Thirst Vomitting Sweating Pulse weak Anxious Respirations shallow/rapid Cool Cyanotic Unconscious BP low Eyes blank RN CHAMPS (Alternatively: "MR. C.H.
CNS causes include HEAD: Hypoxia/hypoglycemia Epilepsy Anxiety Dysfunctional brain stem (basivertebral TIA) Cardiac causes are HEART: Heart attack Embolism (PE) Aortic obstruction (IHSS, AS or myxoma) Rhythm disturbance, ventricular Tachycardia Vascular causes are VESSELS: Vasovagal Ectopic (reminds one of hypovolemia) Situational Subclavian steal ENT (glossopharyngeal neuralgia) Low systemic vascular resistance (Addison's, diabetic vascular neuropathy) Sensitive carotid sinus
Pleuritic pain Tracheal deviation Hyperresonance Onset sudden Reduced breath sounds (and dyspnea) Absent fremitus X-ray shows collapse Non-pharmacological analgesia.
Kidney – nephropathy Neuromuscular – peripheral neuropathy, mononeuritis, amyotrophy Infective – UTIs, TB Vascular – coronary/cerebrovascular/peripheral artery disease Eye – cataracts, retinopathy Skin – lipohypertrophy/lipoatrophy, necrobiosis lipoidica 4 T's: Teratoma Thymoma Testicular-type T-cell / Hodgkin's lymphoma Risk is 30% at age 30.
Good intervention (i.e. early) Non-compliance with treatment Order of differentiation (>1 cell type) Stage of disease Ill health Spread (diffuse) "Go look for the adenoma please": Tropic hormones affected by growth tumor are: GnRH
Prolactin function To assess abdomen, palpate all 4 quadrants for DR. GERM: Distension: liver problems, bowel obstruction Rigidity (board like): bleeding Guarding: muscular tension when touched Evisceration/ ecchymosis Rebound tenderness: infection Masses
Glaucoma Hyperemesis gravidarum Infection [pyelonephritis, meningitis] "All patients take meds": Reading from top left: Aortic Pulmonary Tricuspid Mitral Scale types is 3 V's: Visual response Verbal response Vibratory (motor) response Scale scores are 4,5,6: Scale of 4: see so much more Scale of 5: talking jive Scale of 6: feels the pricks (if testing motor by pain withdrawal) "Assessed mental state to be positively clinically unremarkable": Appearance and behaviour [observe state, clothing...] Mood [recent spirit] Speech [rate, form, content] Thinking [thoughts, perceptions] Behavioural abnormalities Perception abnormalities Cognition [time, place, age...] Understanding of condition [ideas, expectations, concerns] SAMPLE history Signs and symptoms Allergies Medications Past medical history, injuries, illnesses Last meal/intake Events leading up to the injury and/or illness OPQRST history Onset of symptoms Provocation/pallitive Quality or character of pain Region of pain or radiation Signs, symptoms and severity Time of onset, duration, intensity
Character: sharp or dull pain Location: region (joint) of origin Onset: sudden vs. gradual Radiation: Intensity: how severe (scale 1–10), impact on ADLs (activities of daily living), is it getting better, worse or staying the same?
Duration: acute vs. chronic Events associated: falls, morning stiffness, swelling, redness, joint clicking or locking, muscle cramps, muscle wasting, movement limitation, weakness, numbness or tingling, fever, chills, trauma (mechanism of injury), occupation activities, sports, repetitive movements Frequency: intermittent vs. constant, have you ever had this pain before?
Past history Location Onset/offset Type/character (of pain) Radiation Aggravating/alleviating factors Duration Intensity Other associated symptoms 9 F's: Fat Feces Fluid Flatus Fetus Full-sized tumors Full bladder Fibroids False pregnancy 12 P's Psychological (mental) status Pupils: size, symmetry, reaction Paired ocular movements Papilloedema Pressure (BP, increased ICP) Pulse and rate Paralysis, paresis Pyramidal signs Pin prick sensory response Pee (incontinent) Patellar reflex Ptosis "Breakfast is fast, dinner is slow, both go down": Bobbing is fast Dipping is slow In both, the initial movement is down.
