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Terms in this set (317)
What lab order contains the "H&H" (hemoglobin and hematocrit)?
CBC (complete blood count)
What is the difference between a BMP and a CMP?
A CMP is a BMP+liver function tests (LFT's)
What part of the CBC does a "Differential" further characterize, RBC or WBC?
WBC (white blood cells)
What does Creatine measure?
Kidney function (insufficiency or failure) and whether a CT can be done
Is a high potassium level called "hyperkalemia" or "hypernatremia"?
What body organ do "LFT's" investigate?
Would "Aspartate Transaminase" be documented as "AST" or "ALT"?
Which cardiac enzyme is more specific to heart damage, Troponin or CK-MB?
What does a negative D-Dimer mean?
What does a positive D-Dimer mean?
Pt must be ruled out for PE; there is a blood clot somewhere. Pt must receive a CTA Chest or VQ scan
What does an elevated BNP diagnose?
Does the blood sample for an ABG come from a vein or an artery?
Name two parts of the "cardiac order set".
CBC, BMP, CK/CK-MB, Troponin, EKG, CXR
What procedure must first be performed before CSF can be obtained?
LP (lumbar puncture)
What do "Coag" lab tests examine?
Ability to form blood clots
Name one of the three "Coag" lab tests.
Prothrombin Time (PT), International Normalized Ratio (INR), Partial Thromboplastin Tine (PTT)
What does Lipase diagnose?
What do both "CRP" and "ESR" test for?
Active inflammation in the body
What is the difference between a Urine Dip and a Urine Micro?
Urine dip is quick and simple test performed at bedside and urine micro is more complex and sent to lab
Name one of the three labs that are particularly important to track for efficiency.
D-Dimer, Troponin, and Creatine (from BMP)
What type of body structures are XR's best suited to examine?
Bones (dense tissue)
Do emergency physicians interpret XR's or CT's?
Only XR's. CT's must be interpreted by a radiologist.
What is the difference between CT and CTA?
CT is without IV contrast a CTA is with IV contrast
What does an US of the RUQ rule out or diagnose?
Gallbladder problems (cholelithiasis or cholecystitis)
Name one type of Orthopedic Procedure that may be performed by the EP.
Splint application, joint reduction, arthrocentesis
What does I&D stand for?
Incision and drainage
Name two procedures that qualify the patient for critical care.
Central line placement, endotracheal intubation, CPR, CPAP/BiPAP, cardioversion, chest tube placement
What does LAD stand for as an EKG abbreviation?
Left Axis Deviation
Name two diagnoses that would qualify a patient for critical care time.
Acute MI, Unstable Angina, Acute Coronary Syndrome (ACS), A-Fib with RVR, Aortic Dissection, Bowel Perforation, Ectopic Pregnancy, Severe GI Bleeding, Severe AMS, Acute CVA, Overdoses, Acute CHF, Acute COPD Exacerbation, Severe Hypoxia, Allergic Reaction, Pnuemothorax, Pulmonary Embolism, Sepsis, Severe Trauma, Critically abnormal vital signs, Critically abnormal lab test results, Renal failure, Rhabdomyolysis, Severe dehydration, DKA
When might an ER doctor obtain a Physician Consult?
When needing a consult on a specialty or when deciding whether to admit or not.
Do any pt complaints belong in the physical exam?
If a pt says their abdomen feels very painful, can you automatically document "abdominal tenderness" in the physical exam? Why or why not?
No. Patient complaints are subjective and belong in the HPI. Only information coming from a physician belongs in the PE.
Which of these two physical exam findings could a physician appreciate without auscultating the pt's lungs:
a. No respiratory distress
b. No rales
No respiratory distress
What does PERRL stand for?
Pupils are Equal Round Reactive to Light
What does AT/NC mean?
What does NAD stand for?
No Acute Distress
If a pt has pale conjunctiva, what does that indicate?
What is scleral icterus, and what does it indicate?
Scleral icterus is yellowish pigmentation of the conjunctival membranes over the sclerae. This indicates liver failure.
Name an instrument a physician may use to closely investigate the eyes?
In which body system would you document "TM erythema and bulging"?
What is the medical term for nostril?
To describe a "runny nose" would the doctor use the word "epistaxis" or "rhinorrhea"?
