

cough with sputum, fever, CP

rhonchi

CXR

pneumonia protocol applies--protocol requires documenting ABS, vital signs, Sa02, mental status, blood cultures

collapsed lung due to trauma or a spontaneous small rupture of the lung

Sob and one sided CP

absent breath sounds unilaterally

CXR

document the percentage of lung collapsed. PTs will have tube inserted to reinflate the lung

long-term damage to the lung's alveoli (emphysema) along w/ inflammation and mucous production (chronic bronchitis)

smoking

SOB

decreased breath sounds, wheezes, rales

CXR and history of smoking

constricting of the airway due to inflammation and muscular contraction of the bronchiole know as a bronchospasm

Sob/wheezing--improved by nebulizer treatments

wheezes

clinically

physician will ask home nebulizer? steroids? hx of hospital for asthma? hx of intubation? asthmas triggers?

blockage of the arteries supplying blood to the brain resulting in permanent brain damage

unilateral focal neurological deficits: one-sided weakness/numbness or changes in speech/vision

HTN, HLD, Dm, hx of TIA/CVA, smoking, fhx, cva, AFIB

neurological deficits: hemiparesis, unilateral paresthesias, aphasia, visual field deficits

Clinically

always document date/time of "last known well." this is used to evaluate eligibility to tPA, a blood thinner that can reverse a CVA

traumatic or spontaneous rupture of blood vessels in the head leads t bleeding in the brain

HA, sudden onset, worst ever

changes in speech, vision, sensation, motor strength, AMS, seizure, HA

unilateral neurological deficits

CT head or LP

document tPA not indicated due to hemorrhage

vascular changes temporarily deprive a part of the brain of oxygen (usually last less than 1 hr)

transient focal neurological deficit, changes in speech, vision, strength, or sensation

clinically

known as mini strokes, document tPA considered and not indicated due to sx resolving

HA and neck pain

fever, neck pain, neck stiffness, AMS

meningismus, nuchal rigidity

lumbar puncture LP

neck/back pain, bilateral extremity weakness

midline bony tenderness, deformities, bilateral extremity weakness, numbness, decreased rectal tone

Ct cervical spine, CT thoracic spine, CT lumbar spine (depending on where the injury is)

remember to document use of C-collar and backboard

tongue bite, confusion, HA, incontinence

somnolent, confused

physician will ask sz in the past? date of last seizure? what seizure med? missed med dose? how do they feel before, during, after, now?

inflammation or viral infection of the facial nerve causes one-sided weakness of the entire face

facial droop with sudden onset

jaw or ear pain, increased tear flow from one eye

no extremity weakness, no changes in speech/vision

unilateral weakness of the upper and lower face

clinically

bell's palsy is the most common cause of facial droop in young PTs who do not have CVA risk

always document if the HA is similar/dissimilar to any prior HA. never document "worst of life" etc unless specifically instructed by physic

multiple causes, most common are hypoglycemia, infection, intoxication, and neurological

different than focal neuro deficit. AMS is generalized and typically caused by things that affect the whole brain. focal neuro deficits=loca

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

RLQ pain, gradual onset, constant, worse with movement

decreased appetite, fever

mcburney's point tenderness, RLQ tenderness

CT a/p with PO contrast

elderly, infants, abdominal surgery, narcotic pain medication

abd pain, vomiting, constipation

abd distension, bloating, no BMs

abd tenderness, guarding, rebound, abnormal bowel sounds, abd dissension, tympany

CT A/P with PO contrast, Acute ABD series AAS

minerals from the liver's bile condense to form gallstones which can irritate, inflame, or obstruct the gallbladder

RUQ abd pain after eating fatty foods

RUQ pain, sharp, worse with eating/deep breaths, palpation

RUQ tenderness, murphy's sign

ABD US RUQ

hemorrhage in the upper or lower gastrointestinal tract can lead to anemia

hematemesis, coffee ground emesis, hematochezia, melena

generalized weakness, lightheadedness, SOB, abd pain, rectal pain

pale conjunctiva, pillow, tachycardia, rectal exam: melena, grossly bloody stool

heme positive stool during a rectal exam

ED concern is the need for a possible blood transfusion

acute inflammation and infection of abnormal pockets of the large intestine known as diverticuli

advanced age

LLQ pain

nausea, fever, diarrhea

CT A/P with PO contrast

EtOH abuse, cholecystitis, specific medications

LUQ, epigastric pain

LUQ tenderness, epigastric tenderness

elevated lipase lab test or sometimes elevated amylase

stomach acid regurgitating into the esophagus

epigastric pain, burning, improved with antacids

epigastric tenderness

due to proximity of the stomach to the heart, PTs with cardiac risk factors and epigastric pain will receive a cardiac workup

infection of the tissue in the kidneys, usually spread from a UTI

flank pain with dysuria

costo-vertebral angle tenderness

CT abd/pel without contrast or confirmed UTI with tenderness on exam

flank pain, sudden onset, radiating to groin

hematuria, unable to void

CT abd/pelvis

fertilized egg develops outside th uterus, usually in the fallopian tube, high risk for rupture and death

pregnancy, STD

lower abd pain, vaginal bleeding while pregnant

US pelvis

any female with positive pregnancy test comparing of lower ab pain or bleeding will always receive an US pelvis

twisting of an ovarian artery reducing blood flow to an ovary, possible resulting in infarct

lower abd pain, RLQ, LLQ

adnexal tenderness, tenderness in the RLQ, LLQ

US pelvis

time sensitive, document accurate times for PT arrival, US results and consultations

twisting of the spermatic cord resulting in loss of blood flow and nerve function to the testicle

testicular tenderness and swelling

US scrotum

most often viral infection causes congestion, cough, and inflammation or the upper airway

cough/congestion

fever, sore throat, HA, myalgias

rhinorrhea, boggy turbinates, pharyngeal erythema

clinically

pay special attn to complaints of CP/SOB for URI PTs and be careful to describe accurately to not create impression of MI or PE

erythema, effusion, dullness of bulging of the tympanic membrane

pharyngeal erythema, tonsillar hypertrophy, tonsillar exudates

rapid strep

strep is bacterial so ABX will help, biggest concern is the possibility of a peri-tonsillar abscess (signs include uvular shift or assemytry

most bleeds that don't stop are usually cauterized, PTS on blood thinners will have coagulation labs to make sure their blood isn't too thin

remember to document if there is any recent trauma to the back that might increase the physician's concern of spinal injury

remember the majority of extremity injuries will receive some type of splint, remember to document splint application

widened and weakened arterial wall at risk of rupture

midline abd pain

midline pulsatile abdominal mass, abd bruit, unequal femoral pulses, hypotension

CT A/P with IV contrast dye

separation of the muscular wall from the membrane of the artery, putting the PT at risk of aortic rupture and death

CP radiating to the back, ripping or tearing

unequal brachial or radial pulses, hypotension

CT chest with IV contrast dye

blood slows down while flowing through long straight veins in the extremities, slow-flowing blood is more likely. clot will occlude the vein

PMHx of DVT/PE, FHx, recent surgery, cancer, immobility, pregnancy, BCP, smoking, LE trauma, LE casts

extremity pain and swelling, usually located in lower extremity

calf tenderness, cords, homan's sign

US/Doppler of the extremity

must have the pus=pocket drained, remember to document I procedure notes

ED concern is anaphylaxis or respiratory failure

Neurological: LOC, confusion, numbness, weakness, HA, neck/back pain Internal organ: SOB, CP, ABD pain