Scribe America Day 2 Review

Arterial Blood Gas (ABG or VBG) showing low pH(acidosis) or positive serum ketones

How can diabetic ketoacidosis (DKA) be diagnosed?

effects are transient and condition proves rapidly

How does a TIA differ from a CVA?

EKG

How is A-Fib diagnosed?

AMS is generalized and caused by things that affect the whole brain

How is AMS different from a focal neuro deficit?

cardiac catheterization (not done in ED)

How is CAD diagnosed?

heme positive stool (guaiac positive)

How is GI bleed diagnosed in ED?

CXR

How is PNA diagnosed?

CXR

How is PTX diagnosed?

CT A/P with PO contrast/ Acute Abdominal series (AAS)

How is SBO diagnosed?

urine dip or urinalysis (nitrite, WBC and bacteria in urine)

How is a UTI diagnosed?

it has fluctuance (underlying collection of pus)

How is abscess different from cellulitis?

CT A/P with PO contrast

How is appendicitis diagnosed?

US pelvis to determine location of the fetus

How is ectopic pregnancy diagnosed?

clinically, potentially normal CT Head

How is ischemic CVA diagnosed?

US pelvis to assess blood flow to the ovaries

How is ovarian torsion diagnosed?

elevated lipase lab test

How is pancreatitis diagnosed?

...

Name 3 important things to document for any trauma patient?

EKG (STEMI) or elevated troponin (non-STEMI)

Two ways a MI can be diagnosed

CXR or elevated BNP (B-type natriuretic peptide)

What 2 studies diagnose CHF?

what happened prior, during and after syncopal episode and how patient currently feels.

What are 4 important things to document for syncopal episodes?

extremity pain and swelling

What are common signs of DVT?

CAD, HTN, HLD, DM, smoker, FHx of CAD < 55yrs

What are the "cardiac risk factors"?

headache, fever, neck pain/stiffness

What are the 3 symptoms of meningitis?

HTN, HLD, DM, Hx TIA/CVA, smoking, FHx CVA, A-Fib

What are the Risk factors for Ischemic CVA?

swelling, itching (pruitis) and rash

What are the only 3 symptoms of a true allergic reaction?

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

What are the risk factors for a DVT?

...

What are we worried about for someone with a GI bleed?

SOB or pleuritic chest pain (CP worse with deep breaths)

What could be the CC of someone with a PE?

helps break down food; gallbladder

What does bile do? Where is it stored?

palpitations (fast, pounding, irregular)

What does ptatient feel with A-Fib?

atrial fibrillation (electrical abnormalities in "wiring" of the heart

What is A-Fib?

constricting of the airway due to inflammation and muscular contraction of the bronchioles, "bronchospasm"

What is Asthma?

Coronary artery disease

What is CAD?

deep vein thrombosis: blood clot in an extremity (usually in calf)

What is DVT?

twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting infarct of the ovary

What is Ovarian Torsion?

Pneumonia (infiltrate (bacterial infection) and inflammation inside the lung

What is PNA?

Pneumothorax (collapsed lung)

What is a PTX?

transient ischemic attack (vascular changes temporarily deprive a part of the brain of oxygen- symptoms typically last less than an hour)

What is a TIA?

Urinary Tract Infections (in bladder or urethra)

What is a UTI?

Abdominal Aortic Aneurysm: widened and weakened arterial wall at risk of rupture

What is an AAA?

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

What is an aortic dissection?

tubal pregnancy, fertilized egg develops outside the uterus

What is an ectopic pregnancy?

pyelonephritis (infection of the tissue in the kidney's, usually spread from UT)

What is pyelo?

medical clearance; determining the patient is not medically ill

What is the Emergency Physician's main responsibility for psychiatric patients?

trauma (MVA/MCA)

What is the most common cause of PTX?

anaphylaxis or respiratory failure

What is the pain concern with an allergic reaction?

diverticulosis

What is the pre-existing condition you must have before you can get diverticulitis?

post-Ictal

What is the state after a seizure?

SOB or productive cough with fever

What might a person with PNA complain of?

abdominal pain, vomiting, no BM's, distension, bloating

What might a person with SBO complain of?

flank pain with sudden onset radiating to groin; hematuria, N/V, unable to void

What might a person with kidney stones complain of?

epigastric pain (burning improves with antacids)

What might someone with GERD complain of?

angina, MI, CABG, cardiac stents, angioplasty

What other past histories would suggest that a patient has CAD?

arteries

What part of the heard oes CAD affect?

wheezing

What physical exam finding closely associates with asthma?

Murphy's sign

What physical exam finding is closely associated with cholecystitis?

incision and drainage

What procedure will be performed for every abscess?

smoking

What social history do most COPD patietns also have?

CT A/P with PO contrast

What studies would diagnose diverticulitis?

CTA chest (CT chest with IV contrast) or VQ scan

What study would diagnose PE?

CT head or LP

What study would diagnose a bleed?

headache with sudden unset (thunderclap); changes in speech, vision, sensation, motor strength; AMS, seizure

What symptoms might a person with a brain bleed complain of?

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

What symptoms might a person with an ischemic CVA complain of?

dysuria

What will be the CC of someone with a UTI?

LLQ pain

What would be the CC for someone with diverticulitis?

LP

What would diagnose meningitis?

LUQ, epigastric pain

What would someone with pancreatitis complain of?

hemorrhagic and ischemic

2 types of CVA's?

red, swollen, painful, and sometimes warm area of skin

3 symptoms of cellulitis?

hematemesis, coffee ground emesis, hematochezia, melena

4 CC's for a GI bleed patient?

hypoglycemia, infection, intoxication, and neurological

4 causes of altered mental status?

epigastrium, RUQ, LUQ, periumbilical, RLQ, LLQ, Suprapubic

7 areas of the abdomen

SOB with pedal edema and orthopnea

Associated Symptoms for CHF

diaphoresis, N/V, and SOB

Associated symptoms of an MI other than CP?

decreased appetite, fever, N/V

Associated symptoms of appendicitis

no because you wouldn't be able to distinguish the clot

Can a CT chest without IV contrast diagnose a PE?

abdominal US, RUQ

How are gallstones diagnosed?

CT Abd/Pelvis; RBC in UA may be clue

How are kidney stones diagnosed?

a gallstone vs inflammation of the gallbladder

Difference between cholelithiasis and cholecystitis?

hand device vs machine

Difference between inhaler and nebulizer?

no

Does a PMHx of CVA mean the patient has CAD?

yes

Does a surgical history of angioplasty mean that the patient has CAD?

CAD is chronic and MI is acute

Explain the difference between CAD and MI

MI

For older patients with GERD symptoms, what life threatening disease must be ruled out?

no

If someone has a PMHx of A-Fib or CHF do they also have CAD?

Acid Reflux

Layman's term for GERD?

known DVT, PMHx of DVT or PE, FHx, recent surgery, cancer, A-fib, immobility, pregnancy, BCP, smoking

Risk factors for PE?

flanks

Where would a patient feel pain if they have pyelo?

febrile seizures

what is a common cause for seizures in children?

sharp RUQ pain , worse with eating, d breaths and palpation

what might be the chief complaint of a person with gallstones?