Differential Diagnosis based on Chief Complaint

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mac519
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274154
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Differential Diagnosis based on Chief Complaint
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2014-05-15 10:30:09
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Paramedic Diagnosis
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Differential Diagnosis
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  1. Causes
    - obstruction
    - viral or bacterial infection
    Appendicitis (causes)
  2. Important History
    - The classic Hx of anorecia and periumbilical pain followed by n/v and RLQ pain (occurs in only 50% of cases). In 80% of cases, s/s occur for < 48 hrs.  Elderly tend to have s/s longer.
    Appendicitis (important Hx)
  3. Key Physical Exam Findings
    - Periumbilical pain becoming RLQ pain
       - McBurney's point is location of pain
       - Rebound tenderness
    - N/V
    - Low grade fever
    - Possible shock if rupture occurs
    - Elevated WBC
    Appendicitis (key physical exam findings)
  4. Treatment Plan
    - ABC's
    - Supportive
    - Pain management
       - morphine
       - meperidine
    - Surgical
       -appendectomy
    Appendicitis (Rx plan)
  5. Causes
    - Atherosclerotic disease
    - Infectious disease
    - Traumatic injury
    - Hypertension
    - Genetic disorders
       - Marfan's syndrome
    Abdominal Aortic Aneurysm (causes)
  6. Important Hx
    - Typically it will be asymptomatic as long as it is stable. As it begins to expand or leak, unexplained hypotension and or unexplained syncope .  65% of ruptured AAA's die before arrival at hospital.
    Abdominal Aortic Aneurysm (important Hx)
  7. Key Physical Exam Findings
    - Sudden onset of abdominal or back pain described as tearing or ripping
    - urge to defecate
    - pulsating, tender mass that may be palpated (rare)
    - signs of shock
    - decreased H&H if leaking/rupture
    Abdominal Aortic Aneurysm (key physical exam findins)
  8. Rx plan
    - ABC's
    - IV (large bore, 1000cc), O2, Monitor
    - pain management (monitor BP)
    - rapid, gentle Tx to appropriate facility with notifcation
    Abdominal Aortic Aneurysm (Rx plan)
  9. Causes
    - occlusion of the intestinal lumen
    Bowel Obstruction (causes)
  10. Important Hx
    - Many factors including adhesions, hernias, fecal impaction, polyps, paralytic ileus (can happen after general anesthesia), volvulus (twisting), intussuception (telescoping of one section of bowel into another) and tumors.
    Bowel Obstruction (important Hx)
  11. Key Physical Exam Findings
    - N/V, constipation/diarrhea (depends on the degree of obstruction), fever
    - bowel sounds: hyperperistalsis or diminished
    - abdominal pain and distention
    - feculent breath 
       - may vomit feces
    - elevated WBC count
    - BUN and CREATINE levels may be elevated = dehydration
    Bowel Obstruction (key physical exam findings)
  12. Rx plan
    - ABC's
    - IV and supportive care
    - nasogastric tube
    - pain management
    - antibiotics and possibly surgery
    Bowel Obstruction (Rx plan)
  13. Causes
    - inflammation of the gallbladder, most often associated with the presence of gallstones
    Cholecystitis (causes)
  14. Important Hx
    - most commonly at night with a recent Hx of ingestion of fried or fatty foods.  may also have a family Hx of the disease.  fair, fat, female, and fifty.  elderly tend to have more vague s/s.
    Cholecystitis (important Hx)
  15. Key Physical Exam Findings
    - N/V
    - abdominal pain and tenderness upon palpation ot the RUQ
       - Murphy's sign (pain with inspiration upon palpation of the gallbladder)
       - Kehr's sign (acute pain in shoulder due to blood in the peritoneal cavity)
    - Chills and fever may also be present
    - jaundice
    - elevated WBC count
    elevated liver enzymes
    Cholecystitis (key physical exam findings)
  16. Rx plan
    - ABC's, IV and supportive care
    - medications
       - promethazine
       - meperidine (no morphine)
    - antibiotics and possible surgery to remove the gallbladder/gallstones
    Cholecystitis (Rx plan)
  17. Causes
    - when the ovum develops outside of the uterus
    - most often in the fallopian tube but sometimes in the ovary
    Ectopic Pregnancy, Ruptured (causes)
  18. Important Hx
    - typically will be discovered within the first two months.  patients may have a Hx of missed menstruation and no birth control use.
