Med 536 Communicating About Prognosis Workshop. Case 2

Size: px
Start display at page:

Download "Med 536 Communicating About Prognosis Workshop. Case 2"

Transcription

1 Med 536 Communicating About Prognosis Workshop Case 2 ID / CC: 33 year-old man with intracranial hemorrhage History of the Presenting Illness 33 year-old man with a prior history of melanoma of the neck (status-post resection) was driving on the highway with his family when he developed a severe headache. He pulled over to the side of the road and then developed loss of consciousness. 911 was called and he was taken to an outside hospital where a Head CT revealed a large hemorrhage in the left parieto-occipital area and acute hydrocephalus. In the emergency room at that facility, his pupils reacted to light and he had intact cough, gag and corneal reflexes. He was then transferred to Harborview Medical Center for further management. Review of Systems Cannot be obtained Past Medical History Melanoma of the neck. Status-post excision Social History Married. 1 Child. Active duty military with 4 overseas deployments. Non-smoker. Occasional alcohol use. No illicit drug use Allergies None Medications Aspirin 81 mg daily Family History Unknown at time of admission Vitals Temperature 36.6 BP 120/67 HR 87 RR 10 (on mechanical ventilator) Ventilator Settings: AC TV 500 cc Set Rate 10. Actual Rate 10.FIO2 0.9 PEEP 5 Exam General: Head: Eyes: ENT: Lungs: Heart: Abdomen: Well-developed, well-nourished man. Intubated. Normocephalic, atraumatic. No icterus. ET Tube in situ. Moist oral mucosa. Clear to auscultation bilaterally. No crackles or wheezes Regular rate and rhythm. Normal S1, S2. No murmur, rubs, gallops. No distended neck veins. No lower extremity edema Soft, non-tender, non-distended. No organomegaly. + bowel tones

2 Skin: Neuro: Warm, no rashes. No petecchiae or purpura Pupils react to light bilateral (4 mm à 2 mm) Intact corneal reflexes. No cough, no gag. No response to voice or painful stimuli. Negative oculocephalic reflex. Unable to assess sensation. Normal muscle bulk and tone. Deep tendon reflexes not assessed Admission Laboratory Studies Chemistry Panel: Sodium: 145 Creatinine 1.0 Complete Blood Count: WBC 16 Hematocrit 40 Platelets 303 ABG: ph 7.25 PCO2 66 PO Blood alcohol level: 0 mg/dl (legal limit < 80 mg/dl) Toxicology Screen: Negative Admission Radiology Studies Chest Radiograph:

3 Chest CT: Head CT:

4 The Case Continues It is now 6 hours after the patient was admitted. The neurosurgeons opted not to take the patient to the operating room and ordered an MRI of the brain to determine the source of his bleeding. He remains hemodynamically stable and continues to have stable respiratory status on the ventilator. His neurologic exam is as follows: - Intubated, remains unconscious off sedative medications - Absent Corneal, papillary and oculocephalic reflexes. No cough, no gag - He is not over-breathing the ventilator - No response to verbal stimuli. - No motor response to pain - Toes down-going bilaterally; 2+, symmetric quadriceps or biceps tendon reflexes. Based on his clinical exam, formal brain death testing is performed. The results of this testing are as follows: Brain Death Examination Two separate neurologic examinations were performed 3 hours apart by different physicians. The results are as follows: Test Examiner #1 Examiner #2 Pupillary Response Absent Absent Corneal Reflex Absent Absent Oculovestibular Reflex Absent Absent Oculocephalic Reflex Absent Absent Cough Absent Absent Gag Absent Absent Motor Response to Pain Absent Absent Apnea Trial An arterial blood gas was performed documenting a P a CO 2 of 38 mm Hg. The patient was placed on an F I O 2 of 1.0 for 10 minutes and then disconnected from the ventilator. An anesthesia bag with was hooked up to the end of the endotracheal tube to monitor for evidence of respirations. Supplemental oxygen was delivered in a blow-by fashion through the anesthesia bag. The patient remained off the ventilator for a period of 10 minutes during which time no spontaneous respirations were detected. A blood gas performed at the end of the 10 minute period revealed that the P a CO 2 had risen to 63 mm Hg during the trial.

5 Questions To Consider What do the results of this test indicate? According to the law in the State of Washington, what is the implication of these test results? How would you explain the results of these tests to the patient s wife. What questions do you anticipate that she will ask and what would you say in response to those questions? Your Group s Tasks Task 1: One member of your group will stand up in front of the room and present a concise synopsis of the patient s clinical situation. Your goal is to summarize what initially happened, his clinical course and the results of the subsequent testing in 2 minutes. Task 2: One member of your group will have a conversation with the patient s wife, who has been joined by her parents and the patient s brother. They are awaiting the results of your examinations. Your task is to inform the mother of the results and explain the implications of these results. In other words, explain the clinical picture you are dealing with. You should then explain what will transpire from this point forward.

