Method of differential diagnosis
- Acquire and isolate pertinent data
- Isolate the “key features” and using semantic qualifiers, build a pt problem presentation. Look for pathognomonic sings or symptoms. Be aware of unusual features
- Choose a framework- anatomic, physiologic, mneumonic
- Apply key features to framework
- From the above, develop a “provisional diagnosis” along with the differential. Eliminate the unlikely by considering probability. Be aware of the critical entities not to miss. List other common diagnoses
Systems that may cause anatomic causes of chest pain
- CV
- Pulmonary
- MSK
- GI
- CNS/psychiatric
Pathognominic signs of ruberous sclerosis
- Facial fibromas
- Cardiac rhabdomyoma
- Ash leaf spot
Psoriasis pathognomonic sign
MI
The CPs not to miss
P4A3
- Pulmonary embolus
- Pneumothorax
- Perforated esophagus
- Pericarditis
- Acute MI
- Aortic aneurysm
- Acute chest syndrome
- Darrow says know
STEMI
Increasing troponin and ST elevation
NSTEMI
Increasing troponin and no ST elevation
Standard admission orders
D4A5
- Diagnosis (primary/differntial)
- Disposition (destination, condition)
- Drugs, home meds, O2
- Diet (IV fluids)
- Allergies
- Activity
- Assessment/nursing- vital signs, weight status, I and O
- Analysis, evaluation, workout
- Alleviation/treatment (meds, procedures, PT)
Global registry of coronary events score (GRACE)
Ranges from 2-372 with scores over 140 as very significant
- Age
- heart rate
- systolic blood pressure
- creatinine
- killip class (no CHF to cardiogenic shock)
- cardiac arrest at admission
- elevated cardiac markers
- ST segment deviation
Causes of pulmonary htn
Group 1: idiopathic pulmonary arterial htn (PAH)
Group 2: pulmonary htn owning to left sided heart disease
Group 3: pulmnoary htn owning to lung diseases and/or hypoxia
Group 4: chronic thromboembolic pulmonary htn (CTEPH)
Acute chest syndrome
occurs in sickle cell anemia as a pulmonary illness defined by a new infiltrate on chest radiograph in combination with at least 1 critical sign or symptom- chest pain, cough, wheezing, tachypnea, fever
- darrow says know
reduced blood flow to bone marrow
can cause painful ischemia and necrosis of the marrow, increased serume levels of free fatty acids and the enzyme secretory phospholipase A2 that occur during the syndrome are similar to the levels seen in the fat emboli syndrome.
Solves the unusual finding of extremity or bone pain in acute chest syndrome
VINDICATED
used in the mneumonic approach
- Vascular
- Infectious, inflammatory, infiltrative
- Neoplastic/neuromuscular
- Degenerative, deficiency
- Idiopathic, intoxication (drugs)
- congenital
- Autoimmune, allergic
- Traumatic
- Endocrine/metabolic, environmental
- Depression
- Darrow says know!
Causes of hypertension –> CRAMPS
- Coarctation, cuff too small
- CNS disease
- Renal parenchymal disease
- Renal vascular
- Aldosteronism
- Arteriosclerosis
- Medicaitons
- Myxedema, mellitus
- Pheochromocytoma, polycythemia
- Preclampsia, pseudohypertension
- Steroid excess, scleroderma
- Stroke volume increase
Miss CH ATRIEL
Causes of atrial fibrillation
- Mitral valve disease
- Inherited
- Sick (CHF symptoms)
- Sick sinus syndrome
- CHF
- HTN, holiday heart syndrome
- Atherosclerosis
- Thyrotoxicosis
- Rheumatic heart disease
- infiltrative and inflammatory process
- Embolus
- Lone AF
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CV and PV system66
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How to approach a clinical problem2
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rx writing18
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interpretation of clinical lab tests46
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Cardiac Auscultation Lab65
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Admitting orders15
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cardiovascular procedures25
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difficult patient13
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Community medicine21
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Shock Simulation cases53
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vasopressors and intropes21
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BATES43
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Shock Articles29