    Ectopic Pregnanc, Ruptured (important Hx)
  19. Key Physical Exam Findings
    - severe unilateral abdominal lower pain
       - rebound tenderness
    - vaginal spotting
    - internal hemorrhage, sepsis and shock
    - shoulder pain may also be present
    - decreased H&H if bleeding
    Ectopic Pregnancy, Ruptured (key physical exam findings)
  20. Rx plan
    - ABC's
    - supportive: pain management
    - fluid replacement if signs of shock are present
    - early recognition
    Ectopic Pregnancy, Ruptured (Rx plan)
  21. Causes
    - Upper: peptic ulcers, mallory weiss tear, esophageal varicies, gastritis, NSAIDs
    - Lower: diverticulitis, ulderative colitis, tumors, hemorrhiods, Crohn's disease
    GI Bleeding (causes)
  22. Important Hx
    - detailed Hx of when this started is important.  most upper GI bleeds have s/s for 30 days before Pt seek medical care
    - lower GI bleeds tend to be more serious in the elderly due to multiple medical issues/medications
    GI Bleeding (important Hx)
  23. Key Physical Exam Findings
    - upper (varies w/cause): hematemesis (vomiting blood), melena (dark, sticky feces containing partially digested blood), hematochezia (passage of fresh blood through the anus, rare), syncope, shock, epigastric pain, heartburn, dysphagia
       - decreased H&H, PT, PTT important

    - lower (varies w/cause): abdominal pain, abdominal cramping, rebound tenderness may be present, hematochezia, sycope, shock, fever
       - decreased H&H, PT, PTT important
    GI Bleeding (key physical exam findings)
  24. Rx plan
    - ABC's
    - IV and supportive care.  treat for shock.  perform orthostatic VS.
    - patient hygiene will be difficult -- but should be attempted
    GI Bleeding (Rx plan)
  25. Causes
    - crohn's disease
    - ulcerative colitis
    Inflammatory Bowel Disease (causes)
  26. Important Hx
    - Family Hx of these conditions is important for Dx.  Tends to be in younger Pts, Jewish decent is involved with Crohn's disease.
    Inflammatory Bowel Disease (Important Hx)
  27. Key Physical Exam Findings
    - Diarrhea: mucus or bloody
    - Constipation: Primarily in ulcerative colitis
    - Rectal urgency and tenesmus (feeling of incomplete rectal emptying) and painful defecation
    - Abdominal cramping and pain: RLQ = Crohn's.  Periumbilically or LLQ = ulcerative colitis
    - Fever, dehydration
    - Increased WBC count, decreased H&H
    Inflammatory Bowel Disease (key physical exam findings)
  28. Rx plan
    - ABC's
    - Supportive: pain management
    - Fluid replacement if signs of shock are present
    Inflammatory Bowel Disease (Rx plan)
  29. Causes
    - The disease reults from infection of the cervix, uterus, fallopian tubes, and ovaries and other supportive structures
    Pelvic Inflammatory Disease (causes)
  30. Important Hx
    - Typical Pt is < 25 y/o, has multiple sexual partners (gonorrhea and trachomatis).  Other bacteria may be transmitted from doctor's instruments during an exam.
    Pelvic Inflammatory Disease (Important Hx)
  31. Causes
    - H. Pylori infection
    - Non-steroidal inflammatory drug use
    - Increased gastric acid
    Peptic Ulcer (causes)
  32. Important Hx
    - Pts often are aware of the condition and may  take over the counter antacids.  Often the pain will subside with the consumption of food.