Med 536 Communicating About Prognosis Workshop. Case 1

Med 536 Communicating About Prognosis Workshop. Case 1 Med 536 Communicating About Prognosis Workshop Case 1 ID / CC: 39 year-old woman status-post motor-vehicle collision History of the Presenting Illness Previously healthy 39 year-old woman was found in

More information

History Data Panel. Case 030 Preg Trauma. Presenting Complaint Altered mental status s/p MVC. Person Giving Information EMS

History Data Panel. Case 030 Preg Trauma. Presenting Complaint Altered mental status s/p MVC. Person Giving Information EMS History Data Panel Presenting Complaint Altered mental status s/p MVC Person Giving Information EMS History of Present Illness 28 year old woman, 35 weeks pregnant per report of her husband the passenger.

More information

Policy No: Title: Determination of Death by Brain Criteria Department: PATIENT CARE. Originated: May 1992

Policy No: Title: Determination of Death by Brain Criteria Department: PATIENT CARE. Originated: May 1992 Title: Determination of Death by Brain Criteria Department: PATIENT CARE Policy No: Page 1 of 6 Revised: April 2009 Previous revisions: 9/96, 7/99, 7/07 Reviewed: August 2010 Originated: May 1992 I. POLICY:

More information

Take A Breath: Pulmonary Management of the Organ Donor. Whitni Noyes, RN, CPTC Midwest Transplant Network

Take A Breath: Pulmonary Management of the Organ Donor. Whitni Noyes, RN, CPTC Midwest Transplant Network Take A Breath: Pulmonary Management of the Organ Donor Whitni Noyes, RN, CPTC Midwest Transplant Network Objectives Recognize MTN referral criteria. Be familiar with the apnea test for brain death pronouncement.

More information

YALE-NEW HAVEN HOSPITAL CLINICAL ADMINISTRATIVE POLICY & PROCEDURE MANUAL

YALE-NEW HAVEN HOSPITAL CLINICAL ADMINISTRATIVE POLICY & PROCEDURE MANUAL YALE-NEW HAVEN HOSPITAL CLINICAL ADMINISTRATIVE POLICY & PROCEDURE MANUAL Administrative Policy Title: Brain Death, Guidelines Determination of Death by Neurological Criteria in the Pediatric Patient Manual

More information

GUIDELINES: The following guidelines for determining brain death in adults are accepted practice parameters of the American Academy of Neurology 1

GUIDELINES: The following guidelines for determining brain death in adults are accepted practice parameters of the American Academy of Neurology 1 Page 1 of 5 PURPOSE: The purpose of this policy is to provide licensed staff and medical personnel with a guideline to determine when a patient on a ventilator demonstrates clinical brain death. POLICY

More information

DETERMINATION OF NEUROLOGIC DEATH IN ADULTS AND CHILDREN April 2010

DETERMINATION OF NEUROLOGIC DEATH IN ADULTS AND CHILDREN April 2010 Chicago, Illinois PAGE: 1 of 7 DETERMINATION OF NEUROLOGIC DEATH IN ADULTS AND CHILDREN April 2010 Key Content Expert: Medical Center Ethics Committee in consultation with Chiefs of Service for Neurology

More information

History Data Panel. Case 024 Myxedema Coma. Presenting Complaint weakness. Person Giving Information paramedic

History Data Panel. Case 024 Myxedema Coma. Presenting Complaint weakness. Person Giving Information paramedic History Data Panel Presenting Complaint weakness Person Giving Information paramedic History of Present Illness Mildred Smith is an 88 year-old female who is DNR/DNI, BIBA from home with several days of

More information

Respiratory Care and Organ Donation

Respiratory Care and Organ Donation Respiratory Care and Organ Donation Whitni Noyes, RN, OPTC Midwest Transplant Network Midwest Transplant Network CMS requires every accredited hospital to have an agreement with an OPO. MTN is the first

More information

PUFF THE MAGIC DRAGON

PUFF THE MAGIC DRAGON PUFF THE MAGIC DRAGON AN UNUSUAL CASE OF A PUFFY FACE MA ACP Annual Scientific Meeting Gurbir Gill, M.D., PGY-3 (Associate) George M. Abraham, MD, MPH, FACP Department of Medicine, Saint Vincent Hospital,

More information

A 43year old man presented with cough and breathlessness. Presented by Dr. Enayet-Ul-Islam Dhaka Medical College Hospital

A 43year old man presented with cough and breathlessness. Presented by Dr. Enayet-Ul-Islam Dhaka Medical College Hospital A 43year old man presented with cough and breathlessness Presented by Dr. Enayet-Ul-Islam Dhaka Medical College Hospital PARTICULARS OF THE PATIENT: Patients name : Mr. Md. Ismail,43 years. Address : Chittagong.

More information

Patient to complete this information

Patient to complete this information Patient to complete this information Patient s Name Birth date Today s date Referring Physician Primary Care Physician Age Occupation Retired, how long? Prior operations Medications Type Date Name Dose

More information

Student Guide Module 4: Pediatric Trauma

Student Guide Module 4: Pediatric Trauma Student Guide Module 4: Pediatric Trauma Problem based learning exercise objectives Understand how to manage traumatic injuries in mass casualty events. Discuss the features and the approach to pediatric

More information

Brain Death Determination: Outline. Definition. Brain Death Determination. Brain Death Determination. No conflict of interest

Brain Death Determination: Outline. Definition. Brain Death Determination. Brain Death Determination. No conflict of interest No conflict of interest : Outline Definition Definition Confounding factors Clinical examination Apnea test Confirmatory testing Communicating the diagnosis Ethical issues Brain death remains the preferred