Living situation/ lifestyle Anxiety Depression Daily activities (describe a typical day) Environmental risks / exposure Relationships Support system / stress "6 students and 3 teachers go for CAMPFIRE": Site, size, shape, surface, skin, scar Tenderness, temperature, transillumination Consistency Attachment Mobility Pulsation Fluctuation Irreducibility Regional lymph nodes Edge
Iatrogenic Neoplastic Vascular Endocrine Structural / mechanical Traumatic Inflammatory Genetic / congenital Autoimmune Toxic Infective Old age / degenerative Nutritional Spontaneous / idiopathic
Senile chorea Drugs APLA syndrome Neurodegenerative conditions: HD, neuroacanthocytosis, DRPLA Conception related: pregnancy, OCP's Endocrine: hyperthyroidism, hypo-, hyperglycemia
Dominantly inherited, mostly Reflexes decreased Enzymes normal Apathetic floppy baby Milestones delayed Skeletal abnormalities
Hypertension/ hyperlipidemia Elderly Atrial fib Diabetes mellitus/ drugs (cocaine) Smoking/sex (male) Horny PAMELA: Ptosis Anhydrosis Miosis Enophthalmos Loss of ciliary-spinal reflex Anisocoria
Wet, wobbly, wacky: Some drugs create awesome knockers Spironolactone Digitalis Cimetidine Alcohol Ketoconazole[23] Conduct disorder is seen in children.
Understandable (such as bereavement, major stresses) Neurotic (high anxiety personalities, negative parental upbringing, hypochondriasis) Agitation (usually organic causes such as dementia) Pseudodementia Pain Importuning (whingeing, complaining) Nihilistic Endogenous Secondary (i.e. cancer at the head of the pancreas, bronchogenic cancer) Syndromal DIMES & 3Ps: Drugs (or withdrawal) Infection (PUS = Pneumonia, UTI, Skin) Metabolic (e.g. Na, Ca, TSH) Environmental Structural Pain Pee Poo
Infections – PUS, CNS Withdrawal – alcohol, sedatives, barbiturates Acute metabolic changes – pH, hypo/hyper Na, Ca, acute liver or renal failure Trauma – brain injury, subdural hematoma CNS – post-ictal, stroke, tumour, brain mets Hypoxia – CHF, anemia Defficiencies – thiamine, niacin, B12 (e.g. chronic G and T alcoholics) Endocrinopathies – hypo-/hyper-cortisol, hypoglycemia Acute vascular – hypertensive encephalopathy, septic hypotension Toxins and Drugs – especially anti-cholinergics, opioids, benzodiazepines Heavy metals
Pain Infection Nutrition Constipation Hydration Medication Electrolytes "The sad tale of Erikson Motors": Mr. Trust and MsTrust had an auto they were ashamed of.
emphysema) Preliminary is ABCDEF: AP or PA Body position Confirm name Date Exposure Films for comparison Analysis is ABCDEF: Airways (hilar adenopathy or enlargement) Breast shadows / bones (rib fractures, lytic bone lesions) Cardiac silhoutte (cardiac enlargement) / costophrenic angles (pleural effusions) Diaphragm (evidence of free air) / digestive tract Edges (apices for fibrosis, pneumothorax, pleural thickening or plaques) / extrathoracic tissues Fields (evidence of alveolar filling) / failure (alveolar air space disease with prominent vascularity with or without pleural effusions) "If you see holes on chest X-ray, they are weird": Wegener's granulomatosis (now known as granulomatosis with polyangiitis) Embolic (pulmonary, septic) Infection (anaerobes, pneumocystis, TB) Rheumatoid (necrobiotic nodules) Developmental cysts (sequestration) Histiocytosis Oncological Lymphangioleiomyomatosis Environmental, occupational Sarcoid Alternatively: L=Left atrial myxoma
Loss of joint space Osteopyhtes Subcondral sclerosis Subchondral cysts "WW 2" (World War II): Water is white in a T2 scan.
SLUDGE and the Killer B's: Salivation Lacrimation Urination Diaphoresis, diarrhea Gastrointestinal cramping Emesis Bradycardia Bronchospasm Bronchorrhea[28] also known as DUMBBELLS Diarrhea Urination Miosis Bradycardia Bronchospasm Emesis Lacrimation Loss of muscle strength Salivation/sweating Cheyne-Stokes breathing sounds like "chain smokes" Drugs causing gynaecomastia: DISCO Isoproterenol Dopamine Epinephrine Atropine sulfate[citation needed] C3, 4, 5 keeps the diaphragm alive[29] 7 P's Preparation Preoxygenation Pretreatment Paralysis with induction Positioning Placement of tube Postintubation management[30]