    Peptic Ulcer (important Hx)
  33. Key Physical Exam Findings
    - Burning or gnawing discomfort in the LUQ
    - May develop before meals or during stressful events
    - May vomit blood or have melena
    - Elevated WBC count 
    - Decreased H&H if bleeding
    Peptic Ulcer (key physical exam findings)
  34. Rx Plan
    - ABC's
    - Supportive
    - Fluid replacement if signs of shock are present
    Peptic Ulcer (Rx plan)
  35. Causes
    - Kideny stones entering/blocking the urethra
    Renal Calculi (causes)
  36. Important Hx
    - Prior Hx may be indicative.  Flank or groin pain with changes in urinary output is the strongest indicator.  Patterning: Flank pain that is severe with sudden and near complete relief followed by suprapubic/penile pain.
    Renal Calculi (important Hx)
  37. Key Physical Exam Findings
    - Severe flank pain radiating to the groin or severe pain in the groin
       - Writhing in pain -- is unable to find a comfortable position
       - Non-rebound tenderness
    - Hematuria
    - Dysuria/Anuria (often with intense pain)
    - Pain is severe (approaches level of childbirth)
    - Elevated WBC count
    - Elevated BUN and Creatinine
    Renal Calculi (key physical exam findings)
  38. Rx Plan
    - ABC's
    - Supportive
    -  IV fluids
    - Pain management
    Renal Calculi (Rx plan)
  39. Causes
    - Various cases which result in loss of kidney function
    Renal Failure, Acute (causes)
  40. Important Hx
    - Acute failure is usually the result of an identifiable condition.  Prerenal: shock, prolonged dehydration, sepsis.  Intrarenal: Toxic exposures or overdoses.  Postrenal: bilateral renal calculi, prostate hypertrophy.
    Renal Failure, Acute (important Hx)
  41. Key Physical Exam Findings
    - Dysuria/Anuria
    - Ascites (fluid in the peritoneal cavity causing swelling)
    - Pulmonary edema
    - Lt/Rt failure due to voume overload
    - Altered LOC: Confusion, disorientation, to coma
    - Elevated WBC count
    - Hyperkalemia (frequently)
    - Elevated BUN and Creatinine
  42. Renal Failure, Acute (key physical exam findings)
  43. Rx Plan
    - ABC's
    - IV and supportive care (avoid LR -- contains K+)
    - Furosemide
    - Carefully monitor ECGs
    - Dialysis is usually indicated
    - Hyperkalemia: calcium chloride, sodium bicarb, albuterol, furosemide
    Renal Failure, Acute (Rx plan)
  44. Causes
    - Cessation of alcohol consumption from 1 to 14 days prior
    Alcohol Withdrawal (causes)
  45. Important Hx
    - First s/s -- 6-12 hrs.  Most dangerous symptoms (seizures) will tend to appear within a few days of the last drink.  Some DT symptoms may be delayed up to 2 weeks.
    Alcohol Withdrawal (important Hx)
  46. Key Physical Exam Findings
    - All stages: hepatomegaly, abdominal tenderness
    - Mild: tremors, irritability, n/v, anxiety
    - Moderate: tachycardia/tachypnea, intense anxiety, hypertension
    - Severe: seizure, hallucinations (may be severe), hyperthermia, alatered LOC
    - Blood glucose could be critically low
    - Liver enzymes elevated. Major abnormalities in the Chem 7, CBC, Coagulation panel
    - Metabolic acidosis
    Alcohol Withdrawal (key physical exam findings)
  47. Rx Plan
    - Supportive care: ⇩lights in ambulance, (-) siren
    - Restraint may be needed
    - Immediately treat seizures with benzodiazepines
    - D50 may be risky due to thiamine deficiency
    Alcohol Withdrawal (Rx plan)
  48. Causes
    - Cerebral aneurysm
    - Hypertension
    - Coagulopathies
    - Cocaine Abuse
    - Brain Tumor
    CVA: Hemorrhagic (causes)
  49. Important Hx
    - 15-20% of all strokes, occur during stress; Hx of hypertension; use of cocaine or other sympathomimetic.  Compliance with medications is important: taking antihypertensives, Coumadin, using cocaine, etc.