More information

Canadian Trauma Trials Collaborative. Occult Pneumothorax in Critical Care (OPTICC): Standardized Data Collection Sheet

Canadian Trauma Trials Collaborative. Occult Pneumothorax in Critical Care (OPTICC): Standardized Data Collection Sheet Canadian Trauma Trials Collaborative STUDY CENTRE: Institution: City / Province: / Occult Pneumothorax in Critical Care (OPTICC): Standardized Sheet PATIENT DEMOGRAPHICS: First Name: Health record number

More information

CASE-BASED SMALL GROUP DISCUSSION SESSION 6 MHD I. October 14, 2015

CASE-BASED SMALL GROUP DISCUSSION SESSION 6 MHD I. October 14, 2015 Session 6, MHD I, STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION SESSION 6 MHD I October 14, 2015 Helpful Resources McPhee, SJ, Hammer GD. Pathophysiology of Disease: An Introduction to Clinical

More information

Deceased donor. Solid organ transplantation

Deceased donor. Solid organ transplantation Deceased donor Solid organ transplantation Deceased donor donation process 1. Potential donor detection 2. Brain death diagnosis 3. Donor management 4. Organ allocation 5. Organ retrieval Brain death Irreversible

More information

Ethical Challenges With Documenting Brain Death

Ethical Challenges With Documenting Brain Death Ethical Challenges With Documenting Brain Death William Reitsma, BSN, CPTC Consultant AOPO Accreditation Surveyor 2015 Doug Miller Symposium Wisconsin Dells, Wisconsin When are You Dead? History of Brain

More information

European Resuscitation Council

European Resuscitation Council European Resuscitation Council Incidence of Trauma in Childhood Leading cause of death and disability in children older than one year all over the world Structured approach Primary survey and resuscitation

More information

For the Disease Summary for this case study, see the CD-ROM. Patient s Chief Complaints. History of Present Illness

For the Disease Summary for this case study, see the CD-ROM. Patient s Chief Complaints. History of Present Illness Bruyere_Case09_034-038.qxd 5/2/08 3:09 PM Page 34 CASE STUDY 9 PULMONARY THROMBOEMBOLISM For the Disease Summary for this case study, see the CD-ROM. PATIENT CASE Patient s Chief Complaints I have severe

More information

Bisan Salhi, M.D. 69 Jesse Hill Jr. Dr. Atlanta, GA Phone:

Bisan Salhi, M.D. 69 Jesse Hill Jr. Dr. Atlanta, GA Phone: Bisan Salhi, M.D. 69 Jesse Hill Jr. Dr. Atlanta, GA 30303 Phone: 734-657-4539 30 June 2006 Dear Sir or Madam: 1. Thank you for the opportunity to evaluate Mr. Liviu Negut. Enclosed is my preliminary medical

More information

Rural STEMI System of Care Success. Nicole Huber, PA-C Cumberland Healthcare Emergency Department

Rural STEMI System of Care Success. Nicole Huber, PA-C Cumberland Healthcare Emergency Department Rural STEMI System of Care Success Nicole Huber, PA-C Cumberland Healthcare Emergency Department DISCLOSURES I HAVE NO ACTUAL OR POTENTIAL CONFLICT OF INTEREST IN RELATION TO THIS PRESENTATION Ideal Process

More information

Post-Cardiac Arrest Syndrome. MICU Lecture Series

Post-Cardiac Arrest Syndrome. MICU Lecture Series Post-Cardiac Arrest Syndrome MICU Lecture Series Case 58 y/o female collapses at home, family attempts CPR, EMS arrives and notes VF, defibrillation x 3 with return of spontaneous circulation, brought

More information

Determination of Death

Determination of Death Policy Legal Standard UTMB physicians will determine death in accordance with this policy which is based on Texas law and the practice parameters recommended by the American Academy of Neurology for adults

More information

1/29/2014. Kimberly Johnson Hatchett, MD PGY-4 11/15/13

1/29/2014. Kimberly Johnson Hatchett, MD PGY-4 11/15/13 Kimberly Johnson Hatchett, MD PGY-4 11/15/13 History of Present Illness 14 month old previously healthy infant boy presented via EMS after being found by his mother to be breathing loudly and non-responsive.

More information

PROPOSED REVISIONS OF ISMA BRAIN DEATH GUIDELINES

PROPOSED REVISIONS OF ISMA BRAIN DEATH GUIDELINES RESOLUTION 17-04 Introduced by: Action: PROPOSED REVISIONS OF ISMA BRAIN DEATH GUIDELINES Emil Weber, MD Adopted as Amended RESOLVED, that ISMA adopt updated brain death guidelines for adults and children,

More information

A walk through a STEMI

A walk through a STEMI A walk through a STEMI M.M. s Story Kim Robison Ashley Corcoran Situation M.M. is an 82 year old male brought in by private vehicle on 10/22/17 to the Emergency Department Pt. c/o left arm numbness, pain

More information

Documentation Dissection

Documentation Dissection History of Present Illness: Documentation Dissection The patient is a 50-year-old male c/o symptoms for past 4 months 1, severe 2 bloating and stomach cramps, some nausea, vomiting, diarrhea. In last 3

More information

Images have been removed from the PowerPoint slides in this handout due to copyright restrictions.

