1
Q
What Conditions are Individuals > 60yrs at Risk for?
A
Hypertension
PE
Neurogenic Claudication
DVT
AAA (Male)
2
Q
What Conditions are Individuals > 50yrs at Risk for?
A
Patients Visiting Clinics Should Consider Options Seriously, Please.
Peripheral Artery Disease
Vascular Claudication
Cervical Spondylotic Myelopathy
Spinal Metastasis
Colon Cancer (Male)
OA (>55yrs, Female)
Spinal Compression Fracture (Female)
Pathological Hip Fracture (Female)
3
Q
What Conditions are Individuals < 50yrs at Risk for?
A
RA (Female)
4
Q
What Conditions are Individuals > 45yrs at Risk for?
A
Cellulitis
5
Q
What Conditions are Individuals < 45yrs at Risk for?
A
Acute Compartment Syndrome (Female)
6
Q
What Conditions are Individuals > 40yrs at Risk for?
A
Gout (Male)
7
Q
What Conditions are Individuals < 35yrs at Risk for?
A
Acute Compartment Syndrome (Male)
8
Q
What Conditions are Individuals < 20yrs at Risk for?
A
Diabetic Ketoacidosis
9
Q
What Conditions are Individuals 40 - 60 yrs at Risk for?
A
Greater Trochanteric Pain Syndrome (Female)
10
Q
What Conditions are Individuals 20 - 60 yrs at Risk for?
A
Mechanical LBP
* Somatic Referred
* Radicular Pain w/ Radiculopathy
* Radicular Pain w/out Radiculopathy
Mechanical Neck Pain
* Somatic Referred (Peaks 40 - 50 yrs)
* Radicular Pain w/ Radiculopathy (Peaks 50 - 54)
* Radicular Pain w/out Radiculopathy (Peaks 50 - 54)
11
Q
What Conditions are Individuals 20 - 55 yrs at Risk for?
A
Cauda Equina (Male)
12
Q
What Conditions are Individuals 20 - 50 yrs at Risk for?
A
Avascular Necrosis of the Femoral Head (Male)
13
Q
What Conditions are Individuals 15 - 40 yrs at Risk for?
A
Ankylosing Spondylitis (Male)
14
Q
What Conditions are Individuals 12 - 13 yrs at Risk for?
A
Slipped Capital Femoral Epiphysis (Male)
15
Q
What Conditions are Individuals 4 - 10 yrs at Risk for?
A
Legg Calve Perthes Disease (Male)
16
Q
Conditions of the Neck
A
Mechanical Neck Pain
* Somatic or Non-Specific Neck Pain
* Radicular Pain With Radiculopathy
* Radicular Pain Without Radicuplopathy
Cervical Spondylotic Myelopathy
Atlantoaxial Instability
ALWAYS Consider:
Cancer
Infection
Potential Consideration:
RA
17
Q
Conditions of the Leg
A
COPS VAD
Cellulitis in Leg
Osteomyelitis
Peripheral Artery Disease
Septic Arthritis
Vascular Claudication
Acute Compartment Syndrome
Deep Vein Thrombosis (DVT)
ALWAYS Consider:
Cancer
Infection
Potential Consideration:
RA
OA
18
Q
Conditions of the Hip
A
Colon Cancer
Greater Trochanteric Pain Syndrome
Pathological Hip Fracture
Avascular Necrosis of Femoral Head
Slipped Capital Femoral Epiphysis
Legg Calve Perthes Disease
ALWAYS Consider:
Cancer
Infection
Potential Consideration:
RA
OA
19
Q
Conditions of the Spine
A
Mechanical Low Back Pain
* Somatic Referred Pain)
* Radicular Pain With Radiculopathy
* Radicular Pain Without Radiculopathy
Cauda Equina Syndrome
Ankylosing Spondylitis
Neurogenic Claudication
Spinal Compression Fracture
ALWAYS Consider:
Cancer
Infection
Potential Consideration:
RA
20
Q
Conditions of the Joints
A
Osteroarthritis (OA)
Rheumatoid Arthritis (RA)
Gout
21
Q
Systemic Conditions
A
True EMERG (3)
* Myocardial Infarction
* Pulmonary Embolism
* Abdominal Aortic Aneurysm
Vessels (3)
* Angina
* Hypertension
* Peripheral Artery Disease
Metabolic (3)
* Diabetic Ketoacidosis
* Hypoglycemia
* Hyperglycemia
22
Q
What is Angina?