    CVA: Hemorrhagic (important Hx)
  50. Key Physical Exam Findings
    - Rapid onset and escalation
    - Severe H/a: worst H/a of life
    - Decreased mental status, seizures
    - N/V -- may be projectile, blurred vision, loss of vision (unilateral), facial droop, ptosis, ataxia, vertigo, hemiparesis, hemiplegia, aphasia, neglect (not even knowing a limb is present without looking)
    - Initial HTN
    - Cushing's reflex (as ICP rises)
    - Ensure blood sugar is normal (if low treat)
    - Minor drop in H&H
    CVA: Hemorrhagic (key physical exam findings)
  51. Rx Plan
    - Airway & ventilation, intubate if necessary
    - IV TKO (may use hypertonic saline [3%] [medical command])
    - Monitor; rapid Tx to stroke center
    - CT scan needed!
    - 02 to 94-99% Sp02
    - Thrombolytic checklist
    - Seizure precautions
    - Don't treat HTN
    - Treat documented hypoglycemia
    - Keep head elevated to 30°
    - Sedate/Analgesia as needed (helps w/ICP)
    - Needs neurosurgery
     
    CVA: Hemorrhagic (Rx plan)
  52. Causes
    - Cerebral Thrombosis
    - Pressure from a mass
    - Hypoperfusion
    CVA: Ischemic (causes)
  53. Important Hx
    - 80-85% of all strokes; Atherosclerotic disease; angina; previous strokes; s/s slower to develop. S/S tend to plateau in severity.
    CVA: Ischemic (important Hx)
  54. Key Physical Exam Findings- Rapid onset and escalation- Severe H/a: worst H/a of life- Decreased mental status, seizures- N/V -- may be projectile, blurred vision, loss of vision (unilateral), facial droop, ptosis, ataxia, vertigo, hemiparesis, hemiplegia, aphasia, neglect (not even knowing a limb is present without looking)- Initial HTN- Cushing's reflex (as ICP rises)- Ensure blood sugar is normal (if low treat)- Minor drop in H&H
    - Tends to not have ICP
    CVA: Ischemic (key physical exam findings)
  55. Rx Plan
    - Airway & ventilation, intubate if necessary- IV TKO (may use hypertonic saline [3%] [medical command])
    - Monitor; rapid Tx to stroke center
    - CT scan needed!
    - 02 to 94-99% Sp02
    - Thrombolytic checklist
    - Seizure precautions
    - Don't treat HTN
    - Treat documented hypoglycemia
    - Keep head elevated to 30°
    - Sedate/Analgesia as needed (helps w/ICP)
    CVA: Ischemic (Rx plan)
  56. Causes
    - Focal cerebral dysfunction
    - Momentary hypotension
    CVA: TIA (causes)
  57. Important Hx
    - Hx of TIAs; hypertension; atherosclerotic disease; s/s last for minutes to hours with full recovery in 24 hrs.  No permanent neuro deficit.  Talk with family/bystander -- s/s may be gone by the time you get there.
    CVA: TIA (important Hx)
  58. Key Physical Exam Findings
    - Similar to ischemic stroke with shorter duration and no permanent deficits
    - Dizziness
    CVA: TIA (key physical exam findings)
  59. Rx Plan
    - Treat as CVA
    - Encourage Pt to seek medical care: 10% of TIA have CVA within 7 days
    CVA: TIA (Rx plan)
  60. Causes
    - Lack of insulin while still eating
    - Certain diets
    - Infection/illness
    Diabetic: Ketoacidosis (causes)
  61. Important Hx
    - Onset gradual over a day or more, usually preceded by polydypsia, polyuria, and polyphagia.  Fatigue, nausea, vomiting, and abdominal pain, are common.
    - Type 1 diabetics
    - 25% of the Pts have this as their first indication that they are diabetic!
    Diabetic: Ketoacidosis (important Hx)
  62. Key Physical Exam Findings
    - Hyperventilation correlates with defree or metabolic acidosis
       - Kussmaul's respirations
       - PETCO2 is low
    - Ketonic "fruity" odor to breath
    - Dehydration: this can dramatically modify laboratory values.  Tachycardia and hypotension are common.