Images have been removed from the PowerPoint slides in this handout due to copyright restrictions. Arterial Blood Gas Interpretation Routine Assessment Inspection Palpation Auscultation Labs Na 135-145 K 3.5-5.3 Chloride 95-105 CO2 22-31 BUN 10-26 Creat.5-1.2 Glu 80-120 Arterial Blood Gases WBC 5-10K

More information

PRACTICE GUIDELINE. DEFINITIONS: Mild head injury: Glasgow Coma Scale* (GCS) score Moderate head injury: GCS 9-12 Severe head injury: GCS 3-8

PRACTICE GUIDELINE. DEFINITIONS: Mild head injury: Glasgow Coma Scale* (GCS) score Moderate head injury: GCS 9-12 Severe head injury: GCS 3-8 PRACTICE GUIDELINE Effective Date: 9-1-2012 Manual Reference: Deaconess Trauma Services TITLE: TRAUMATIC BRAIN INJURY GUIDELINE OBJECTIVE: To provide practice management guidelines for traumatic brain

More information

Compliant EM Coding and Documentation Outpatient Coding

Compliant EM Coding and Documentation Outpatient Coding Compliant EM Coding and Documentation Outpatient Coding Steve Adams, MCS, COC, CPC, CPMA, CPC-I, PCS, FCS, COA Steve.adams@ingaugehsi.com 770-709-3598 www.thecodingeducator.com Incident To & Shared Visits

More information

ATLS: Initial Assessment and Management. SAUSHEC Medical Student Lecture Series

ATLS: Initial Assessment and Management. SAUSHEC Medical Student Lecture Series ATLS: Initial Assessment and Management SAUSHEC Medical Student Lecture Series Objectives Identify sequence of priorities in assessing the multiply injured patient Apply principles outlined in primary

More information

Patient Care Report Guidelines

Patient Care Report Guidelines A rrival on scene / Scene assessment C omplaint H istory A. Position of patient B. Impression of patient C. Does the patient acknowledge your presence D. Any significant characteristics of the scene A.

More information

Declaring Brain Death. Ali Salim, MD Professor of Surgery Chief, Division of Trauma, Burns, Surgical Critical Care, and Emergency General Surgery

Declaring Brain Death. Ali Salim, MD Professor of Surgery Chief, Division of Trauma, Burns, Surgical Critical Care, and Emergency General Surgery Declaring Brain Death Ali Salim, MD Professor of Surgery Chief, Division of Trauma, Burns, Surgical Critical Care, and Emergency General Surgery Disclosures I have nothing to disclose Why should we know

More information

A Challenging Case: Von Willebrand Disease and Pulmonary Hypertension in Pregnancy

A Challenging Case: Von Willebrand Disease and Pulmonary Hypertension in Pregnancy A Challenging Case: Von Willebrand Disease and Pulmonary Hypertension in Pregnancy Diana S. Wolfe, MD, MPH Assistant Professor Department of Obstetrics & Gynecology and Women s Health Associate Fellowship

More information

Pediatric Advanced Life Support

Pediatric Advanced Life Support Pediatric Advanced Life Support Pediatric Chain of Survival Berg M D et al. Circulation 2010;122:S862-S875 Prevention Early cardiopulmonary resuscitation (CPR) Prompt access to the emergency response system

More information

Crit Vent Bundle for Mechanical Ventilation (337) [337] Physician - Also, enter Critical Care Admission Orders

Crit Vent Bundle for Mechanical Ventilation (337) [337] Physician - Also, enter Critical Care Admission Orders Crit Vent Bundle for Mechanical Ventilation (337) [337] Physician - Also, enter Critical Care Admission Orders Initial Vent Settings (Single Response) [6360] If no previous orders and no choice made by

More information

Daniel A. Beals MD, FACS, FAAP Pediatric Surgery and Urology Community Medical Center Associate Professor of Surgery and Pediatrics University of

Daniel A. Beals MD, FACS, FAAP Pediatric Surgery and Urology Community Medical Center Associate Professor of Surgery and Pediatrics University of Daniel A. Beals MD, FACS, FAAP Pediatric Surgery and Urology Community Medical Center Associate Professor of Surgery and Pediatrics University of Washington Seattle Children s Hospital Objectives Define

More information

Patient Assessment. Chapter 8

Patient Assessment. Chapter 8 Patient Assessment Chapter 8 Patient Assessment Scene size-up Initial assessment Focused history and physical exam Vital signs History Detailed physical exam Ongoing assessment Patient Assessment Process

More information

SIMPLY Arterial Blood Gases Interpretation. Week 4 Dr William Dooley

SIMPLY Arterial Blood Gases Interpretation. Week 4 Dr William Dooley SIMPLY Arterial Blood Gases Interpretation Week 4 Dr William Dooley Plan Structure for interpretation 5-step approach Works for majority of cases Case scenarios Some common concerns A-a gradient BE Anion

More information

CASE PRESENTATION. Dr.M.Pramod kumar Final year PG MD Anaesthesia Department of anaesthesia

CASE PRESENTATION. Dr.M.Pramod kumar Final year PG MD Anaesthesia Department of anaesthesia CASE PRESENTATION Dr.M.Pramod kumar Final year PG MD Anaesthesia Department of anaesthesia Patient name : XXX Sex : male Age : 60 years Address : madirala (V), suryapet. Date of admission : 7-06-2017 Date

