ED Course 2: Pathophysiology

Key Symptoms of CAD

Exertional CP and SOB; improved with NTG and rest

Key Symptoms of MI

exertional CP/pressure and SOB, Nausea/vomiting, and Diaphoresis (sweating)

Define Coronary Artery Disease

Plaque build up to the coronary arteries, leading to poor blood flow to the heart and can cause chronic chest pain (Angina)

Define Myocardial Infarction

Heart muscle tissue death caused by a blockage of a coronary artery.

What diseases make up the "Triple threat"?

DM, HTN, HLD

Key Symptoms of CHF

SOB, orthopnea (SOB worse with lying down and at night) with bilateral leg swelling

Key symptom of AFib

palpitations

Key symptoms of PE

pleuritic CP (worse with deep breathing) and SOB

Key symptoms of COPD

Chronic SOB, wheezing, cough and Chest tightness, worse when sick and over progressive

Key symptoms of Asthma

attacks of SOB, cough, wheezing and chest tightness when triggered and then improved with breath treatments

Key symptoms of PNA

Productive cough, fever, SOB, CP

Define Focal neurological deficits

One area of the brain dysfunctioning leading to specific loss of functions throughout the body such as one sided weakness/numbness, speech and visual issues, loss of coordination

Key symptoms of Ischemic CVA

Focal neurological deficits

Key symptoms of Hemorrhagic CVA

Thunderclap HA, FND

Key symptoms of a TIA

Transient (short-lived) FND

Key symptoms of Meningitis

HA, neck pain/stiffness, fever

Why is NTG given in the ED?

It is a vasodilator. Used to improve blood flow to the heart for CAD and MI

Why is ASA given in the ED?

It is an antiplatelet agent. Used to prevent a blockage in the coronary artery so to prevent an MI.

Some patients also take it daily as a preventative measure.

Why is tPA given?

It is a thrombolytic. It's used to break up the blood clot in the brain during an ischemic stroke

What is the difference between an ischemic CVA and hemorrhagic CVA?

Ischemic CVA is poor blood flow to the brain caused by a clot while hemorrhagic CVA is bleeding in the brain caused by a ruptured blood vessel

What is murphy's sign and what does it indicate?

Specific area of tenderness to the RUQ on abdominal exam indicating cholecystitis

What is mcburney's point sign and what does it indicate?

Specific area of tenderness to the RLQ on the abdominal exam indicating appendicitis

Key symptoms of Cholelithiasis

RUQ pain worse with eating fatty foods

Key symptoms of appendicitis

RLQ pain worse with movement

What condition is characterized by dysuria with frequency and urgency and was found have suprapubic tenderness on exam?

UTI

What condition is characterized by one sided flank pain and hematuria?

Kidney stone (nephrolithiasis/renal calculi)

What condition is characterized by dysuria and flank pain with tenderness to the costovertebral angles?

Pyelonephritis

Define Sepsis

Bacterial infection in the blood causing inflammation throughout the body which can lead to shock and death

Define Abdominal Aortic Aneurysm

Bulge in the aorta within the abdomen region, which can lead to rupture and death

Define Aortic Dissection

Tear in the aortic lining leading to the blood vessel be ripped away from the muscle causing "ripping and tearing" chest pain, which can lead to death

What is the difference between a STEMI and NSTEMI?

NSTEMIs are smaller blockages to the heart leading to a smaller area of tissue death and do not cause any EKG changes while STEMIs are larger blockages leading to large areas of tissue death and will lead to ST elevations on EKG

What condition is characterized by symptoms of fever/AMS with abnormal vitals?

Sepsis

What does a PMHx of DM, HTN, and HLD put you at risk for?

plaque build up issues such as CAD, MI, Ischemic CVA

These risk factors put the patient at higher risk for what condition?

Recent international travel and sick contact/exposure

meningitis

These risk factors put the patient at higher risk for what condition?Anticoagulant use (blood thinners), recent head injury/trauma, HTN

Hemorrhagic CVA

These risk factors put the patient at higher risk for what condition?triple threat, AFib

Ischemic CVA and also TIA

These risk factors put the patient at higher risk for what condition?

CAD, Triple threat, smoking, FHx

MI

This risk factor puts the patient at higher risk for what condition?

Smoking

chronic bronchitis, emphysema, lung cancer, and heart disease can be caused by this

These risk factors put the patient at higher risk for what condition?

recent DVT and clotting factors like long traveling, immobilization, hormone changes

PE

This risk factor puts the patient at higher risk for what condition?Alcoholism

AFib

What do we call LOC, passing out, or fainting?

Syncope

What do we call confusion/decreased responsiveness, unrepsonsive?

Altered mental status

what is Mechanism of Injury and why is it important?

Documentation for traumas about how the patient was injured to help us determine the severity of injury

What is Glasgow Coma scale?

Scale from 3-15 that measures a patient's responsiveness on exam used to documentation for trauma

Why do we document blood thinner use for traumas?

It helps us determine risk of internal bleeding

Define cellulitis

Skin cell infection

Define abscess

Skin infection with collection of underlying pus

Pertinent positive/ associated symptoms

Symptoms the patient does have that raises suspicion for certain diagnoses

Pertinent negatives

Symptoms the patient does NOT have that lowers suspicion for certain diagnosis

Risk factors for CAD/MI

Past Medical Hx: CAD/MI, HTN, HLD, DM

Family Hx: CAD/MI <55 years old

Social Hx: Smoking

Risk factors for PE

Past Medical Hx: Known DVT, previous DVT or PE. Afib

Social Hx: Smoking

Other: recent surgery, cancer, pregnancy, birth control pills or other hormone replacement meds

Risk Factors for ischemic stroke

Past Medical Hx: TIA/CVA, Afib, HTN, HLD, DM

Family Hx: CVA

Social Hx: Smoking

Risk Factors for hemorrhagic stroke

Recent head trauma

Use of anticoagulants

Uncontrolled HTN

True or false: A patient had a heart attack requiring cardiac stents in 2014. This means they have CAD.

TRUE

2 types of MI :

STEMI and NON-STEMI

Patient takes lasix 40 mg BID (Twice daily). This means they likely have a history of

CHF

Coumadin is a(n) _______

Blood thinner / anticoagulant

How does your provider diagnose Afib?

EKG / ECG

Define angina

chest pain due to coronary artery disease

Treatment of bacterial pneumonia

antibiotics

Treatment of COPD

bronchodilators, supplemental oxygen, corticosteroids, potentially ventilatory support

Classic symptoms of meningitis

neck pain/stiffness, headache, fever, AMS

What is a common cause of AMS in elderly patients?

UTI

Define dysuria

painful urination

Define hematuria

blood in the urine

Define diaphoresis

sweating

True or false: the chief complaint of back pain is almost always benign.

True

Symptoms of AAA

midline abdominal pain

Symptoms of aortic aneurysm

ripping / tearing chest pain that may radiate into the back

If a patient has certain confirmed past medical or surgical histories, it means they have coronary artery diseases. Name 2 or more of these histories

Angina

MI

CABG

Cardiac stents or angioplasty