What would dry mucous membranes indicate?
Why is midline bony tenderness "worse" than paraspinal tenderness?
Midline bony tenderness indicates spinal injury whereas paraspinal tenderness involves the muscles beside the spine.
If you saw "RRR" written in the cardiac exam, what do you think it might mean? (Hint: It is a normal cardiac finding)
Regular Rate and Rhythm
Name the rhythm that the physician would hear if the pt was in A-fib.
Irregularly Irregular Rhythm
If the phy checks the pulse on the right wrist and says " the pulses are fine", what would you document in the physical exam: a) Wrist pulse 5/5, right
b) Radial pulse OK
c) Right wrist pulse is fine
d) Right radial pulse is 2+
right radial pule is 2+
Name two "Peritoneal signs" in the abdominal exam?
Rigidity, Voluntary/Involuntary Guarding, Rebound Tenderness
What abdominal sign is indicated of Cholecystitis?
Murphy's sign: when there is tenderness while touching gallbladder
If the doctor takes 1 finger and presses in a specific spot in the RLQ, what is the name of the finding they are investigating?
Appendicitis; McBurney's point
Which of the findings is NOT a peritoneal sign:
Guarding, Rebound, Tenderness, Rigidity
What would a "Guaiac positive" stool sample diagnose?
Heme in stool
What phrase do you have to document in the GU exam for every female pelvic exam performed by a male physician?
Female Chaperone Present
What is bony tenderness a sign of?
Bone deformity, fracture, or injury
What is CVA tenderness?
Costovertebral Angle tenderness (flank pain)
What is fluctuance a sign of?
What is the difference between a laceration and abrasion?
Laceration is a cut and abrasion is a scrape
What procedure is associated with a laceration, but not an abrasion?
What does A&Ox3 mean?
Alert and Oriented to person, place, and time
What section of the neurological exam would you document "Normal Finger-Nose-Finger test" and "Normal-Heel-to-Shin"?
What does DTR stand for?
Deep Tendon Reflexes
Point to the general area of your body that Cranial Nerves (CN) control.
In the neurological exam, what does "Normal gait" mean?
In the psychiatric exam, what does SI and HI stand for?
Suicidal Ideation and Homicidal Ideation
Is the Glascow Coma Scale (GCS) associated with Trauma pts or Medical pts?
Would you document "RUE strength 3/5 under the "Neurological" or "Extremities" section of the exam?
What would you guess "TTP" means? (e.g. "TTP in the RUQ")
Tenderness to Palpation
A mother states her child has been extremely tired and drowsy recently; based on that, could you document "Lethargic" in the child's physical exam?
How is pancreatitis diagnosed?
Elevated lipase lab test
Name four possible CC's for a GI bleed pt.
Hematemesis, coffee ground emesis, hematochezia, melena
How is a GI bleed diagnosed in ED?
Heme positive stool/vomit (guaiac positive)
What are we worried about for someone with a GI bleed?
What is the pre-existing condition you must have before you can get diverticulitis?
What would be the CC for someone with diverticulitis?
What studies would diagnose diverticulitis?
CT A/P with PO contrast
What might a person with a SBO complain of?
Abdominal pain, vomiting, no BM's, distension, bloating
How is a SBO diagnosed?
CT A/P with PO contrast/ Acute Abdominal series (AAS)
What is a UTI?
Urinary Tract Infections (in bladder or urethra)
What is pyelo?
Pyelonephritis (infection of the tissue in the kidney's, usually spread from UT)
What will be the CC of someone with a UTI?
Where would a patient feel pain if they have pyelo?
How is a UTI diagnosed?
Urine dip or urinalysis (nitrite, WBC and bacteria in urine)
What might a person with kidney stones complain of?
Flank pain with sudden onset radiating to groin; hematuria, N/V, unable to void
How are kidney stones diagnosed?
CT Abd/Pelvis; RBC in UA may be a clue
What is an ectopic pregnancy?
Tubal pregnancy, fertilized egg develops outside the uterus
How is ectopic pregnancy diagnosed?
What is ovarian torsion?
Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting infarct of the ovary
How is ovarian torsion diagnosed?
Name the 2 types of CVA's (strokes).