More information

NEW PATIENT QUESTIONNAIRE For Dr Benoy Benny. Section 1: Today s Date: Date of Birth: Age:

NEW PATIENT QUESTIONNAIRE For Dr Benoy Benny. Section 1: Today s Date: Date of Birth: Age: Baylor Physical Medicine and Rehabilitation NEW PATIENT QUESTIONNAIRE For Dr Benoy Benny Dear Patient: Please complete this questionnaire before you come for your appointment. Be sure to call us as soon

More information

Neurological Determination of Death Adult

Neurological Determination of Death Adult Approved by: Vice President and Chief Medical Officer Neurological Determination of Death Adult Corporate Policy & Procedures Manual Number: VII-B-400 Date Approved June 9, 2015 Next Review (3 years from

More information

Acute Respiratory Distress

Acute Respiratory Distress Acute Respiratory Distress Respiratory Distress: Amos Charles, MD Clinical Associate Professor of Medicine Warren Alpert School of Medicine of the Brown University Providence Rhode Island. Waleed Ibrahim-Ali

More information

HeartCode PALS. PALS Actions Overview > Legend. Contents

HeartCode PALS. PALS Actions Overview > Legend. Contents HeartCode PALS PALS Actions Overview > Legend Action buttons (round buttons) Clicking a round button initiates an action. Clicking this button, for example, checks the child s carotid pulse. Menu buttons

More information

Program Script. Nursing Assessment The Head-to-Toe Assessment

Program Script. Nursing Assessment The Head-to-Toe Assessment Program Script Nursing Assessment The Head-to-Toe Assessment This document comprises the complete script for this program including chapter titles. This is provided to instructors to enhance the educational

More information

LOKUN! I got stomach ache!

LOKUN! I got stomach ache! LOKUN! I got stomach ache! Mr L is a 67year old Chinese gentleman who is a non smoker, social drinker. He has a medical history significant for Hypertension, Hyperlipidemia, Type 2 Diabetes Mellitus, Chronic

More information

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv.8.18.18 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) SUDDEN PROGRESSIVE FORM OF ACUTE RESPIRATORY FAILURE ALVEOLAR CAPILLARY MEMBRANE BECOMES DAMAGED AND MORE

More information

BRAIN STEM CASE HISTORIES CASE HISTORY VII

BRAIN STEM CASE HISTORIES CASE HISTORY VII 463 Brain stem Case history BRAIN STEM CASE HISTORIES CASE HISTORY VII A 60 year old man with hypertension wakes one morning with trouble walking. He is feeling dizzy and is sick to his stomach. His wife

More information

NEO 111 Melanie Jorgenson, RN, BSN

NEO 111 Melanie Jorgenson, RN, BSN NEO 111 Melanie Jorgenson, RN, BSN Inspection: performing deliberate, purposeful observations in a systematic manner Palpation: using the sense of touch Percussion: striking one object against another

More information

Percussion These 4 techniques are the foundation of the physical exam. Respiration Blood pressure Body

Percussion These 4 techniques are the foundation of the physical exam. Respiration Blood pressure Body 1 Chapter 11: Physical Exam Techniques 2 Introduction Although patient assessment formally starts with the, the physical examination actually begins when you first set eyes on your patient. The purpose

More information

Simulation and Clinical Learning Tillamook Healthcare Simulation Program Pulmonary Embolus

Simulation and Clinical Learning Tillamook Healthcare Simulation Program Pulmonary Embolus Simulation and Clinical Learning Tillamook Healthcare Simulation Program Pulmonary Embolus Simulation Objective: Demonstrate management of a patient experiencing an acute pulmonary embolus. Scenario: Physiologic

More information

Emergency Medical Training Services Emergency Medical Technician Basic Program Outlines Outline Topic: ASSESSMENT Revised: 11/2013

Emergency Medical Training Services Emergency Medical Technician Basic Program Outlines Outline Topic: ASSESSMENT Revised: 11/2013 Emergency Medical Training Services Emergency Medical Technician Basic Program Outlines Outline Topic: ASSESSMENT Revised: 11/2013 DEFINITIONS General Impression - EMT develops a plan of action from the

More information

UNIVERSITY OF TENNESSEE HOSPITAL 1924 Alcoa Highway * Knoxville, TN (865) LABEL

UNIVERSITY OF TENNESSEE HOSPITAL 1924 Alcoa Highway * Knoxville, TN (865) LABEL 1003 UNIVERSITY OF TENNESSEE HOSPITAL 1924 Alcoa Highway * Knoxville, TN 37920 (865) 544-9000 LABEL Knoxville Neurology Clinic Orders and Progress tes : NAME: MED REC#: PHYSICIAN: DATE: DATE PHYSICIAN'S

More information

CASE-BASED SMALL GROUP DISCUSSION MHD II

CASE-BASED SMALL GROUP DISCUSSION MHD II MHD II, Session 11, Student Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD II Session 11 April 11, 2016 STUDENT COPY MHD II, Session 11, Student Copy Page 2 CASE HISTORY 1 Chief complaint: Our baby

More information

Name Signature Date IRB & Ethics Committee Dr. Ejaz A. Khan Chairman IRB & EC Dr. Shoukat Matabddin

