SPE Flashcards
(86 cards)
1
Q
general inspection for
A
acute distress, ill appearing, AMS
2
Q
duration includes
A
constant vs intermittent
3
Q
character includes
A
quality, severity
sitting, supine, breathing, eating
4
Q
radiation includes
A
jaw, arm, back, shoulders
5
Q
timing includes
A
time of day/ recurring circumstances
6
Q
also ask what with OLDCAARTS
A
previous episodes
7
Q
pertinent ROS (21)
A
1- dyspnea/ DOE 2- syncope 3- orthopnea (# of pillows) 4- PND 5- palpitations 6- edema 7- claudication 8- cough 9- wheezing 10- HAs 11- abd pain 12- indigestion/ heartburn/ reflux 13- difficulty swallowing 14- pain w swallowing 15- appetite change 16- food intolerance 17- N/V 18- constipation 19- hematemesis 20- melena 21- anxiety/ nervousness
8
Q
pertinent hx (11)
A
1- recent viral illness 2- recent MI/ heart disease or illness 3- trauma 4- HTN 5- hyperlipidemia 6- heart disease 7- lung disease 8- HF 9- DM 10- prior CXR/ EKG/ addl studies 11- recent life changes/ stressors
9
Q
other ROS (14)
A
1- fever 2- chills 3- fatigue 4- malaise 5- sweats 6- sleep interruptions 7- unintentional weight changes 8- rash/ skin changes 9- dizziness 10- numbness 11- ST 12- hoarseness 13- diarrhea 14- changes in urinary habits/ sxs
10
Q
PMH (7)
A
1- medical illnesses 2- medications/ OTC supps 3- medication allergies (also seasonal/ latex) 4- surgeries/ hospitalizations 5- accidents/ injuries 6- immunizations 7- LMP (if female)
11
Q
FH
A
first degree- heart disease, HTN, DM, CA
12
Q
SH
A
tobacco, alcohol, drugs, exercise, occupation
13
Q
PE skin
A
socks off
diaphoresis, turgor, rash
14
Q
PE neck
A
JVD, Kussmaul’s sign (increase in JVP with inspiration), palpate carotid pulse
15
Q
what to do in PE before lungs
A
draping
16
Q
PE lungs inspect
A
body habitus & chest wall, breathing pattern/ chest symmetry/ chest expansion
17
Q
PE lungs palpate
A
increased/ decreased tactile fremitus
18
Q
PE lungs auscultate
A
decreased breath sounds, crackles, rhonchi, wheezing
19
Q
PE CV inspect/ palpate
A
PMI, tenderness, crepitus
20
Q
PE CV auscultate
A
seated and supine aortic, pulmonic, tricuspid, mitral with diaphragm and bell
for: pericardial friction rub, murmurs, gallops, S3/ S4
21
Q
PE abd inspect
A
distension, pulsatile masses, periumbilical or flank bruising
22
Q
PE abd auscultate
A
hyper/hypoactive bowel sounds, abdominal bruits
23
Q
PE abd percuss
A
hyperresonance, tympany, dullness
24
Q
PE abd palpate
A
liver, spleen, kidneys, abdominal aorta size, tenderness (mostly epigastric), masses
25
PE MSK
edema, peripheral pulses
26
labs
CBC, CMP, troponin, BNP
+/- CK-MB, myoglobin, UDS
others to consider: PT/ INR, ESR
27
imaging
EKG, CXR
28
additional studies
D-dimer, CT chest, CTA, PHQ, GAD
29
things not to forget
```
vitals
secondary diagnoses
disposition
ER precautions
follow up
```
30
pleuritic, positional CP
friction rub
diffuse ST elevations in V1-V6 with associated PR depressions
pericarditis
31
pericarditis tx
Ibuprofen OR Aspirin
**both until symptom free for 24 hours (usually 7-14 days) → then taper weekly for 2-4 weeks
PLUS
Colchicine (prevents recurrence)
32
pericarditis tx if Dressler syndrome (fever & pulmonary infiltrates)
aspirin or colchicine, avoid NSAIDs
33
pericarditis pt edu
sxs resolve w/i 1-2 days of treatment
good long-term prognosis
avoid strenuous activity until symptoms resolved
34
hx of viral prodrome
young adult
S3 gallop
cardiomegaly on CXR
myocarditis
35
myocarditis tx
supportive - ACE inhibitors, diuretics, BBs
36
substernal, poorly localized, exertional, short in duration CP relieved w/ rest or nitro
+ dyspnea, N/V, diaphoresis, numbness, fatigue
EKG → ST depression
stable angina
37
stable angina outpt tx
daily Aspirin & BBs (both decrease mortality)
+ daily statin
sublingual nitro prn
(use CCBs if BBs c/i’d)
38
stable angina definitive tx
revascularization (percutaneous transluminal coronary angiography) vs CABG (L main coronary artery or 3 vessel involvement)
39
stable angina pt edu
HTN/ DM control, exercise, diet, smoking cessation
40
retrosternal CP not relieved with rest or nitro
pain at rest
≥ 30 min
radiation (lower jaw/ teeth, L arm, epigastrium, back, shoulders)
+/- anxiety, diaphoresis, tachy, palpitations, N/V, dizziness
ACS
| unstable angina vs NSTEMI vs STEMI
41
caution for silent MI in who
women, elderly, diabetics, obese
42
atypical MI sxs
abd pain, jaw pain, dyspnea w/o CP
43
how to distinguish between unstable angina vs NSTEMI/ STEMI
cardiac enzymes
44
ACS tx if normal EKG
MONA + serial enzymes/ EKG’s
45
UA or NSTEMI tx
MONA BASH
46
STEMI tx
MONA BASH + reperfusion
47
arrhythmias, ventricular aneurysm/ rupture, cardiogenic shock, papillary muscle dysfunction, heart failure, L ventricular wall rupture are complications of
