Approach to the patient
Chapter 2. Approach to the patient The approach to the patient follows scene safety and scene assessment. In trauma cases you will already have information about the patient’s likely injuries…
An introduction to clinical examination
Chapter 3. An introduction to clinical examination Examination will be described in the order used in the standard approach which is a common theme throughout this book – the <C>ABCDE…
I: CARDIOVASCULAR
Adapted from: Wang K, Asinger RW, Marriott H. ST-segment elevation in conditions other than acute myocardial infarction. N Eng J Med. 2003;349:2128–2135. CHEST PAIN Approach Obtain & review an ECG…
XIV: PEDIATRICS
APPENDICITIS Definition • Inflammation of the appendix History • Diffuse/periumbilical pain → localizing to RLQ, anorexia, nausea, vomiting, irritability (may be the only sx in age <2), fever Physical Findings…
IX: ENDOCRINE & METABOLIC
• Step 4a: Is there an anion gap? Anion gap acidosis: (Na – (Cl + bicarb)) > 14 (see chart) Note: Needs to be corrected for albumin; a fall in…
XVIII: TRAUMA
HEAD TRAUMA Background • Leading cause of traumatic death in pts <25 • 80% mild (GCS 14–15), 10% mod (GCS 9–13), 10% severe (GCS <9) injuries • CPP = MAP…
XVI: TOXICOLOGY
History • Timing, quantity of ingestion/exposure, access to household chemicals/other meds, coingestions, enteric-coated/extended-release substances Physical Exam • VS, pupils, skin, neuro findings (AMS, nystagmus, myoclonus, tremor), peristalsis, smell Evaluation •…
X: ENVIRONMENTAL
History • Excessive fluid loss (V/D, sweating, polyuria, diuretic/laxatives, bowel regimen), inadequate intake (debilitated, institutionalized, NM d/o, H&N pathology), altered thirst mechanism (intoxication, systemic illness, malignancy, antipsychotic use) Findings •…
IV: INFECTIOUS DISEASE
ENDOCARDITIS (Arch Intern Med 2009;169(5):463) History • RFs: IVDU, congenital or acquired valvular dz, prosthetic valves, structural heart dz, HD, indwelling venous catheters, cardiac surgery, bacteremia, chronic alcoholism, previous endocarditis…
V: NEUROLOGY
Delirium Definition • Acute state of temporary or fluctuating disturbance of consciousness (eg, impaired cognition, perception disturbances, reduced attention, hypo- or hyperactivity) that is caused by an organic medical condition…
