WAIS AFZAL, MD. PGY-1 Department of Internal Medicine Jamaica Hospital Medical Center
|
|
|
- Phillip Stone
- 5 years ago
- Views:
Transcription
1 WAIS AFZAL, MD PGY-1 Department of Internal Medicine Jamaica Hospital Medical Center
2 CHIEF COMPLAINT My Head Is Blowing
3 HPI 47 y.o. female, presented to ER with intermittent headaches, and intermittent left sided weakness, tingling, and numbness that got worse last night. Pt says since last week she had intermittent headaches and left sided weakness. Pt visited her PMD for the above symptoms who prescribed Tylenol#3, and continuation of her antihypertensive treatment. Pt's symptoms started to persist since last night, and did not disappear since then. In addition, Pt complains of dizziness, dysphagia, nausea, and vomited once. Pt denied any problem with speech, blurry vision, syncope, LOC, chest pain or palpitation. CT was negative for bleeding or any acute changes. Pt was seen by Neurology in ER; no tpa was not given as Pt was out of widow period. MRA Brain and Neck was recommended. Upon examination at bedside, Pt was crying and complaining of severe headache 10/10.
4 Review of Systems: Negative except as above. Allergies: Lipitor causes myalgia. PMH: HLD, HTN, stroke with no residual weakness, depression, herpes zoster iridocyclitis, acne. PSH: Carotid endarterectomy in LIJ North Shore in 2006, tubal ligation. SH: Denied any smoking, ETOH, or illicit drug use. FH: Father with stroke, died of sudden cardiac death at age 34, sister with stroke.
5 Home Medications TYLENOL # mg tablet TID PRN. Amlodipine 5 MG tablet OD. Clindamycin-tretinoin gel Clobetasol 0.05 % cream Clotrimazole-betamethasone external cream Omeprazole 40 MG capsule OD. Rosuvastatin 20 MG tablets HS. Terconazole 0.8 % vaginal cream Triamcinolone 0.5 % cream
6 PHYSICAL EXAMINATION BP 143/82 Pulse 109 Temp 99.7 F (37.6 C) (Oral) Ht 5' 4" (1.626 m) Wt 130 lb ( kg) BMI 22.3 kg/m2 SpO2 98% LMP 10/10/2014 General appearance: alert, appears stated age, cooperative, crying, and complains of headaches. Head: NC, AT, PERRLA, EOMI. Neck: surgical scar form carotid artery surgery on the right side of neck. No JVD, no carotid bruit. Lungs: CTA B/L. Heart: RRR, S1, S2 normal, no murmur, click, rub or gallop Abdomen: +BS, soft, ND, NT, no HSM. Extremities: extremities normal, atraumatic, no cyanosis or edema Pulses: 2+ and symmetric Neurologic: AAO X 3, motor 5/5 in right upper and lower extremities, motor 3/5 in left upper and lower extremities, DTRs 2+ in all 4 extremities, sensation intact B/L, DTR symmetric, Babinski negative B/L.
7 LABS
8 Labs PT 11.7 PTT 29.5 INR 1.0 Troponin <0.012 Pregnancy test negative
9 EKG
10 EKG Normal sinus rhythm. Nonspecific T wave abnormality. Abnormal ECG. No previous EKGs available for comparison.
11
12 CXR There is no evidence of an infiltrate, effusion, or PTX. Overlying leads are seen.
13
14
15
16
17 CT Head Without Contrast A noncontrast CT of the brain was performed. Exam is compared to prior study of April Exam reveals the ventricles are normal in size and configuration. There is no evidence of a mass or mass effect. There is no evidence of an acute hemorrhage, intra-axial or extra-axial collection. No abnormal areas of parenchymal attenuation are seen. The visualized paranasal sinuses and mastoid air cells are well aerated. IMPRESSION: NO FOCAL INTRACRANIAL LESION.
18 Neuro Consult No tpa warranted as Pt is out of the therapeutic window period. Start Plavix 75 mg once daily, Lipitor 80mg at bedtime. Continue ASA 81mg daily. 2D ECHO. MRI Brain, MRA head/neck. Rehab/ PT evaluation once medically stable Lipid panel with aim to maintain LDL less than 75 mg/dl. Maintain BP < 130/80mmHg Monitor blood glucose and to maintain between mg/dl DVT prophylaxis with heparin s/c, Telemetry Monitoring, Neuro checks as per protocol, Fall/aspiration precautions.