Course of Action?
A
Myocardial Ischemia When Oxygen Demand Exceeds Supply
REFER, semi-urgent
23
Q
Discriminating Features: Angina
A
Pain
* Moderate Chest Pain, Tightness, and Discomfort
* Related to Tone (Diameter) in Arteries
* Consistent Pain
* Male: Chest, Neck, Arm Pain
* Female: Scapula, Jaw, Tooth Pain
Onset
* Exertion
* Emotion
* Cold
* Large Meal
Lag Time
* Pain Starts 5-10 Minutes After Activity Starts
* Pain Ends 3-5 Minutes After Activity Ceases
Worse with Lying Down
Subsides with Rest or Nitroglycerin
24
Q
What is Myocardial Infarction?
Course of Action?
A
Narrowing or Complete Occlusion of Coronary Artery Causing Infarction (Cell Death)
REFER, TRUE EMERG
25
Discriminating Features: Myocardial Infarction
Pain
* Sudden, Severe, Crushing, Intolerable Pain
* Pain Radiating to Left Arm, Throat, Neck, and Back
* Constant Pain for 30 Min to Hours
* Pain Related to Ischemia
* "Feeling of Doom"
* Can Be Painless/Silent
SUDDEN Onset
UNRELIEVED by Rest, Change in Position, or Nitroglycerin
26
What is Hypertension?
Course of Action?
High Blood Pressure
Normal BP:
SBP < 120 mmHg
DBP < 80 mmHg
Elevate BP:
SBP 120 - 129 mmHg
DBP < 80 mmHg
Stage 1 HTN:
SBP 130 - 139 mmHg
DBP 80 - 89 mmHg
Stage 2 HTN
SBP ≥ 140 mmHg
DBP ≥ 90 mmHg
REFER, relatively soon
27
Signs of Hypertension
> 60 Years
Morning headache, nighttime pee,
Vision changes bothering me.
28
What is Peripheral Artery Disease/Vascular Occlusive Disease?
Course of Action?
Narrowing of Arteries due to Atherosclerosis
REFER, relatively soon
29
Discriminating Features: Peripheral Artery Disease / VOD
> 50 Years
Pain
* Dull, Aching Pain
* Constant, Intermittent, or Neurogenic Claudication
Loss of Pulse Below Occlusion
Numbness in Foot
Aggravated by Elevating Foot
Relieved by Hanging Foot over the Side of Chair
30
What is Abdominal Aortic Aneurysm
(AAA)?
Course of Action?
Aortic Aneurysm
Vessel Dilation > 50% of Normal
Risk of Rupture when > 5cm
Rupture: REFER, TRUE EMERG
31
Discriminating Features: AAA
> 60 Years
Male
Pain
* Low Back or Abdominal Pain
* Constant or Intermittent
* Sharp, Intense, Knifelike
* Rupture: Hot, Searing, Ripping
Early Satiety
Weight Loss
Nausea
Palpable Mass in Abdomen
UNRELIEVED with Change in Position or Spinal Movement
32
What is a Pulmonary Embolism?
Course of Action?
Blockage of Artery in the Lungs
(Clot, Air, Fat, Marrow)
REFER, TRUE EMERG
33
Discriminating Features: Pulmonary Embolism
> 60 Years
Pleuritic Chest Pain
(Intensifies with Deep Breath or Cough)
SLIP PIA
Lungs
* SoB (Dyspnea)
* Low O2 Saturation
* Increased Respiratory Rate (Tachypnea)
* Persistent Cough
Heart
* Palpitations
* Increased HR (Tachycardia)
* Anxiety
Significant Risk Factor: DVT
34
What is Diabetic Ketoacidosis?
Course of Action?
Ketones in Blood
(Type I Diabetes)
REFER, TRUE EMERG
35
Signs of Diabetic Ketoacidosis
Sweet, Dry, Weak, Fast
* Fruity Breath
* Dehydration
* Weak
* Rapid Pulse
* Laboured Breathing
Often During Exertion
36
What is Hypoglycemia?
Course of Action?
Low Blood Sugar
Honey or Fruit Juice (Fast Acting Glucose)
REFER, semi-urgent
37
Signs of Hypoglycemia
Headache, weak, nervous, shaky,
Irritable, sleepy, confused, dizzy.