Hemorrhagic and Ischemic
What sx might a person with a brain bleed c/o?
Headache with sudden onset (thunderclap); changes in speech, vision, sensation, motor strength; AMS, seizure
What study would diagnose a bleed?
CT Head or LP
What sx might a person with an ischemic CVA c/o?
Unilateral focal neurological deficits: one sided weakness/numbness or changes in speech/vision
How is ischemic CVA diagnosed?
What is a TIA?
Transient Ischemic Attack; vascular changes temporarily deprive a part of the brain of oxygen- symptoms typically last less than an hour
How does a TIA differ from a CVA?
Effects are transient and condition proves rapidly
what is a common cause for seizures in children?
What is the name of the state after a seizure?
What are 3 symptoms of meningitis?
AMS, Fever, Neck Pain/Stiffness
What would diagnose meningitis?
What are 4 important things to document for syncopal episodes?
what happened prior, during and after syncopal episode and how patient currently feels.
Name 4 causes of altered mental status.
hypoglycemia, infection, intoxication, and neurological
How is AMS different from a focal neuro deficit?
AMS is generalized and caused by things that affect the whole brain
What is DVT?
Deep Vein Thrombosis: Blood clot in an extremity (usually in calf)
What are the risk factors for a DVT?
PMHx of DVT or PE, FHx, Recent Surgery, Cancer, Immobility, Pregnancy, BCP, Smoking, LE Trauma, LE Casts
What are common signs of DVT?
Extremity pain and swelling
What is an AAA?
Abdominal Aortic Aneurysm: Widened and weakened arterial wall at risk of rupture
What is an aortic dissection?
Separation of the muscular wall from the membrane of the artery, putting the pt at risk of aortic rupture and death
What are 3 symptoms of cellulitis?
Red, swollen, painful, and sometimes warm area of skin
How is abscess different from cellulitis?
An abscess will always have a pus pocket
What procedure will be performed for every abscess?
Incision and Drainage
What is the main concern with an allergic reaction?
Anaphylaxis or Respiratory failure
What are the ONLY three symptoms of a true allergic reaction?
Rash, itching, swelling
How can Diabetic Ketoacidosis (DKA) be diagnosed?
Arterial Blood Gas (ABG or VBG) showing low pH (acidosis) or Positive Serum ketones
What is the Emergency Physician's main responsibility for psychiatric patients?
Name 3 important things to document for any trauma patient.
Blood thinning medications, MOI, GCS
Normal, nothing of concern
A patient's inability to tolerate their body-state, due to pain or respiratory failure
The state of having a fever, concerning for infection
New onset, likely concerning
Long-standing, not of direct concern
An individual's normal state of being
Listening with a stethoscope
The act of pressing on an area (by the doctor)
Admitted to the hospital overnight
Seen and sent home the same day
Delivered through a vein
Brief injection through the vein
In tandem with, usually with normal saline
Directly into the muscle
Directly into the skin
Orally, by mouth
Rectally, into the rectum
Under the tongue
Droplet; example ophthalmic eye drops
Continuous injection through a vein
Directly through the skin
How to Write Medication Orders
Medication Name -> Dosage or Strength -> Route
total body swelling
The disease that a physician is considering as the reason for the patient's symptoms OR a diagnosis of symptoms of two or more diseases by comparison
The bottom aperture of the internal surface of a hollow organ; often referring to the uterus or eye
Excessive or profuse bleeding
persistently high atrial blood pressure (typically >140/90)
persistently low atrial blood pressure (typically <100/65)
Area of dead tissue following prolonged ischemia
Localized lack of blood supply to an area
Any body orifice
Able to be touched or easily perceived
Persistent thirst or frequent drinking of liquids; possibly indicative of diabetes
The breaking-open of a bodily structure
Dangerous infection of the blood with pathological microorganisms or their toxins
a forcible pulling away of a part or structure
a crackling or grating sound usually of bones
escape of fluid into a cavity
tumor consisting of blood vessels
star-shaped, radiating from the center
Acute on chronic
New exacerbation of a chronic condition
Symptoms that are always present but changing in severity, never fully resolving
Symptoms that completely resolve at times, but continue to return repeatedly
Occasional, sporadic, transient
Gone, no longer existing
Resolving spontaneously after onset
Draws away from the midline