19 MAR ASSESSMENT Acute CVA: - Old CVA: - Right CEA in LIJ: - Left Sided Weakness: - Family History of CVA: HTN: Depression:
20 MAR PLAN Telemetry. MRA Brain. MRA Head/Neck. Lipid Panel with LDL goal of < 70 mg/dl. Plavix 75 mg PO daily. ASA 81 mg PO daily; continue. Lipitor 80 mg PO HS. Tylenol for headache PRN. NPO for now. Keep BP <130/80 mm-hg; continue amlodipine as needed. Maintain fingerstick between mg/dl. SLP evaluation. PT/Rehab evaluation. Neurocheck Q4 hrs. Vitals per Nursing Protocol. DVT Prophylaxis: Seizure, fall and aspiration precautions.
21
22
23
24 MRA Head No current evidence of diffusion restriction to suggest acute ischemia. No hemodynamic significant stenosis.
25
26
27 MRA Neck NO HEMODYNAMIC SIGNIFICANT STENOSIS.
28 Hospital Course; day 2-3? New CVA vs. Migraine Variant: Telemetry. Vitals per Nursing Protocol. Plavix 75 mg PO daily. ASA 81 mg PO daily; continue. Crestor 40 mg PO HS. Percocet PRN for headache. Xanax 0.5 mg HS PRN. Headache and weakness improves. Will discharge once Neurology clears Pt.
29 Neurology Follow-up Assessment: Weakness 4+/5, headaches still present, but intensity decreased. MRA Head and Neck reviewed. Migraine Variant: Etiology most likely complex migraine Plan: Amitriptyline 25mg HS. Start Medrol Pack for abortion of headaches. Continue with ASA 81mg, Plavix 75mg and Crestor 40 mg every day for secondary prevention of strokes. Follow up with Neurology in 2 weeks.
30 Discharge Meds Amitriptyline tablet 25 mg PO HS. Aspirin tablet 81 mg PO daily. Clopidogrel tablet 75 mg PO daily. Famotidine tablet 40 mg PO daily. MethylPREDNISolone tablet 4 mg PO taper. Rosuvastatin tablet 40 mg POS HS.
31 INTERNAL MEDICINE DISCHARGE Left sided weakness 4+/5. Regular medication intake. Activity: As tolerated. Diet: Low Sodium,Carb consistent. No smoking, no alcohol, no drugs advised. Neurology Follow up in 2 weeks.
32 Migraine Variant Migraine variant is the term applied to a migraine that exhibits itself in a form other than headache only. Such conditions are less recognized, less common, and less well understood than the typical migraines that usually affect children and young adults. Migraine variants may be characterized by the following: Paroxysmal episodes of prolonged visual auras. Atypical sensory, motor, or visual aura. Confusion. Dysarthria. Focal neurologic deficits. Gastrointestinal (GI) manifestations. Other constitutional symptoms, with or without a headache.
33 Take Home Message Not Every Weakness/Numbness is Stroke Thank You For Your Attention
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
The Importance of Stroke Programs in an Acute Care Setting by Debbie Estes, RN, BSN Stroke Program Coordinator, Medical City of Dallas
The Importance of Stroke Programs in an Acute Care Setting by Debbie Estes, RN, BSN Stroke Program Coordinator, Medical City of Dallas Objectives Describe the road to the gold Discuss the importance of
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
A 45 year old African American man presents to the IMC with a chief complaint of my
AN EVIDENCE BASED APPROACH TO HYPERTENSION AND HYPERLIPIDENIA: A CASE STUDY A 45 year old African American man presents to the IMC with a chief complaint of my pressure is high. Apparently he recently
Diagnosis: Allergies with reaction type:
Patient Name: Diagnosis: Allergies with reaction type: ICU Stroke-Ischemic S/P tpa Version 2 5/29/14 This order set is designed to be used with an admission set or for a patient already admitted Nursing
OHSU HEALTH CARE SYSTEM PRACTICE GUIDELINES
OHSU HEALTH CARE SYSTEM NEUROSCIENCES (includes ischemic stroke, TIA, intracerebral hemorrhage and non-subarachnoid hemorrhage) Last Reviewed Date: September 2013 POLICY STATEMENT: OHSU hospitals and clinics
ND STROKE Coordinators Case Studies. STEMI and Stroke Conference, Fargo, ND, August 5, 2014
ND STROKE Coordinators Case Studies STEMI and Stroke Conference, Fargo, ND, August 5, 2014 STROKE Coordinator Case Study Essentia Health, Fargo Essentia Health Stroke Alert Process Within 24 hours of Last
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
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
Shawke A. Soueidan, MD. Riverside Neurology & Sleep Specialists
Shawke A. Soueidan, MD Riverside Neurology & Sleep Specialists 757-221-0110 Epidemiology of stroke 2018 Affects nearly 800,000 people in the US annually Approximately 600000 first-ever strokes and 185000
Acute Stroke with Alteplase Administration Order Set
Review Due Date: 2017 October PATIENT CARE DERS Weight: Adverse Reactions or Intolerances Drug No Yes (list) Food No Yes (list) _ Latex No Yes Admission Admit to Neurology service: Dr. Critical Care Diagnosis:
Protocol for IV rtpa Treatment of Acute Ischemic Stroke
Protocol for IV rtpa Treatment of Acute Ischemic Stroke Acute stroke management is progressing very rapidly. Our team offers several options for acute stroke therapy, including endovascular therapy and
What Do You Think of My Posterior?