    - Altered LOC
    - Elevated Glucose (>300 mg/dL), ⇧K+
    Diabetic: Ketoacidosis (key physical exam findings)
  63. Rx Plan
    - Manage ABC's
    - IV for re-hydration if needed
       - IV fluids will ⇩K+ and Glucose
    - 12 lead - watch for hyperkalemia
    - Tx
    Diabetic: Ketoacidosis (Rx plan)
  64. Causes
    - Infections
    - Serious illness: CVA, MI, CHF, renal failure
    Diabetic Hyperosmolar Hyperglycemic Non-Ketosis (causes)
  65. Important Hx
    - Onset gradual over days or weeks, usually preceded by polyphagia, polyuria, and polydipsia.  
    - Fatigue, nausea and vomiting are common.
    -Type 2 diabetics.
    - In 30-40% of cases, this incidence is the Pts first indication of diabetes.
    Diabetic Hyperosmolar Hyperglycemic Non-Ketosis (important Hx)
  66. Key Physical Exam Findings
    - Severe dehydration: this can dramatically modify laboratory values.  Tachycardia and hypotension are common.
    - Decreasing LOC, stroke like findings
    - Elevated Glucose (>600 mg/dL)
    - PETCO2 should be normal
    Diabetic Hyperosmolar Hyperglycemic Non-Ketosis (key physical exam findings)
  67. Rx Plan
    - Manage ABC's
    - IV for re-hydration if needed
    - Tx
    Diabetic Hyperosmolar Hyperglycemic Non-Ketosis (Rx plan)
  68. Causes
    - Decreased eating
    - Increased exercise
    - Increased insulin (combinations)
    Diabetic: Insulin Shock (causes)
  69. Important Hx
    - This occurs over hours.  Find out when the Pt was last normal.
    Diabetic: Insulin Shock (important Hx)
  70. Key Physical Exam Findings
    - Skin cool and clammy
    - Altered LOC; confusion, agitation, aggression, odd behavior, seizure, coma
    - Tachycardia (bradycardia in neonates), tachypnea, hypo/hypertension
    - Blood glucose: (<50 mg/dL, for profound change in LOC usually <30 mg/dL)
    Diabetic: Insulin Shock (key physical exam findings)
  71. Rx Plan
    - ABCs as needed
    - IV - D50 or Glucagon IM
       - If Pt has control of airway, can give oral glucose, sugary fluids
    - May sign AMA: ensure competency and ability to care for self -- eat high starch meal
    Diabetic: Insulin Shock (Rx plan)
  72. Causes
    - Trauma
    - Infection (see meningitis)
    - Stroke (see CVA)
    Intracerebral Hemorrhage (causes)
  73. Important Hx
    - Head injury mechanism.  Helmet use, LOC at the scene, other injuries, C-Spin considerations, alcohol use, anticoagulants, antihypertensives (beta blockers, ace inhibitors). Elderly at higher risk for diffuse axonal injury.
    Coma may be immediate with blow to head, or delayed by minutes, hours or longer.
    Intracerebral Hemorrhage (important Hx)
  74. Key Physical Exam Findings
    - Skull / face deformity, amnesia, anosmia (loss of sense of smell), anisocoria, rhinorrhea, ptosis, hearing loss, hemiplegia, lucid interval, altered LOC -- confusion to coma, ICP s/s.
    - Drainage of cerebrospinal fluid from nose or ear suggests open skull fracture.
    - If isolated, closed head injury, minor drop in H&H.
    Intracerebral Hemorrhage (key physical exam findings)
  75. Rx Plan
    - Airway prn
       - Ensure oxygenation/ventilation
       - Hyperventilation for obvious ICP Pts
    - C-spine as needed
    - IV, monitor & treat dysrhythmias
       - Maintain BP of approximately 120 SBP
       - Even momentary hypotension can cause cerebral ischemia
    - Tx to appropriate facility
    Intracerebral Hemorrhage (Rx plan)
  76. Causes
    - Neisseria Meningitides
    - Influenza (dramatic drop in # of cases since vaccine)
    Meningitis: Bacterial/Viral (causes)
  77. Important Hx
    - Bacterial: typically very ill within 24 hours.  Gradually to coma, (1-2 days). Untreated is highly fatal.
    - Viral -- s/s for 3-7 days (viral is self-limiting needing only supportive care).
    - Hx of exposure to someone ill or known to have meningitis. Recent travel can also help provide information about which organism is reponsible.