NSTEMI/ STEMI
48
post-MI pericarditis + fever + pulmonary infiltrates
Dressler syndrome
49
CP at rest, midnight to early morning
not exertional
not relieved with rest
transient ST elevations
vasospastic (variant, Prinzmetal) angina
50
vasospastic angina tx
CCB’s at night
nitro
**BB’s avoided (lead to unopposed vasospasm)**
51
triggers for vasospastic angina tx
cold weather, exercise, alpha-agonists, hyperventilation
52
retrosternal, postprandial, increased with supine, relieved with antacids CP
water brash, sour taste in mouth
cough, ST
GERD
53
GERD alarm sxs
dysphagia, odynophagia, weight loss, bleeding
| → endoscopy
54
GERD dx gold standard
24 hr ambulatory pH monitoring
55
intermittent/ mild GERD and tx
< 2 episodes per week
| prn antacids and H2 receptor antagonists
56
severe GERD and tx (drug class)
≥ 2 episodes/ week
| PPI’s
57
GERD tx (specific)
Famotidine
if no relief → Omeprazole
+ lifestyle mod
58
GERD complications
esophagitis, stricture, Barrett’s esophagus, esophageal adenocarcinoma
59
GERD pt edu
elevate head of bed 6-8 inches, avoid lying down for 3 hrs after eating
avoid food that delays gastric emptying (fatty, spicy, chocolate, peppermint, caffeine)
smoking cessation
decreased alcohol intake
weight loss
60
constant, boring chest/ epigastric pain that radiates to the back
exacerbated supine, eating
relieved leaning forward, sitting, fetal position
N/V/fever
epigastric tenderness
tachycardia
periumbilical/ flank bruising
pancreatitis
61
best lab for pancreatitis
lipase (3x uln)
62
pancreatitis tx
supportive - NPO, high-volume IV fluid resuscitation, analgesia
*antibiotics NOT routinely used
63
pancreatitis pt edu
90% recover without complications in 3-7 days with supportive care
64
dyspnea, pleuritic CP, cough
dullness to percussion
decreased tactile fremitus
decreased breath sounds
pleural effusion
65
transudative causes of pleural effusion
CHF > nephrotic syndrome, cirrhosis
66
exudative causes of pleural effusion
any condition a/w infection/ inflammation, PE, malignancy
67
pleural effusion initial test of choice vs gold standard
CXR
| thoracentesis
68
pleural effusion tx
treat underlying disease
thoracentesis
chest tube fluid drainage if empyema
69
tall, thin man 20-40 yo, smoker OR underlying lung disease
pleuritic, unilateral, non-exertional, sudden CP
dyspnea
unilateral hyperresonace to percussion
decreased fremitus
decreased/absent breath sounds
pneumothorax
70
tall, thin man 20-40 yo, smoker OR underlying lung disease
pleuritic, unilateral, non-exertional, sudden CP
dyspnea
unilateral hyperresonace to percussion
decreased fremitus
decreased/absent breath sounds
PLUS
```
increased JVP
systemic hypotension
tracheal deviation
+/- chest flail
tachypnea
```
tension pneumothorax
71
pneumothorax tx if small PSP < 3 cm from chest wall at apex
observation + supplemental O2
72
pneumothorax tx if large PSP > 3 cm from chest wall at apex
needle or catheter aspiration vs chest tube/ catheter thoracostomy
73
pneumothorax tx if stable, SSP
chest tube or catheter thoracostomy + hospitalization
74
pneumothorax tx if tension
needle aspiration followed by chest tube thoracostomy
75
pneumothorax pt edu
avoid pressure changes for a min of 2 weeks
| high altitudes, smoking, unpressurized aircrafts, scuba diving
76
hypercoagulable state, venous stasis, vascular inflammation or injury
hx of recent surgery, long travel, estrogen use
dyspnea
pleuritic chest pain
cough
wheezing
orthopnea
+/- hemoptysis
hypoxemia
EKG with S1Q3T3 pattern, right ventricular strain, new incomplete right bundle branch block
+/- homan’s sign
PE
77
PE diagnostics if stable
D-dimer testing, spiral CTA chest. V/Q scan (esp if pregnant)
78
PE diagnostics if unstable
bedside echocardiography or venous compression ultrasound
79
PE tx
heparin w/ factor Xa inhibitors and oral direct thrombin inhibitors thereafter
3+ months of anticoagulation
80
when to use warfarin in tx of PE
factor Xa or direct thrombin inhibitors are not available and for patients with severe renal insufficiency
81
warfarin target INR range
2.0-3.0
82
when to tx PE with embolectomy
hemodynamically unstable PE in whom thrombolytic therapy is contraindicated
83
when to tx PE with vena cava filter
patients at high risk of recurrence who are unable to tolerate anticoagulants
84
Hx:
- CP
- SOB
- LE swelling
- Weight gain
- Orthopnea
PE:
- LE edema
- JVD
- Systolic: S3
- Diastolic: S4
Labs:
- CXR: Kerley B Lines
- Echo
- BNP >
CHF (exacerbation)
85
CHF tx
- Lasix
Systolic:
- Ace Inhibitor + β-blocker + Loop Diuretic
Diastolic:
- Ace inhibitor + β-blocker or CCB (do not use diuretics in stable chronic diastolic failure)
86
CHF pt edu
Low salt diet
| Med compliance