What Do You Think of My Posterior? Posterior Stroke and Stroke Mimics Peter Panagos, MD, FACEP, FAHA Associate Professor Emergency Medicine and Neurology Washington University School of Medicine Disclosures
Operation Stroke. How to Reduce the Risk of Stroke Complications
Operation Stroke How to Reduce the Risk of Stroke Complications Objectives Focus on Acute Stroke as an active disease Discuss the most common stroke complications Describe how first 72 hours sets the stage
Introduction to Risk Stratification
Introduction to Risk Stratification Tim Fendler, MD, MSc Heart Failure/Transplant Fellow St. Luke s Mid America Heart Institute 1 Disclosures: No financial relationships to disclose. A 74 year-old male
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
CEREBRO VASCULAR ACCIDENTS
CEREBRO VASCULAR S MICHAEL OPONG-KUSI, DO MBA MORTON CLINIC, TULSA, OK, USA 8/9/2012 1 Cerebrovascular Accident Third Leading cause of deaths (USA) 750,000 strokes in USA per year. 150,000 deaths in USA
Alan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with L numbness & slurred speech 2 episodes; 10 mins & 2 hrs Hypertension Type II DM Examination pulse 80/min reg, BP 160/95
Patient Encounters in the Primary Care Setting
Patient Encounters in the Primary Care Setting Carmine D Amico, D.O. Clinical Cases Overview Learning objectives Clinical case presentations Questions for audience participation 1 Clinical Cases Learning
NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS. ACUTE CEREBROVASCULAR ACCIDENT TPA (ACTIVASE /alteplase) FOR THROMBOLYSIS
NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS ACUTE CEREBROVASCULAR ACCIDENT TPA (ACTIVASE /alteplase) FOR THROMBOLYSIS I. Purpose : A. To reduce morbidity and mortality associated
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
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,
PATIENT S NOTES History and Physical Brain Attack Stroke
UNIVERSITY HOSPITALS OF CLEVELAND PATIENT S NOTES History and Physical Brain Attack Stroke 040527.01 page 1 of 8 Name Hospital # Date Sex Age Dr. Service Division Rm No Date and Time: Current inpatient
Med 536 Communicating About Prognosis Workshop. Case 2
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
ADULT POST NEUROLOGIC INTERVENTION ORDERS 2 of 4
9 Actual 9 Estimated DOWNTIME INTERVENTION 1 of 4 Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Admit to Dr.: Bed Type: Dx: ( ) Check, circle and/or fill in all
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:
Beating outside the Box a case presentation on pericarditis. Kathryn R. Brim, DO, PGY1 Internal Medicine Resident
Beating outside the Box a case presentation on pericarditis Kathryn R. Brim, DO, PGY1 Internal Medicine Resident Presentation Mr. P.A. is a 47 year old male who presented to the emergency department with
47 Year-Old Female with Headache. Olesya Krivospitskaya, MD Second year endocrinology fellow
47 Year-Old Female with Headache Olesya Krivospitskaya, MD Second year endocrinology fellow HPI: 47 y.o. female presented to ER with c/o acute onset of headache at the vertex of her head and retro-orbital
Alan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with L numbness & slurred speech 2 episodes; 10 mins & 2 hrs Hypertension Type II DM Examination P 80/min reg, BP 160/95, normal
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
Primary Stroke Center Quality & Performance Measures
Primary Stroke Center Quality & Performance Measures This section of the manual contains information related to the quality performance of Primary Stroke Centers. Brain Attack Coalition Definitions Recognition