Draws toward the midline
Able to move about, not confined to a bed
To stand erect with arms at the sides and palms of the hands turned forward
Situated in front of or directed toward the front
Connection between bones; joint
Toward the feet
Toward the head
Pertaining to the neck or to the cervix of the uterus
Farther from the surface
Spread out over a wide area
Farther from the limb root
Backward flexion, as in bending backward either a hand or foot
Bending or angulation
Divides the body into anterior and posterior parts
Lower, farther from the crown
Farther from the midline
That which raises
Nearer to the midline
Divides the body into left and right
Palmer or Volar
Palm side of hand or body
Sole of foot
Posterior or Dorsal
Rear or back
That which turns palm of hand downward
Body position lying face down with forearms and hands turned palm side down
Nearer to the limb root
Pertaining to the radial (lateral) side of the arm
Nearer to the surface
Upper, nearer to crown of head
That which turns palm of hand upward
Body position lying face up
Right angles to long axis; divides the body into upper and lower parts
Pertaining to the ulnar (medial) side of the arm
Looking around, awake, attentive
The state of the patient's body, often referring to obesity
Extremely skinny, bony, malnourished
The general appearance and nature of a patient
General appearance of lacking water; dry lips, dry mucosa
Extremely thin and malnourished, wasting
Not appearing healthy
When an infant or baby cannot be made to stop crying
Generalized feeling of discomfort or lack of well-being
Poor nutritional state
Appearing stable and at no risk of deterioration
The state of crying, or being about to cry
Does not follow commands or go along with physician requests
Poor self hygiene
Normal state of mental and body development
ATNC; Normal external head inspection
Bruising behind the ears, indicative of a basilar skull fracture
Disease of the brain
Swelling of the face often secondary to an allergic reaction
Anatomical feature of an infant's skull, the "soft-spot"
The forehead and the anterior top of the skull
Infection of the meninges, the membranes that contain the brain and spinal cord
The most posterior part of the skull, the back of the head
Location across the posterior top of the skull
Bruising around the eyes, indicative of a basilar skull fracture
Infection of the sinuses, usually causing sinus pressure
The sides of the head, near the temples
Fill in the blanks for ED flow:
Walk-in --> ____ --> Bed --> Physician Assessment --> Lab/Rad/Meds --> Results --> MDM --> Diagnosis --> Consults --> ____
What are the 5 vital signs?
Heart Rate (HR), Blood Pressure (BP), Respiratory Rate (RR), Temperature [
F] (T), Oxygen Saturation [%] (SaO2)
The HPI and ROS are what type of information (subjective or objective)?
The Physical Exam is what type of information (subjective or objective)?
While evaluating a patient complaining of chest pain, your physician tells you that the heart sounds are normal. Would you document it in the HPI, ROS, or PE?
PE (Physical Exam)
Would you be contradicting yourself if you wrote "The patient has abdominal pain" in the HPI, but then later in the physical exam documented "The abdomen is non tender." Why or why not?
No. Patient complaints are subjective and the physical exam is objective.
What is the difference between the HPI and ROS?
While both the HPI and ROS are subjective, HPI stands for History of Present Illness and ROS stands for Review of Systems. HPI deals with acute and chief complaint while ROS is everything.
What does disposition (dispo) mean?
What sub categories are included within the Past History section of the template?
PMHx (Past Medical History) such as cardiac, pulmonary, and psychological.
PSHx (Past Surgical History) such as orthopedic, vascular, and neurological.
FHx (Family History) such as abdominal, neurological, and general.
SHx (Social History) such as tobacco use, illicit drug use, and alcohol (EtOH) abuse.
What is the abbreviation for cardiac bypass?
CABG (Coronary Artery Bypass Graft)
What is the abbreviation for high blood pressure?
What is the medical term for acid reflux?
GERD (Gastroesophageal Reflux Disease)
What is the medical term for stroke?
Cerebrovascular Accident (CVA)
What is the term for gallbladder removal?
What does NKDA stand for?
No Known Drug Allergies
What is the medical term for redness?
What is the medical term for bruising?
If the doctor says the exam was "benign", what does that mean?
Normal, of no danger to health
What is CAD?