Name Signature Date IRB & Ethics Committee Dr. Ejaz A. Khan Chairman IRB & EC Dr. Shoukat Matabddin Prepared by Reviewed By Name Signature Date IRB & Ethics Committee Dr. Ejaz A. Khan Chairman IRB & EC Dr. Shoukat Matabddin Dr. M. Salim Khan Medical Director Approved by Dr. Manzoor H Qazi Chief Executive

More information

Indicators for assessing unconsciousness and death during slaughter without stunning

Indicators for assessing unconsciousness and death during slaughter without stunning Indicators for assessing unconsciousness and death during slaughter without stunning Antonio Velarde Parma, January, 30th 2013 References - EFSA opinions of 2004 and 2006 on the stunning and killing of

More information

Optimize vent weaning and SBT outcomes. Identify underlying causes for SBT failures. Role SBT and weaning protocol have in respiratory care

Optimize vent weaning and SBT outcomes. Identify underlying causes for SBT failures. Role SBT and weaning protocol have in respiratory care Optimize vent weaning and SBT outcomes Identify underlying causes for SBT failures Role SBT and weaning protocol have in respiratory care Lower risk of developing complications Lower risk of VAP, other

More information

CRRT Fundamentals Pre-Test. AKI & CRRT 2017 Practice Based Learning in CRRT

CRRT Fundamentals Pre-Test. AKI & CRRT 2017 Practice Based Learning in CRRT CRRT Fundamentals Pre-Test AKI & CRRT 2017 Practice Based Learning in CRRT Question 1 A 72-year-old man with HTN presents to the ED with slurred speech, headache and weakness after falling at home. He

More information

Physical Examination Reporting Form

Physical Examination Reporting Form Building Trades National Medical Screening Program Physical Examination Reporting Form Name: Date: P1. Vital Signs Height: BP: / Weight: lbs. #2 nd BP:* / Arm: L R Cuff Size:** Regular Large Ped Pulse:

More information

Cesarean section for breech presentation. Jonathan H. Waters, M.D.

Cesarean section for breech presentation. Jonathan H. Waters, M.D. Cesarean section for breech presentation Jonathan H. Waters, M.D. 1 26 y.o. G1P0 presented to triage in labor at 38 weeks. Patient was a known breech with a failed version 5 days before presentation. PMH

More information

H&P Checklist (Inpatient) Evaluator: Subject: Program:

H&P Checklist (Inpatient) Evaluator: Subject: Program: H&P Checklist (Inpatient) Evaluator: Subject: Program: PROFESSIONALISM 1) Introduces self/role and preceptor Did 2) Verbal and non-verbal language demonstrates respect for patient & family. Did 3) Respects

More information

Note for Jane Doe on 7/22/05 - Chart 5407

Note for Jane Doe on 7/22/05 - Chart 5407 Note for Jane Doe on 7/22/05 - Chart 5407 Chief Complaint: This 31 year old female presents today with abdominal pain. Duration: Condition has existed for one month. Modifying Factors: Patient indicates

More information

SMALL GROUP DISCUSSION

SMALL GROUP DISCUSSION MHD II, Session 1 Student Copy Page 1 SMALL GROUP DISCUSSION MHD II Session 1 Gastroinestinal Monday, January 9, 2017 STUDENT COPY MHD II, Session 1 Student Copy Page 2 CASE 1 CHIEF CONCERN: "I'm passing

More information

Date of Admission: [DATE]. Date of Discharge:

Date of Admission: [DATE]. Date of Discharge: Date of Admission: [DATE]. Date of Discharge: History of Present Illness: Mr. [NAME] AKA [NAME] is a 31-year-old male who presents to the [PLACE] Trauma Surgery Service as a moderate trauma on [DATE] following

More information

Hospital of the University of Pennsylvania POLICY MANUAL

Hospital of the University of Pennsylvania POLICY MANUAL Page 1 of 8 KEY WORDS: Brain Death Coma # 1-6-11 Procedures Following Patient Death # 1-6-13 Organ Donation and Anatomical Donation and Pennsylvania s Anatomical Gift Act #1-6-17 Withholding and Withdrawing

More information

Assessment of the Adolescent, Pre-Teen, and Teen Student for School Nurses

Assessment of the Adolescent, Pre-Teen, and Teen Student for School Nurses Assessment of the Adolescent, Pre-Teen, and Teen Student for School Nurses KIMBERLY RICHARDS RN, BSN CLINICAL UNIT LEADER NOVANT HEALTH MATTHEWS MEDICAL CENTER MEDICAL SURGICAL/HOSPICE ONCOLOGY Agenda

More information

CASE PRESENTATION VV ECMO

CASE PRESENTATION VV ECMO CASE PRESENTATION VV ECMO Joshua Huelster, MD Fellow in Critical Care Medicine Department of Pulmonary and Critical Care Medicine Hennepin County Medical Center Disclosure There are no conflicts of interest

More information

Baseline Vital Signs and SAMPLE History. Chapter 5

Baseline Vital Signs and SAMPLE History. Chapter 5 Baseline Vital Signs and SAMPLE History Chapter 5 Baseline Vital Signs and SAMPLE History Assessment is the most complex skill EMT-Bs learn. During assessment you will: Gather key information. Evaluate

More information

Last printed 9/15/2016 9:51 AM. Departmental/Patient Care Page 1 of 6. Origination Date: 6/18/2014. Grady Memorial Hospital Brain Death Policy