TIA: Updates and Management 2008
TIA: Updates and Management 2008 S. Andrew Josephson, MD Department of Neurology, Neurovascular Division University of California San Francisco Commonly Held TIA Misconceptions TIA is easy to diagnose
CAN T MISS ECG FINDINGS L. THOMAS RICHARDS, MD ASSISTANT PROFESSOR OF EMERGENCY MEDICINE
Topics in Emergency Medicine 2010 CAN T MISS ECG FINDINGS L. THOMAS RICHARDS, MD ASSISTANT PROFESSOR OF EMERGENCY MEDICINE OBJECTIVES Examine three common presentations to the ED which compel the EM provider
Stroke Topics. Advances in the Prevention and Treatment of Stroke. Non-Contrast Head CT. Patient 1-68 yo man
Stroke Topics Advances in the Prevention and Treatment of Stroke August 10, 2009 John W. Engstrom, M.D. Professor of Neurology Acute treatment options for ischemic stroke tpa, clot retraction, future directions
Discharge Summary-Page 1
Discharge Summary-Page 1 Admission diagnosis: 1. Gastritis. 2. Alcoholic cirrhosis, ascites, grade 1 esophageal varices. 3. Recent left knee arthroplasty. 4. Osteoporosis naqmq : 1. Three chest X-rays
Unclogging The Pipes. Zahraa Rabeeah MD Chief Resident February 9,2018
Unclogging The Pipes Zahraa Rabeeah MD Chief Resident February 9,2018 Please join Polleverywhere by texting: ZRABEEAH894 to 37607 Disclosures None Objectives Delineate the differences between TPA vs thrombectomy
BACK AND NECK PAIN QUESTIONNAIRE
Neurological Surgery and Spine Surgery, S.C. 1 Westbrook Corporate Center, Suite 800 Westchester, Illinois 60154 BACK AND NECK PAIN QUESTIONNAIRE Please PRINT all information CLEARLY and answer all questions
Nuts for Neuro and why I hate EMR
Nuts for Neuro and why I hate EMR Roberta S Rose, DO private practice in General neurology Staff physician: IRMC and SRMC I have no disclosures, I m just a working stiff Stroke overview: 2018 Guidelines
33-Year-Old Female With Amenorrhea DISHA KUMAR NARANG, MD PITUITARY ENDORAMA DECEMBER 11, 2014
33-Year-Old Female With Amenorrhea DISHA KUMAR NARANG, MD PITUITARY ENDORAMA DECEMBER 11, 2014 Our Patient 33-year-old female presents to endocrinology clinic after amenorrhea for 4 years History of Present
62-year-old woman with severe headache. Celeste Thomas November 1, 2012
62-year-old woman with severe headache Celeste Thomas November 1, 2012 History of Present Illness History of hypertension and hyperlipidemia Presented to outside hospital after awakening from sleep with
TIA Transient Ischaemic Attack?
TIA Transient Ischaemic Attack? OR Transient loss of function (TLOF) Tal Anjum Consultant Stroke Physician, Morriston Hospital Training & education lead, WASP (Welsh Association of Stroke Physicians) Qs.
TCD AND VASOSPASM SAH
CURRENT TREATMENT FOR CEREBRAL ANEURYSMS TCD AND VASOSPASM SAH Michigan Sonographers Society 2 Nd Annual Fall Vascular Conference Larry N. Raber RVT-RDMS Clinical Manager General Ultrasound-Neurovascular
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Non Categorized SUB Sub Phase (SUB)* Non Categorized Quality Measures STK Diet ED NPO Until Bedside Swallow Screen passed Nursing Orders Activate Code Stroke Vital Signs Q15MINS Int
33 year old male with a history of resected craniopharyngioma (12 years ago) presents after a seizure. Jess Hwang 9/27/12
33 year old male with a history of resected craniopharyngioma (12 years ago) presents after a seizure Jess Hwang 9/27/12 Craniopharyngioma history In 2000, at age 22, he presented with headache and blurry
Topic: Chronic Heart Failure Cases for Monday s March 21th lecture.