Coronary Artery Disease
What other past histories would suggest that a pt has CAD?
Angina, MI. CABG, Cardiac stents, Angioplasty
Does a PMHx of CVA mean the pt has CAD?
Does a surgical history of angioplasty mean that the pt has CAD?
Explain the difference between CAD and an MI.
CAD (Coronary Artery Disease) is the narrowing of the coronary arteries which limits blood supply whereas MI (Myocardial Infarction) is a blockage of the coronary arteries resulting in ichemia and infarct of the heart muscle.
If someone has a PMHx of A-Fib or CHF, do they also have CAD?
What are the "cardiac risk factors?"
SOB, FHx of CAD <55, CP, N/V, CAD, HTN, HLM, DM, Smoker
How is CAD diagnosed?
Cardiac Catheterization (not in ER)
Name two ways that an MI can be diagnosed?
ECG/EKG (STEMI) or Elevated Troponin (Non-STEMI)
What are some associated symptoms of an MI other than CP?
Chest pressure with diaphoresis, N/V, SOB
What are some associated symptoms for CHF?
SOB, Orthopnea, Pedal Edema
What 2 studies would diagnose CHF?
CNX or Elevated BNP (B-Type Natriuretic Peptide)
What is A-Fib?
Atrial Fibrillation; Electrical abnormalities in the "wiring" of the heart causes the top of the heart (atria) to quiver abnormally
What might someone feel like with A-Fib?
Palpations (Fast, Pounding, Irregular)
How is A-Fib diagnosed?
What could be the CC of someone with a PE?
SOB or Pleuritic chest pain (CP worse with deep breaths)
What are the risk factors for a PE?
Known DVT, PMHx of DVT or PE, FHx, Recent surgery, Cancer, A-Fib, Immobility, Pregnancy, BCP, Smoking
What study would diagnose a PE?
CTA Chest (CT Chest w/ IV contrast) or VQ Scan
What part of the heart does CAD affect; Arteries, Veins, or Nerves?
Can a CT Chest without IV contrast diagnose a PE? Why or why not?
No. The IV contrast is needed to image the vasculature. It will not come out without the contrast. The circulation won't be visible.
What is a PTX?
Pneumothorax (Collapsed Lung)
What is the most common cause of a PTX?
How is a PTX diagnosed?
What social history will most COPD patients also have?
What is the difference between a inhaler and a nebulizer for asthma?
Hand device vs Machine
What is asthma?
Constricting of the airway due to inflammation and muscular contraction of the bronchioles, known as a "bronchospasm."
What physical exam finding closely associates with asthma?
What is PNA?
Pneumonia - Infiltrate (bacterial infection) and inflammation inside the lung
What might a person with PNA complain of?
SOB, fever, productive cough
How is PNA diagnosed?
Name all 7 areas of the abdomen.
Epigastrium, RUQ, LUQ, RLQ, RLQ, Periumbilical, Suprapubic
What is the laymen's name for GERD?
What might someone with GERD complain of?
Epigastric pain (burning, improved with antacids)
For older patients with GERD symptoms, what life-threatening disease may also need to be be ruled out?
What does bile do? Where is it stored?
Helps to break down fat; gallbladder
What is the difference between cholelithiasis and cholecystitis?
gallstone vs. inflammation of the gallbladder
What might be the chief complaint of a person with gallstones?
RUQ Pain (Sharp, Worsened with eating, deep breaths, and palpation)
What physical exam finding is closely associated with cholecystitis?
RUQ tenderness, Murphy's sign
How are gallstones diagnosed?
Abdominal US, RUQ
Name associated symptoms of appendicitis
Decreased appetite, fever, N/V
How is appendicitis diagnosed?
CT A/P with PO Contrast
What would someone with pancreatitis c/o?
LUQ, Epigastric pain
Spell the medical term for "Hives" (allergic reaction rash)
What is the medical term for "Swollen lymph nodes?"
If you document "There is right pronator drift" in the neurological exam, can you also document "No focal neurological deficits"?
If you documented "NAD" in the constitutional section, would you be contradicting yourself if you wrote "There is mild respiratory distress" in the pulmonary exam?
Unequal diameter of pupils
Thin outer lining of the eye and eyelid
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