* Headache
* Weakness
* Nervousness
* Shakiness
* Irritability
* Sleepiness
* Confusion
* Dizziness
* Lightheadedness
38
What is Hyperglycemia?
Course of Action?
High Blood Sugar
Honey or Fruit Juice (Fast Acting Glucose)
REFER, semi-urgent
39
Signs of Hyperglycemia
THUNDER
* Thirsty
* Hungry
* Urnate frequently
* Nausea
* Dry Skin
* Eyes Blurry
* Run down (drowsy)
40
What is OA?
Course of Action?
Degeneration of Articular Cartilage in Joint
Treat & Monitor
41
Discriminating Features: OA
> 50 Years, Unless Previous Trauma
> 55 Years THEN Female > Male
Pain:
* Monoarticular
* Asymmetrical
* Hip, Knee, PIP, DIP, and Thumb CMC
* Aggravated w/ Activity
Stiffness < 30 Min
Gradual Onset
42
What is RA?
Course of Action?
Inflammation in Joints
(Chronic Autoimmune Disease)
REFER, semi-urgent
43
Discriminating Features: RA
< 50 Years (Peak 35 - 50)
Female
Genetic
Pain:
* Unexplained Joint Pain
* Polyarticular
* Symmetrical & Bilateral
* Small Joints of Hands and Feet (MCP, PIP, MTP)
Synovial Swelling
Stiffness > 30 Min
Gradual Onset
44
What is Gout?
Course of Action?
Arthritis due to Increased Serum Urate Levels
REFER, URGENT
45
Discriminating Features: Gout
> 40 Years
Male
Pain:
* Rapid, Sudden, Severe Pain
* Monoarticular
* MTP Joint of Great Toe
Swelling
Hot Joint
Erythema (Redness)
SUDDEN Onset (< 24 Hours)
46
What is Mechanical LBP w/ Somatic Referred Pain?
Course of Action?
Pain from MSK Structure in the Back
Treat
47
Discriminating Features: Mechanical LBP w/ Somatic Referred Pain
20 - 60 Years
Pain:
* Back Dominant Pain
* Deep, Achy Pain
* Poorly Localized Pain
* Non-Dermatomal Pattern
NO Neuro Signs or Symptoms
48
What is Mechanical LBP w/ Radicular Pain WITHOUT Radiculopathy?
Course of Action?
Inflammation or Compression of Spinal Nerve Root
Treat & Monitor
49
What is Mechanical LBP w/ Radicular Pain WITH Radiculopathy?
Course of Action?
Inflammation or Compression of Spinal Nerve Root
WITH Neuro Signs & Symptoms
Treat & Monitor
50
Discriminating Features: Mechanical LBP w/ Radicular Pain WITHOUT Radiculopathy
20 - 60 Years
Pain:
* Leg Dominant
* Referred Pain in Dermatomal Pattern Below Knee
* Severe, Sharp, Shooting, Electric
* Constant
Numbness and Paresthesia in Foot
Aggravated by Change in Lumbar Position and Movement Stretching Nerve Root
51
Discriminating Features: Mechanical LBP w/ Radicular Pain WITH Radiculopathy
20 - 60 Years
Pain:
* Leg Dominant
* Referred Pain in Dermatomal Pattern Below Knee
* Severe, Sharp, Shooting, Electric
* Constant
Numbness and Paresthesia in Foot
Aggravated by Change in Lumbar Position and Movement Stretching Nerve Root
RADICULOPATHY:
* Loss of Sensation in Dermatomal Pattern
* Muscle Weakness in Myotomal Patern
* Impaired Reflexes
52
What is Neurogenic Claudication?
Course of Action?
Symptoms of Spinal Stenosis
Compression of Spinal Cord and Nerves due to Narrowing of the Vertebral Canal and Intervertebral Foramen
Treat & Monitor
53
Discriminating Features: Neurogenic Claudication
> 60 Years
Pain:
* Leg Dominant
* Bilateral
* Intermittent Buttock and Leg Pain
* Pain Predictable and Reproducible
* Aggravated by Activity
Compromised Gait
* Intermittent Buttock and Leg Weakness
Foot Pulse Normal and Symmetrical
Eased by Spine Flexion (Shopping Cart) & Sitting
54
What is a Spinal Compression Fracture?
Course of Action?