1 Phar6122: CV section Date: 3/10/05 Topic: Chronic Heart Failure Cases for Monday s March 21th lecture. Directions: This handout includes three chronic heart failure cases of increasing difficulty. In
OHSU Health Care System
Acute Stroke Practice Standard for the Emergency Department (includes ischemic stroke, TIAs, intracerebral hemorrhage, and non-subarachnoid hemorrhage), PS 01.11 Last Reviewed Date: 2/2/10 STATEMENT OF
Management of Acute Ischemic Stroke. Learning Objec=ves. What is a Stroke? Jen Simpson Neurohospitalist
Management of Acute Ischemic Stroke Jen Simpson Neurohospitalist Learning Objec=ves Iden=fy signs/symptoms of stroke Recognize pa=ents who may be eligible for treatment of acute stroke What is a Stroke?
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
It s Always a Stroke; Except For When It s Not..
It s Always a Stroke; Except For When It s Not.. TREVOR PHINNEY, D.O. Disclosures No Relevant Disclosures 1 Objectives Discuss variables of differential diagnosis for stroke Review when to TPA and when
Admit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests. CBC, Electrolytes, Urea, Creatinine, Glucose, INR, PTT, Urinalysis
of nurse 1. Admit under ward Attending Physician: Dr. Admit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests 2. On admission (if not already performed in Emergency Department or in Coronary
ACCESS CENTER:
ACCESS CENTER: 1-877-367-8855 Emergency Specialty Services: BRAIN ATTACK Criteria: Stroke symptom onset time less than 6 hours Referring Emergency Department Patient Information Data: Time last known normal:
Date of Admission: [DATE]. Date of Discharge:
![Date of Admission: [DATE]. Date of Discharge:](/thumbs/74/71277118.jpg "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
2018 Early Management of Acute Ischemic Stroke Guidelines Update
2018 Early Management of Acute Ischemic Stroke Guidelines Update Brandi Bowman, PhC, Pharm.D. April 17, 2018 Pharmacist Objectives Describe the recommendations for emergency medical services and hospital
Primary Care Patient Case Example
Primary Care Patient Case Example Chief Complaint (CC): K.G. presents to your clinic for a follow-up. You work in an interprofessional clinic with physicians. He has no complaints today. History of the
Physician s Order Form. Physician s Order Form. Telemetry/Progressive Care Orders. Continued on next page. >>>>>>> Continued on next page.
DATE: TIME: DATE TIME INTRAVENOS FLID and MEDICATION Status: Admit to Telemetry Admit to Progressive Care nit Transfer to Progressive Care nit Note: Discontinue Previous Orders Transfer to Telemetry nit
Cryptogenic Stroke: A logical approach to a common clinical problem
Cryptogenic Stroke: A logical approach to a common clinical problem Alphonse M. Ambrosia, DO, FACC Interventional Cardiologist CardioVascular Associates of Mesa Mesa, Arizona Speakers Bureau Boston Scientific
Dawn Matherne Meyer PhD,RN,FNP-C. Assistant Professor University of California San Diego
Dawn Matherne Meyer PhD,RN,FNP-C Assistant Professor University of California San Diego Evidence Based Care of the Stroke Patient: A Focus on Acute Treatment, BP Management, & Antiplatelets TIME IS BRAIN
* Final Report * ED Triage Entered On: 01/16/2014 8:45 EST Performed On: 01/16/2014 8:42 EST by
Result date: Result status: 16 January 2014 8:42 EST Auth (Verified) * Final Report * ED Triage Entered On: 01/16/2014 8:45 EST Performed On: 01/16/2014 8:42 EST by Assessment I Chief Complaint : Diarrhea
Overview INTRODUCTION 3/15/2018. Headache Emergencies. Other way to differentiate between them? Is there an easy way to differentiate between them?
Overview Headache Emergencies Primary versus Secondary headache disorder Red flags 4 cases of unusual headache emergencies Disclaimer: we will not talk about brain bleed as patients usually go the ED.
Canadian Stroke Best Practices Initial ED Evaluation of Acute Stroke and Transient Ischemic Attack (TIA) Order Set (Order Set 1)
Canadian Best Practice Recommendations for Stroke Care: All patients presenting to an emergency department with suspected stroke or transient ischemic attack must have an immediate clinical evaluation
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.
CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 04/26/2014 Radiology Quiz of the Week # 108 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
Emergency Room Procedure The first few hours in hospital...