Last printed 9/15/2016 9:51 AM. Departmental/Patient Care Page 1 of 6. Origination Date: 6/18/2014. Grady Memorial Hospital Brain Death Policy Last printed 9/15/2016 9:51 AM Departmental/Patient Care Page 1 of 6 Grady Memorial Hospital Brain Death Policy Origination Date: 6/18/2014 Revision Date: 2/2/2015 I. POLICY STATEMENT: Mission statement:

More information

Note for Jane Doe on 02/10/ Chart 3642

Note for Jane Doe on 02/10/ Chart 3642 Note for Jane Doe on 02/10/2005 - Chart 3642 Consultation was requested by Dr. Smith Chief Complaint (1/1): This 31 year old Caucasian female presents today for evaluation of chest pain. Chest pains HPI:

More information

Trauma Life Support Pre-Hospital (TLS-P) Preparatory Materials

Trauma Life Support Pre-Hospital (TLS-P) Preparatory Materials Trauma Life Support Pre-Hospital (TLS-P) Preparatory Materials 1 1. A high-risk bodily fluid for spreading infection is blood. 2. Items that can reduce the spread of infection include masks, gloves, and

More information

Palliative care in Neurology from the real experience

Palliative care in Neurology from the real experience Palliative care in Neurology from the real experience Haruthai Chotisukarat, MD Pain specialist and Anesthesiologist Prasat Neurological Institute 1 History Present illness 58 years old, Thai male A year

More information

Handling Common Problems & Pitfalls During. Oxygen desaturation in patients receiving mechanical ventilation ACUTE SEVERE RESPIRATORY FAILURE

Handling Common Problems & Pitfalls During. Oxygen desaturation in patients receiving mechanical ventilation ACUTE SEVERE RESPIRATORY FAILURE Handling Common Problems & Pitfalls During ACUTE SEVERE RESPIRATORY FAILURE Pravit Jetanachai, MD QSNICH Oxygen desaturation in patients receiving mechanical ventilation Causes of oxygen desaturation 1.

More information

COMPREHENSIVE PAIN MANAGEMENT NEW PATIENT INTAKE FORM ( )

COMPREHENSIVE PAIN MANAGEMENT NEW PATIENT INTAKE FORM ( ) 1 13660 N 94th Dr., Suite C-4 Peoria, AZ 85381-4841 phone (623) 266-1722 fax (623) 266-1746 COMPREHENSIVE PAIN MANAGEMENT NEW PATIENT INTAKE FORM (Please Print) Last Name: Middle: First: Home Phone: DOB:

More information

21-year-old female with papillary thyroid carcinoma. Celeste Thomas MD January 26, 2012

21-year-old female with papillary thyroid carcinoma. Celeste Thomas MD January 26, 2012 21-year-old female with papillary thyroid carcinoma Celeste Thomas MD January 26, 2012 History of Present Illness 21-year-old woman Saw her PCP to request a referral to dermatology Found to have a fullness

More information

CASE-BASED SMALL GROUP DISCUSSION

CASE-BASED SMALL GROUP DISCUSSION MHD I, Session 11, Student Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD I SESSION 11 Renal Block Acid- Base Disorders November 7, 2016 MHD I, Session 11, Student Copy Page 2 Case #1 Cc: I have had

More information

AMSER Rad Path Case of the Month: December 2018

AMSER Rad Path Case of the Month: December 2018 AMSER Rad Path Case of the Month: December 2018 Rectosigmoid Carcinoma Catherine McNulty, MS IV, Tulane University School of Medicine Dr. Matthew Hartman, M.D. Medical Student Radiology Director Dr. Matthew

More information

Supporting Documents Case Studies

Supporting Documents Case Studies Supporting Documents Case Studies ONA Presentation/Case Studies 1 CASE STUDY #1 CC: Right Breast Lump History of Present Illness: 41 yr old G3P0 with an LMP of 08/01/2017 who presents today to discuss

More information

The student guide to simulation

The student guide to simulation CETL 2008 1 The following guide will introduce you to what the simulators can do But firstly a few words on communication Please verbally and non-verbally communicate with the simulator as if it were a

More information

Brain Death and Disorders of Consciousness. John Banja, PhD Center for Ethics Emory University

Brain Death and Disorders of Consciousness. John Banja, PhD Center for Ethics Emory University Brain Death and Disorders of Consciousness John Banja, PhD Center for Ethics Emory University jbanja@emory.edu Five kinds of catastrophic neurological injury Minimal Responsiveness Persistent Vegetative

More information

Post-Arrest Care: Beyond Hypothermia

Post-Arrest Care: Beyond Hypothermia Post-Arrest Care: Beyond Hypothermia Damon Scales MD PhD Department of Critical Care Medicine Sunnybrook Health Sciences Centre University of Toronto Disclosures CIHR Physicians Services Incorporated Main

More information

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute. Medically Refractory Epilepsy with a Temporal Lobe Lesion Steven Ellis, MD Neurophysiology Fellow, PGY-5 UT Health San Antonio History No history of febrile seizures, meningitis, encephalitis, or head