Vertebrae Collapsing or Compressing
(Commonly T8 - L4)
REFER, urgent
55
Discriminating Features: Spinal Compression Fracture
>50 Years
Risk Increases > 65 Years
Female
Severe Back Pain and Spasm
Abrasion or Contusion from Trauma
Significant RF:
* Prolonged Steroid Use
* History of Osteoporosis
56
What is Cauda Equina?
Course of Action?
Compression of the Dural Sac & Descending Nerve Roots Below
REFER, TRUE EMERG
57
Discriminating Features: Cauda Equina
20 - 55 Years
Male
Pain:
* Severe Back Pain
* Radicular Leg Pain
* Worsening
Bowel & Bladder Dysfunction
Saddle Anesthesia
58
What is Ankylosing Spondylitis?
Course of Action?
Progressive, Chronic Inflammatory Arthropathy of SI Joints & Axial Skeleton
(Fusion on Vertebral Bodies)
REFER, semi-urgent
59
Discriminating Features: Ankylosing Spondylitis
15 - 40 years
Male
Pain:
* Back Pain
* Alternating Buttock Pain
* Night Pain
* Aggravated w/ Rest
* Eased w/ Activity
Morning Stiffness > 30 Min
Gradual Onset
60
What is Colon Cancer?
Course of Action?
Cancer in the Colon
REFER, ugent
61
Discriminating Features: Colon Cancer
> 50 Years
Male
Pain:
* Abdominal, Back, Sacral, Pelvic Pain
* Vague, Aching, Cramping Pain
* Pain UNCHANGING
Change in Bowel Habits
Fatigue & SoB (Dyspnea) due to Anemia
New Unexplained Weight Loss
Significant RF: History of Cancer
62
What is a Pathological Hip Fracture?
Course of Action?
Fracture Cause by Underlying Disease Weakening the Bone
REFER, urgent
63
Discriminating Features: Pathological Hip Fracture
> 50 years
Female
Pain:
* Acute, Severe, Constant Pain
* Hip, Groin, Anterior Thigh Pain
* Aggravated by Movement & WBing
Hip Positioned in External Rotation
Antalgic Gait Pattern
Acute Onset
* Minor or NO Trauma
Significant RF:
* Osteoporosis
* Corticosteroid Use
* Metabolic Disease
* Cancer
64
What is Greater Trochanteric Pain Syndrome?
Course of Action?
Inflammation of Trochanteric Bursa
Treat & Monitor
65
Discriminating Features: Greater Trochanteric Pain Syndrome
40 - 60 Years
Female
Lateral Hip, Lateral Thigh, and Gluteal Pain
Unable to Lie on Affected Side
Trochanteric Tenderness
NO Neuro Signs
66
What is Avascular Necrosis of the Femoral Head?
Course of Action?
Death of Bone Tissue in the Head of the Femur Due to Decreased Blood Supply
REFER, semi-urgent
67
Discriminating Features: Avascular Necrosis of Femoral Head
20 - 50 Years
Male
Pain:
* Progressive Hip Pain
* Aggravated by WBing
Limited ROM: Flexion, Abduction, Internal Rotation
Gradual Onset
Significant RF: CASIA
* Corticosteroid Use
* Autoimmune Disease Medications
* Sickle Cell
* Immunosupressant Use
* Alcohol Abuse
68
What is Slipped Capital Femoral Epiphysis?
Course of Action?
Slippage of Femoral Head off of the Growth Plate
REFER, semi-urgent
69
Discriminating Features: Slipped Capital Femoral Epiphysis
12 - 13 Years
Male
Pain:
* Groin, Thigh, Knee Pain
* Pain Worsening
* Diffuse, Vague Pain
* Aggravated by WBing
Hip Positioned in External Rotation
Gradual Onset
Commonly:
* Recent Growth Spurt
* High Activity Level
* Overweight
Significant RF:
* Hypothyroidism
* Renal Condition
* Growth Hormone Deficiency
* Down Syndrome
* African/Black
* Pacific Islands
* Latinx
70
What is Legg Calve Perthes Disease?
Course of Action?
Temporary Loss of Blood Supply to the Head of the Femur Leading to Bone Tissue Death
REFER, semi-urgent
71
Discriminating Features: Legg Calve Perthes Disease
4 - 10 Years
Male
Pain:
* Groin, Thigh, Knee Pain
* Pain Worsening
* Aggravated by WBing
Limited Range: Flexion, Abduction, Internal Rotation
Limb Appears Shortened
Gradual Onset
* NO Cause (idiopathic Blood Loss)
72
What is DVT?