Emergency Room Procedure The first few hours in hospital... ER 5 level Emergency Severity Index SOP s for Stroke Stroke = Level 2 Target Time = 1 Hour 10 min from door 2 Doctor 25 min from door 2 CT 60
Difficult Diagnosis: An Interactive Session
Difficult Diagnosis: An Interactive Session W A D E S M I T H, M. D. D E P T. O F N E U R O L O G Y, U C S F F E B R U A R Y 1 5, 2 0 1 3 58-year-old man with HTN and HLD Recurrent episodes of dizziness
NOR-CAL EMS MEDICAL ADVISORY COMMITTEE RUN REVIEW, NOVEMBER 2014
Eric M. Rudnick, MD, FACEP, FAAEM Medical Director Northern California EMS NOR-CAL EMS MEDICAL ADVISORY COMMITTEE RUN REVIEW, NOVEMBER 2014. meeting by Engineer Bill Bogenreif 1 CASE #1 Call Type : Fall
Alan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with Non-fluent dysphasia R facial weakness Background Ischaemic heart disease Hypertension Hyperlipidemia L MCA branch
CHART Documentation Format Example
CHART Documentation Format Example The CHART and SOAP methods of documentation are examples of how to structure your narrative. You do not need to format the narrative to look like this; you can simply
TIA AND STROKE. Topics/Order of the day 1. Topics/Order of the day 2 01/08/2012
Charles Ashton Medical Director TIA AND STROKE Topics/Order of the day 1 What Works? Clinical features of TIA inc the difference between Carotid and Vertebral territories When is a TIA not a TIA TIA management
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
Atrial Fibrillation Version 2 11/4/15 This order set must be used with an admission order set if patient not already admitted.
Patient Name: Diagnosis: Allergies with reaction type: Atrial Fibrillation Version 2 11/4/15 This order set must be used with an admission order set if patient not already admitted. Telemetry Medical Telemetry:
Syncope Guidelines What s new? October 19 th 2017 Mohamed Aljaabari MBBCh, FACC, FHRS Consultant Electrophysiologist - Mafraq Hospital
Syncope Guidelines What s new? October 19 th 2017 Mohamed Aljaabari MBBCh, FACC, FHRS Consultant Electrophysiologist - Mafraq Hospital Case Presentation 35 Male presented with sudden loss of consciousness
Treating A Sore Throat With Intubation. A case of Epiglottitis in an elderly patient. Sherif Yani, PGY3 St Joseph s FM Residency
Treating A Sore Throat With Intubation A case of Epiglottitis in an elderly patient. Sherif Yani, PGY3 St Joseph s FM Residency Outline H&P Diagnosis Management Discussion Take-Home Points History 88 y/o
TAVR : Caring for your patients before and after TAVR
TAVR : Caring for your patients before and after TAVR Zubair Ahmed MD FSCAI Interventional Cardiologist Washington Regional Medical Center / Walker Heart Institute What is Aortic Valve Stenosis? AVA ~4
Physician Orders ADULT: Medical Response Team Standing Orders Protocol Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase When to Initiate: Other-See Special Instructions, If MRT is notified per MD, Condition H or any associate, review and Initiate
Management of TIA. Dr Ali Ali Consultant Stroke and Geriatrics Royal Hallamshire Hospital
Management of TIA Dr Ali Ali Consultant Stroke and Geriatrics Royal Hallamshire Hospital Objectives Definition TIA and stroke TIA: Diagnosis & mimics Risk assessment Referral and emergency management Secondary
Topic: Chronic Heart Failure Cases for Monday s March 21th lecture.
1 Phar6122: CV section Date: 3/21/05 Topic: Chronic Heart Failure Cases for Monday s March 21th lecture. Directions: This handout includes three chronic heart failure cases of increasing difficulty. In
GUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE
2018 UPDATE QUICK SHEET 2018 American Heart Association GUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE A Summary for Healthcare Professionals from the American Heart Association/American
Post-op Carotid Complications A Nursing Perspective of What to Watch Out for
Post-op Carotid Complications A Nursing Perspective of What to Watch Out for By Kariss Peterson, ARNP Swedish Medical Center Inpatient Neurology Team 1 Post-op Carotid Management Objectives Review the
Stroke Workshop. Pre-Workshop Handout. With Walter Himmel, Meeta Patel & Anton Helman
2018 Stroke Workshop Pre-Workshop Handout With Walter Himmel, Meeta Patel & Anton Helman Instructions for Getting the Most Out of The EMU Stroke Workshop Handout This workshop has been designed around
Progesterone. What is progesterone? Important information. Before taking this medicine
Progesterone Generic Name: progesterone (proe JESS te rone) Brand Names: First Progesterone MC10, Menopause Formula Progesterone, Prometrium What is progesterone? Progesterone is a female hormone important
LSU Medicine Case Conference. Tuesday May 17, 2011 Gisella Tay, M.D.
