100808 Assessment Based Management.ppt by docster6

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									Assessment Based 
  Management

    (WHAT?)


                    1
         What's That Mean?
• The approach/assessment of every 
  patient.
• Systematic.
• Not necessarily “protocol” driven.
• Open minded.
• Looking at all reasonable possibilities.
• Treatable possibilities.
• Multitasking (treating as your thinking)
                                             2
              Information
• History, history, history
• Exam
  – Physical
  – Emotional
  – Environmental
• Diagnosis (working/field)
• Re-examine

                              3
        Complications
• Environment
• Preconceived ideas
• Prejudice
• Others opinions
• Distracting injuries/issues
• Safety considerations
                                4
Count off by 4s
    1.       
    2.  
    3.  
    4.  
                  6
1. Shortness of Breath

2. Altered Mental Status

3. Abdominal Pain

4. Chest Pain
                           7
•   Asthma
•   COPD Pneumonia
•
•
    Emphysema
    Bronchitis
                          SOB
•   Pneumothorax
•   Hemothorax
•   Pulmonary Embolism
•   MI
•   Congestive Heart Failure
•   Pulmonary Edema
•   Anaphylaxis                 8
•   Cystic Fibrosis
•   Bronchiolitis
•   Adenocarcinoma of the lung
•   Amyotrophic Lateral sclerosis
•   Pulmonary Hamartoma
•   Mesothelioma             SOB
•   Myasthenia Gravis
•   Pulmonary Arterial Hypertension
•   Sucking Chest Injury
•   Flail Chest
                                      9
• Pulmonary Contusion
• Influenza viruses
• ARDS (Acute Respiratory Distress
  Syndrome)
• Croup
• Epiglottis
                          SOB
• RSV (Respiratory Syncytial Virus)
• Tuberculosis
• Respiratory Distress Syndrome
• Adenoviruses
• Atelectasis
                                      10
•   Asbestosis
•   Flavoring Related Lung Disease
•   Goodpasture’s Syndrome
•   Histoplasmosis
•   Hot Tub Lung           SOB
•   Interstitial lung disease
•   Hantavirus Pulmonary Syndrome
•   Silicosis
•   Human Metapneumovirus (HMPV)
•   Radiation Fibrosis
                                     11
• Trauma

• Decreased O2
                 SOB
• Running

• Scared

• Hurt (pain)          46




                            12
•   Drug toxicity/Overdose
•   Metabolic
•
•
    Structural
    Infectious
                             AMS
•   Psychiatric
•   Endocrine
•   Pulmonary
•   Oncologic
•   Cardiovascular
•   GI 
•   Renal
                                   13
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            Abdominal Pain
• Gastrointestinal 
   – Inflammatory: gastroenteritis, appendicitis, gastritis, esophagitis, 
     diverticulitis, Crohn's disease, ulcerative colitis, microscopic 
     colitis 
   – Obstruction: hernia, intussusception, volvulus, post-surgical 
     adhesions, tumours, superior mesenteric artery syndrome, 
     severe constipation 
   – Vascular: embolism, thrombosis, hemorrhage, sickle cell 
     disease, abdominal angina, blood vessel compression (such as 
     celiac artery compression syndrome) 
   – Digestive: peptic ulcer, lactose intolerance, celiac sprue, 
     Jasohnstritis 
• Bile system 
   – Inflammatory: cholecystitis, cholangitis 
   – Obstruction: cholelithiasis, tumours 
• Liver 
   – Inflammatory: hepatitis, liver abscess
• Pancreatic 
   – Inflammatory: pancreatitis 
                                                                             15
• Renal and urological 
  – Inflammation: pyelonephritis, bladder infection 
  – Obstruction: kidney stones, urolithiasis, 
    Urinary retention, tumours 
  – Vascular: left renal vein entrapment
• Gynecological or obstetric 
  – Inflammatory: pelvic inflammatory disease 
  – Mechanical: ovarian torsion 
  – Endocrinological: menstruation, Mittelschmerz 
  – Tumors: endometriosis, fibroids, ovarian cyst, 
    ovarian cancer 
  – Pregnancy: ruptured ectopic pregnancy, 
    threatened abortion 
                                                       16
•   Abdominal wall 
     – muscle strain or trauma 
     – muscular infection 
     – neurogenic pain: herpes zoster, radiculitis in Lyme disease, abdominal 
       cutaneous nerve entrapment syndrome (ACNES), tabes dorsalis 
•   Referred pain 
     – from the thorax: pneumonia, pulmonary embolism, ischemic heart 
       disease, pericarditis 
     – from the spine: radiculitis 
     – From the genitals: testicular torsion 
•   Metabolic disturbance 
     – uremia, diabetic ketoacidosis, porphyria, C1-esterase inhibitor 
       deficiency, adrenal insufficiency,lead poisoning, black widow spider bite, 
       narcotic withdrawal 
•   Blood vessels 
     – aortic dissection, abdominal aortic aneurysm 
•   Immune system 
     – sarcoidosis 
     – vasculitis 
     – familial Mediterranean fever 
•   Idiopathic 
     – irritable bowel syndrome (affecting up to 20% of the population, IBS is 
       the most common cause of recurrent, intermittent abdominal pain) 
                                                                                     17
• Traumatic : 
   – blunt or perforating trauma to the stomach, bowel, spleen, liver, 
     or kidney 
• Inflammatory : 
   – Infections such as appendicitis, cholecystitis, pancreatitis, 
     pyelonephritis, pelvic inflammatory disease, hepatitis, mesenteric 
     adenitis, or a subdiaphragmatic abscess 
   – Perforation of a peptic ulcer, a diverticulum, or the caecum 
   – Complications of inflammatory bowel disease such as Crohn's 
     disease or ulcerative colitis 
• Mechanical : 
   – Small bowel obstruction secondary to adhesions caused by 
     previous surgeries, intussusception, hernias, benign or 
     malignant neoplasms 
   – Large bowel obstruction caused by colorectal cancer, 
     inflammatory bowel disease, volvulus, fecal impaction or hernia 
• Vascular : 
   – occlusive intestinal ischemia, usually caused by 
     thromboembolism of the superior mesenteric artery           105



                                                                           18
                              CHEST PAIN
• Acute coronary syndrome
    – Angina  
    – Myocardial infarction
•   Aortic dissection 
•   Pulmonary embolism 
•   Pneumonia 
•   Hemothorax 
•   Pneumothorax
•   Tension pneumothorax 
•   Arrhythmia                             19
•   Carbon Monoxide 
•   Sarcoidosis 
•   Lead Poisoning 
•   Upper gastrointestinal ailments, for example: 
     –   Gastroesophageal reflux disease (GERD) 
     –   Hiatus hernia 
     –   Disorders of the esophagus 
     –   Functional Dyspepsia 
•   Problems of outer chest structures 
     –   Costochondritis 
     –   Spinal nerve problem 
     –   Fibromyalgia 
     –   Chest wall problems and breast conditions 
     –   Herpes zoster (shingles)
•   Psychological 
     –   Panic attack 
     –   Anxiety 
     –   Clinical depression 
     –   Somatization disorder 
     –   Hypochondria 
•   Hyperventilation
•   Da costa's syndrome 
•   Bornholm disease
•   Precordial catch syndrome
•   Pleurisy                                          31
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