Course of Action?
Blood Clot in Deep Vein
(Often Leg)
REFER, TRUE EMERG
73
Discriminating Features: DVT
> 60 yrs
Unilateral Calf Pain
Calf Tenderness
Warmth in Thigh or Leg
Redness in Thigh or Leg
Calf Edema (Pitting)
> 3cm Compared to Other Side
Dilated Superficial Veins
Significant RF:
Hypercoagulability of Blood
* Major Surgery
* Trauma
* Malignancy/ Cancer
Circulatory Stasis
* Immobility
* Paralysis
Vessel Wall Damage
Previous DVT
Oral Contraceptives
74
What is Acute Compartment Syndrome?
Course of Action?
Muscle and Nerve Ischemia due to Tissue Pressure in Closed Muscle Compartment Exceeding Profusion Pressure
REFER, TRUE EMERG
75
Discriminating Features: Acute Compartment Syndrome
< 45 yrs, Female
< 35 yrs, Male
Pain:
Severe Pain
Aggravated by Passive Stretch
Numbness (Paresthesia)
Motor Weakness (Paresis)
Traumatic Event
76
What is Septic Arthritis?
Course of Action?
Infection of Joint and Synovium
REFER, URGENT
77
Discriminating Features: Septic Arthritis
Pain:
* Monoarticular
* Hip, Knee, Shoulder
Low Grade Fever
Chills
Night Sweats
Fatigue
Rapid Onset
Significant RF:
* Age
* Source of Infection (Gonococcal)
78
What is Osteomyelitis?
Course of Action?
Infection of Bone
REFER, URGENT
79
Discriminating Features: Osteomyelitis
Local Bone Pain
Local Bone Tenderness
Pain & Difficulty w/ WBing
Chills
Fever
Night Sweats
Fatigue
Slow Onset
Significant RF:
* Diabetes
* Age
* Source of Infection (Staphylococcus)
80
What is Cellulitis?
Course of Action?
Bacterial Skin Infection
REFER, URGENT
81
Discriminating Features: Cellulitis
> 45 yrs
Pain
Swelling
Redness
Warmth
82
What is Vascular Claudication?
Course of Action?
Muscle Ischemia due to Metabolic Demands Exceeding Blood Flow
REFER, relatively soon
83
Discriminating Features: Vascular Claudication
> 50 yrs
Pain:
Intermittent
Reproducible
Aggravated by Activity
Eased by Rest
NO Neuro Signs or Symptoms
84
What is Mechanical Neck Pain w/ Somatic Referred Pain?
Course of Action?
Pain Arising from MSK Structure in Neck
TREAT
85
Discriminating Features: Mechanical Neck Pain w/ Somatic Referred Pain
20 - 60 yrs
(Peaks 40 - 50yrs)
Pain:
* Neck Dominant
* Poorly Localized
* Pain in Non-Dermatomal Pattern
NO Neuro Signs or Symptoms
NO Worrisome Cluster of Red Flags
86
What is Mechanical Neck Pain w/ Radicular Pain Without Radiculopathy?
Course of Action?
Compression or Inflammation of Spinal Nerve Root
Lower Motor Neuron Disorder
TREAT & MONITOR
87
Discriminating Features: Mechanical Neck Pain w/ Radicular Pain Without Radiculopathy
35 - 60 yrs
Peaks (50 - 54yrs)
Pain:
* Arm Dominant
* Constant
* Sharp, Shooting, Electric
* Referred Pain in Dermatomal Pattern Below Elbow
Numbness and Tingling in Hand
88
What is Mechanical Neck Pain w/ Radicular Pain WITH Radiculopathy?
Course of Action?
Compression or Inflammation of Spinal Nerve Root
Lower Motor Neuron Disorder
TREAT & MONITOR
89
Discriminating Features: Mechanical Neck Pain w/ Radicular Pain WITH Radiculopathy
35 - 60 yrs
Peaks (50 - 54yrs)
Pain:
* Arm Dominant
* Constant
* Sharp, Shooting, Electric
* Referred Pain in Dermatomal Pattern Below Elbow
Numbness and Tingling in Hand
Radiculopathy:
* Loss of Sensation in Dermatomal Pattern
* Muscle Weakness in Myotomal Pattern
* Impaired Reflexes
90
What is Cervical Spondylotic Myelopathy?