    Meningitis: Bacterial/Viral (important Hx)
  78. Key Physical Exam Findings
    - Chills, fever, H/a, neck pain and stiffness (nuchal rigidty), delirium to coma, photophobia
    - Brudzinski and Kernig's sign
    - Rash -- non-blanching petechiae
    - Infants: Buldging fontanelles, high pitched cry
    - Elevated WBC count
    - May have very low sodium (due to ICP -- no ADH -- polyuria)
    Meningitis: Bacterial/Viral (key physical exam findings)
  79. Rx Plan
    - Manage ABCs as needed
    - IV; ensure euvolemic. If after fluids, BP low, then dopamine
    - Seizure precautions
    - Face mask should be worn
    Meningitis: Bacterial/Viral (Rx plan)
  80. Causes
    - Exposure to narcotics
    - Benzodiazepines
    - Alcohol (see alcohol)
    - Phenobarbital
    Overdose: Depressant (causes)
  81. Important Hx
    - May be recreational, accidental or intentionally harmful. Prior Hx is common. Generally gradual onset of diffuse cerebral depression. Look for track marks.
    Overdose: Depressant (important Hx)
  82. Key Physical Exam Findings
    - Bradypnea/Apnea, decreased LOC, miosis (pupil constriction; opioids), arrhythmias, hypotension, ataxia, slurred specch
    - Altered mental status/unresponsive
    - Drug screen positive for agent involved
    Overdose: Depressant (key physical exam findings)
  83. Rx Plan
    - ABC, IV, O2, monitor
       - Naloxone (opioids)
       - Flumazenil (benzos)
    - Respiratory support as needed (BVM)
    - Watch for agitation/seizures after antidotes
    Overdose: Depressant (Rx plan)
  84. Causes
    - Cholinergic: Sarin, parathion, organophosphates
    - Anticholinergic: atropine, benadryl, antipsychotics
    Overdose: Misc (causes)
  85. Important Hx
    - Can be observed in industrial accidental exposure recreational, or intentional overdose. Ensure scene safety, look for track marks, determine past psychiatric Hx
    Overdose: Misc (important Hx)
  86. Key Physical Exam Findings
    - Cholinergic: SLUDGEM, altered LOC
    - Anticholinergic: dry, flushed skin, hyperthermia, mydriasis (dilated pupils), ⇧HR, hallucinations, delusions, seizures ("red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hot as a hare.")
    Overdose: Misc (key physical exam findings)
  87. Rx Plan
    - IV O2, monitor, supportive
    - Cholinergic:
       - atropine, 2-PAM, diazepam
    - Anticholinergic
       - Manage seizures
    Overdose: Misc (Rx plan)
  88. Causes
    - Exposure to cocaine
    - Methamphetamines
    - Bath salts
    - Pseudoephedrine
    Overdose: Stimulant (causes)
  89. Important Hx
    - Recreational usage. May have prior Hx. Verify if other substances are involved (narcotics, hallucinogens, etc). Nasal scarring/septal defects, track marks. These Pts can suffer real MIs.
    Overdose: Stimulant (Important Hx)
  90. Key Physical Exam Findings
    - Anxiety, tachycardia, CP, hyperthermia, seizures, mydriasis, arrhythmias (wide complex)
    Overdose: Stimulant (key physical exam findings)
  91. Rx Plan
    - IV, O2, monitor
    - Medications
       - Benzodiazepines
       - Beta Blockers
       - NTG / morphine
       - Ca+ Channel Blockers
    -Seizures must be quickly controlled with valium
    Overdose: Stimulant (Rx plan)
  92. Causes
    - Psychological trauma
    - Schizophrenia (or other SEVERE mental illness)
    Psychosis (causes)
  93. Important Hx
    - This is a Pt who is disconnected from reality. A neurotic builds castles in the clouds -- a psychotic lives in them. This Pt can be unpredictable due to reacting to stimuli you cannot experience. Find out about psychiatric Hx: Dx, past successes with medication control and recent medication changes
    Psychosis (important Hx)
  94. Key Physical Exam Findings
    - Delusions, hallucinations, bizarre behavior  and posture
    - Disorganized speech, disorientation, impaired attention
    - Affective symptoms: rapidly changing mood, screaming or muteness
    - Catatonic behavior, outlandish dress or behavior, impaired memory for recent events
    Psychosis (key physical exam findings)
  95. Rx Plan
    - Safety is first due to unpredicatbility
    - Supportive care
    - Bring Pt to common reality
    - Medications: Benzodiazepines
    Psychosis (Rx plan)
  96. Causes
    - Idiopathic (epilepsy)
    - Trauma, brain tumor, brain lesion, stroke, hypoxia
    Seizure: Generalized - Grand Mal (causes)
  97. Important Hx
    - Hx of recent head injury, stroke or TIA, Dx brain tumor or disorder; signs of head injury; signs of medical dysfunction, medic alert tags.