More information

INTERNATIONAL TRAUMA LIFE SUPPORT

INTERNATIONAL TRAUMA LIFE SUPPORT INTERNATIONAL TRAUMA LIFE SUPPORT NC ITLS Rev. 2/18 STUDENT GUIDE TO INTERNATIONAL TRAUMA LIFE SUPPORT What to wear ITLS is a practical course that stresses hands-on teaching. You should wear comfortable

More information

Case Presentation. Dr. K. MonaLisa PG in Psy

Case Presentation. Dr. K. MonaLisa PG in Psy Case Presentation Dr. K. MonaLisa PG in Psy Name : XYZ Age : 35 years Sex : Female Religion : Hindu Marital status : Married Residence : Nalgonda Education : Intermediate Occupation : House-wife Socio-economic

More information

DUKEMedicine. SMITH, JAMES MRN: D DOB: 2/6/1993, Sex: M Adm: 2/15/2016, D/C: 2/15/2016

DUKEMedicine. SMITH, JAMES MRN: D DOB: 2/6/1993, Sex: M Adm: 2/15/2016, D/C: 2/15/2016 History Chief Complaint Patient presents with Motor Vehicle Crash HPI James Smith is a 23 y.o. male here today for evaluation of injuries sustained today in a MVA. He was a restrained driver of a car struck

More information

Chapter 1. Perioperative Evaluation and Management of Surgical Patients. Oral Exam Questions

Chapter 1. Perioperative Evaluation and Management of Surgical Patients. Oral Exam Questions Chapter 1 Perioperative Evaluation and Management of Surgical Patients Oral Exam Questions Case 1 A 62-year-old man with a PMH significant for hypertension, and a 40-pack-year history of smoking is found

More information

Case Scenarios. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC. Consultant, Critical Care Medicine Medanta, The Medicity

Case Scenarios. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC. Consultant, Critical Care Medicine Medanta, The Medicity Case Scenarios Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Case 1 A 36 year male with cirrhosis and active GI bleeding is intubated to protect his airway,

More information

Neurologic Examination

Neurologic Examination John W. Engstrom, MD October 16, 2015 Neurologic Examination Overview The Neurologic Examination Neurologic Examination John W. Engstrom, M.D. Dept. of Neurology University of California, San Francisco

More information

Emergency Room Resuscitation of the Unstable Trauma Patient

Emergency Room Resuscitation of the Unstable Trauma Patient Emergency Room Resuscitation of the Unstable Trauma Patient Goals of trauma resuscitation Maintain: Systemic oxygenation Systemic perfusion Neurologic function Approach to unstable trauma patient Primary

More information

Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra hospital, Isfahan university of medical sciences

Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra hospital, Isfahan university of medical sciences Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra hospital, Isfahan university of medical sciences ٢ Level of consciousness is depressed Stuporous patients respond only to repeated

More information

MHD I SESSION X. Renal Disease

MHD I SESSION X. Renal Disease MHD I, Session X, Student Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD I SESSION X Renal Disease Monday, November 11, 2013 MHD I, Session X, Student Copy Page 2 Case #1 Cc: I have had weeks of diarrhea

More information

Pediatric Asthma. Concepts (in order of emphasis) Jared, 10 years old

Pediatric Asthma. Concepts (in order of emphasis) Jared, 10 years old Pediatric Asthma Jared, 10 years old Overview This scenario is a rich application of the priority setting required by the nurse to rescue a child with an acute asthmatic exacerbation. Concepts (in order

More information

Management of Severe Traumatic Brain Injury

Management of Severe Traumatic Brain Injury Guideline for North Bristol Trust Management of Severe Traumatic Brain Injury This guideline describes the following: Initial assessment and management of the patient with head injury Indications for CT

More information

Data Collection Tool. Standard Study Questions: Admission Date: Admission Time: Age: Gender:

Data Collection Tool. Standard Study Questions: Admission Date: Admission Time: Age: Gender: Data Collection Tool Standard Study Questions: Admission Date: Admission Time: Age: Gender: Specifics of Injury: Time of Injury: Mechanism of Injury Blunt vs Penetrating? Injury Severity Score? Injuries:

More information

Admission of patient CVICU and hemodynamic monitoring

Admission of patient CVICU and hemodynamic monitoring Admission of patient CVICU and hemodynamic monitoring Prepared by: Rami AL-Khatib King Fahad Medical City Pi Prince Salman Heart tcentre CVICU-RN Admission patient to CVICU Introduction All the patients

More information

Exam 1 Review. Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies

Exam 1 Review. Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies Exam 1 Review Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies WBC Count Differential A patient had been admitted to the hospital for acute shortness of breath. A CXR examination

More information

UMC HEALTH SYSTEM Lubbock, Texas :

UMC HEALTH SYSTEM Lubbock, Texas : Consent for Commonly Performed Procedures in the Adult Critical Care Units I, the undersigned, understand that the adult intensive and intermediate care units ( critical care units ) are places where seriously

More information

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) REFERRAL FORM

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) REFERRAL FORM Patient Label This form is accessible on www.royalpapworth.nhs.uk Intensive Care Unit EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) REFERRAL FORM Please always phone Papworth ECMO Coordinator on 01480 830541,

More information

More than meets the eye

More than meets the eye More than meets the eye Ana Paula Abreu, MD, PhD American Association of Clinical Endocrinologists New England Chapter Annual Meeting September 8, 2018 Disclosures No conflict of interest or significant

More information