Course of Action?
Chronic and Progressive Compression of Spinal Cord due to Narrowing of Spinal Canal
REFER, urgent
91
Discriminating Features: Cervical Spondylotic Myelopathy
> 50 Years
Bilateral Arm Pain
Early Signs:
*Buzzing at Both Ends*
* Bilateral Hand Paresthesia
* Bilateral LE Paresthesis
Intermediate Symptoms
*Losing CONTROL*
* Coordination Difficulty
* Overreactive Reflexes
* Noisy Gait
* Tiny Hand Muscles (Intrinsic) Atrophy
* Reflex Signs (Babinski, Clonus, Spasticity)
* Oops! Dropping Things (Fine Motor Control Difficulty)
* Losing Balance
Later Symtpoms
* LE Weakness
* Bowel and Bladder Incontinence
92
What is Spinal Metastases?
Course of Action?
Cancer in Vertebrae
REFER, urgent
93
Discriminating Features: Spinal Metastases
> 50 Years
(Increased Risk > 65yrs)
Pain:
* Non-Mechanical Neck, Shoulder, Back Pain
* Pain Worsening
* Deep Bone Pain
New Unexpected Weightloss
Significant RF: History of Cancer
94
What is a Spinal Infection?
Course of Action?
Infection of Vertebra
REFER, urgent
95
Discriminating Features: Spinal Infection
Non-Mechanical Neck Pain
Fever
Chills
Night Sweats
Mechanism of Infection
Late Neuro Signs:
* Loss of Sensation in Dermatomal Pattern
* Muscle Weakness in Myotomal Pattern
* Impaired Reflexes
* Incontinence
96
What is Atlantoaxial Instability?
Course of Action?
Excessive Movement Between C1 & C2 – Leading to Impingement and Compression of Spinal Cord
REFER, urgent
97
Discriminating Features: Atlantoaxial Instability
Neck Pain
Head "Thumbing" Anteriorly w/ Neck Flexion
BIG SHOCK LAB
* Bilateral Limb Symptoms
* Intermittent Cord Signs
* Gait Problems
* Spasticity
* Hyper Reflexive
* Out of Control Bowel and Bladder
* Clonus
* (K)Coordination and Balance Problems
* Lhermitte Sign
* A Headache
* Babinski Sign
Significant RF:
* RA
* Down's Syndome
* Marfan's Syndrome
* Trauma (MVA, Tackle)
* Pathological fracture
* Infection
98
What is Triage-TiTrATE?
Triage
Timing (Ti)
Triggers (TR)
Sub-Groups (a)
Targeted Exam (TE)
99
What is Triage in Triage-TiTrATE?
Screen for obvious red flag conditions
If identified, REFER
100
In Triage for Vestibular Syndrome, What Red Flags Are Being Screened?
CANIN
* Cardiovascular Symptoms
* Altered Mental State & Alertness
* Neurlogical Symptoms
* Infection
* Neck Pain (Severe Thunderclap Neck Pain & Headache)
101
What is Timing in Triage-TiTrATE?
Assess key aspects of symptoms:
* Onset
* Duration
* Evolution
102
What Are the Timing Groups of Vestibular Syndrome?
Episodic
* Come and Go
* < 24h
Acute
* More Continuous
Chronic
* Persistent > 3 Months
103
What is Triggers in Triage-TiTrATE?
Asses for specific actions, movements, or situations that trigger the onset of symptoms
104
What Are The Trigger Sub-Groups of Vestibular Syndrome?
Triggered Episodic
Spontaneous Episodic
Traumatic/Toxic Acute
Spontaneous Acute
105
What is Sub-Groups in Triage-TiTrATE?
Symptoms classified into timing and trigger specific sub-grounds based on timing and triggers
106
Discriminating Features: Triggered Episodic Vestibular Syndrome
t - EVS
Episodes Seconds to Minutes
Resolution of Symptoms Between Episodes
Consistent Reproducible Trigger
107
What Are the COMMON Benign Causes of t - EVS?