    - Talk w/bystanders to describe the event: body motions, LOC, timing, etc. Ask about medication compliance
    Seizure: Generalized - Grand Mal (important Hx)
  98. Key Physical Exam Findings
    - Aura -- Tonic -- Hypertonic -- Clonic/Tonic -- Postical
    - Ensure glucose is normal (normal glucose levels is abnormal)
    Seizure: Generalized - Grand Mal (key physical exam findings)
  99. Rx Plan
    - ABCs
    - Protect Pt
    - Look for trauma (fall)
    - Valium or other antiseizure meds
    Seizure: Generalized - Grand Mal (Rx plan)
  100. Causes
    - Idiopathic (epilepsy)
    - Trauma, brain tumor, brain lesion, stroke, hypoxia
    Seizure: Generalized - Petite Mal (causes)
  101. Important Hx
    - More common in children, usually lasting 20 seconds with little obvious s/s. Can be triggered by hyperventilation. Ask about medication compliance
    Seizure: Generalized - Petite Mal (important Hx)
  102. Key Physical Exam Findings
    - Blinking
    - Blank stare
    - Confusion
    - Loss of time
    Seizure: Generalized - Petite Mal (key physical exam findings)
  103. Rx Plan
    - ABCs
    - Valium (rarely needed)
    Seizure: Generalized - Petite Mal (Rx plan)
  104. Causes
    - Idiopathic (epilepsy)
    - Trauma, brain tumor, brain lesion, stroke, hypoxia
    Seizure: Partial-Focal Motor (causes)
  105. Important Hx
    - There are a range of presentations for this class of seizure: based on areas of the brain involved.
    - Most of these Pts will have an aura.
    - They should not loss consciousness, but there may be staring with limited responsiveness during the seizure.
    - Seizure can be limited to one portion of the body shaking
    - Check medication compliance
    Seizure: Partial-Focal Motor (important Hx)
  106. Key Physical Exam Findings
    - Behavioral arrest -- staring -- automatisms (chewing, lip smacking, mumbling, and fumbling with hands) -- postictal confusion
    - A typical complex focal seizure lasts about 60-90 seconds and is followed by brief postictal confusion. However, generalized weakness, asthenia, and fatigue may last for a few days.
    Seizure: Partial-Focal MotorSeizure: Partial-Focal Motor (key physical exam findings)
  107. Rx Plan
    - ABCs
    - Valium (rarely needed)
    Seizure: Partial-Focal Motor (Rx plan)
  108. Causes
    - Chronic renal failure
    - Severe acute renal failure
    Uremia (causes)
  109. Important Hx
    - Check medications, other PMH, when last dialysis occurred, what type of dialysis. Diabetes and HTN are common.
    Uremia (important Hx)
  110. Key Physical Exam Findings
    - N/V, fatigue, anorexia, weight loss, muscle cramps, pruritus, mental status change, visual disturbances, increased thirst, increases bleeding, uremic frost, icteric sclera, pulmonary edema, ascites, anasarca, HTN
    - Elevated BUN, Creatinine, hyperkalemia
    - Dramatic changes in chem 7
    - Decreased H&H
    Uremia (key physical exam findings)
  111. Rx Plan
    - IV, O2, monitor
       - No LR
       - Pulse Ox unreliable
    - 12 lead 
    - Dialysis
    - Hyperkalemia
       - Calcium chloride, bicarb, albuterol
    Uremia (Rx Plan)

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