Orthostatic Hypotension
* Most common
* Triggered ONLY by rising
* May only have pre-syncope
* REFER to MD, relatively soon
Benign Paroxysmal Positional Vertig (BPPV)
* Second most common
* Triggered by changes in head and body position
* REFER to HCP w/ Specialization, relatively soon
108
Discriminating Features: Spontaneous Episodic Vestibular Syndrome
s - EVS
Episodes Lasting Minutes to Hours < 24h
Resolution of Symptoms Between Episodes
NO Definite Reproducible Triggers Related to Head or Body Position
109
Discriminating Features: Traumatic/Toxic Acute Vestibular Syndrome
t - AVS
Acute Onset of Continuous Symptoms
Vestibular Symptoms at Rest
Symptoms Aggravated by Head & Body Positions
OBVIOUS Exposure History
* Traumatic Event (Head Injury)
* Toxic Event (Drug Intoxication)
110
Discriminating Features: Spontaneous Acute Vestibular Syndrome
s - AVS
Acute Onset of Continuous Symptoms
Vestibular Symptoms at Rest
Symptoms Aggravated by Head & Body Positions
NO Obvious Exposure History
111
What is Targeted Examination in Triage-TiTrATE?
Differentiates between benign and serious causes of symptoms within each sub-group
112
What is Dizziness?
Disturbed spatial orientation without false sense of motion
113
What is Vertigo?
Self-motion without actual motion
"The room is spinning"
114
What is Unsteadiness?
Unsteady without directional preference
"I'm going to fall"
115
What is Pre-Syncope?
Impending loss of consciousness, lightheaded
Feeling like you are going to pass out
116
What is Syncope?
Loss of consciousness
117
What is a Primary Headache?
Headache w/ no clear underlying cause
Types
* Migraine
* Tension
* Cluster
118
Discriminating Features: Cervicogenic Headache
Course of Action?
HEADS
* History of Neck or Head Trauma
* Exacerbated or Relieved by Movement
* Aching Pain +/- Stiffness
* Dizziness
* Somatic Referred Pain
TREAT
119
Discriminating Features: Migraine Headache
Course of Action?
FLIP
* Front & Side of Head + Ocular Area
* Light Sensitivity (Photophobia)
* Isolated/Unilateral
* Periodic/Episodic (4 - 72h)
REFER, relatively soon
120
What is the Criteria for Migraine Headaches?
Course of Action?
POUND Criteria
* Pulsating
* One Day Duration
* Unilateral
* Nausea and/or Vomiting
* Disability
OR
≥ 5 Attacks Lasting 4 - 72h
WITH 2 OF:
* Unilateral
* Pulsating/Pounding
* Moderate Pain or Severity
* Aggravated by Exertion
AND 1 OF:
* Nausea
* Vomiting
* Photophobia (Light Sensitivity)
* Phonophobia (Sound Sensitivity)
REFER, relatively soon
121
Discriminating Features: Migraine Headache with Aura
Course of Action?
Migraine Headache WITH
Reversible focal neurologic symptoms that develop gradually over 5 - 20 minutes and lasts for less than 60 minutes
NO Motor Weakness
With 1 of:
- Reversible Dysphasic Speech
- Reversible Sensory Symptoms
- Reversible Visual Symptoms
REFER, relatively soon
122
Discriminating Features: Tension Headache
Course of Action?
* Bilateral Head and Neck Pain
* Pain in Occipital and Frontal Region
* Related to Stress
* Non-Pulsating
* No Nausea
* No Vomiting
* No Aura
* Not Aggravated by Movement
REFER to MD, relatively soon
123
Discriminating Features: Cluster Headache
Course of Action?
* Pain Behind Orbit, Supraorbital, and Temporal (Concentrated Around One Eye)
* Severe Stabbing or Ice Pick Pain
* Unilateral
* Sudden Onset
* Peaks 5 - 10 Min
* 1 or More Autonomic Symptom
REFER, relatively soon
124
What is a Secondary Headache?
Headache Due to Underlying Cause
* First or Most Severe Headache of Life
* > 40 with NO History of Headache
* Progressive Frequency or Severity
* Thunderclap Headache
* Rapid Onset w/ Strenuous Exc
125
What Are the Serious Headache Red Flags?
SNOOP
* Systemic Signs of Illness
* Neurologic Symptoms
* Onset Recent or Sudden (Thunderclap)
* Onset After 40
* Prior Headache but this is Progressive or Different
REFER TO MD, URGENT
PTHER 577 Acute Care
flashcards
Decks in class (5)
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