LSU Medicine Case Conference Tuesday May 17, 2011 Gisella Tay, M.D. Chief Complaint I fell down on my porch. HPI 60yo man with past medical history of HTN and recurrent sebaceous cysts was transferred
M F HOME ADDRESS CITY STATE ZIP CODE MARITAL STATUS SINGLE MARRIED DIVORCED WIDOWED PREFERRED PHONE NUMBER TO BE CONTACTED
PRESENT ILLNESS INFORMATION INSURANCE PATIENT HISTORY AND PHYSICAL APPOINTMENT DATE: NAME-LAST FIRST M.I. DATE OF BIRTH AGE SEX SOCIAL SECURITY NO. M F HOME ADDRESS CITY STATE ZIP CODE MARITAL STATUS SINGLE
Syncope and Seizure Questionnaire
Syncope and Seizure Questionnaire World College of Neurology 2/79 Wheatley Drive Bull Creek WA 6149 T 08 93320488 F 08 93329988 Copyright 2011. All rights reserved. Patient Name: MAIN PROBLEM I am here
Chest Pain Acute Coronary Syndrome Version 4 4/10/17 This order set is designed to be used with an admission set or for a patient already admitted
Patient Name: Diagnosis: Allergies with reaction type: Chest Pain Acute Coronary Syndrome Version 4 4/10/17 This order set is designed to be used with an admission set or for a patient already admitted
Both MI and UA can not be Yes. Please correct. Yes
2. MIUA (1) Page MI UA Both MI and UA can not be Yes. Please correct. Did MI occur? No Did UA Requiring admission to hospital or emergency room occur? (after randomization) Date of UA onset Yes Time of
NEUROLOGICAL SURGERY, P.C.
NEUROLOGICAL SURGERY, P.C. PATIENT INFORMATION Name Date of Birth Age Address City Sate NY Zip Home ( ) - Cell ( ) - Work ( ) - Ext: Email Address _ Sex M F Soc. Sec. #: / / Single Married Widowed Separated
HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM
REVIEW DATE REVIEWER'S ID HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM : DISCHARGE DATE: RECORDS FROM: Hospitalization ER Please check all that may apply: Myocardial Infarction Pages 2, 3,
Chest Pain. Scott A. Phillips, M.D. AnMed Health Carolina Cardiology
Chest Pain Scott A. Phillips, M.D. AnMed Health Carolina Cardiology Cardiac Causes -Ischemic vs. Non-ischemic Non-Cardiac Causes -Pulmonary, GI, Musculoskeletal, Dermatology 1. Chest Wall Pain Sharp, Precisely
Nicolas Bianchi M.D. May 15th, 2012
Nicolas Bianchi M.D. May 15th, 2012 New concepts in TIA Differential Diagnosis Stroke Syndromes To learn the new definitions and concepts on TIA as a condition of high risk for stroke. To recognize the
Case Follow Up. Sepi Jooniani PGY-1
Case Follow Up Sepi Jooniani PGY-1 Triage 54 year old M Pt presents to prelim states noticed today he had reddness to eyes, states worse in R eye. Pt denies any pain or itching. No further complaints.
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
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
Social History. Retired internist 2 scotches a day 50 pack-year history, stopped in 2005
April 17, 2008 HPI 78 year old internist complains of 10 days of tingling and discomfort in left toes Unable to walk or sleep due to severe pain Pain worse with movement Redness in left toes Bilateral
42 y/o woman with unwitnessed episode of loss of consciousness and urinary incontinence
Top Five Neurological Emergencies: When To Refer February 23, 2011 Jinny Tavee, MD Associate Professor Neurological Institute Cleveland Clinic Foundation 1 CASE 1 42 y/o woman with unwitnessed episode
Stroke Guidelines. November 19, 2011
Stroke Guidelines November 19, 2011 Clinical Practice Guidelines American Stroke Association Guidelines are comprehensive statements that provide the highest level of scientific evidence for clinical practice.
UHSM ED Pathway ELDERLY FALL / COLLAPSE
UHSM ED Pathway ELDERLY FALL / COLLAPSE Patient name / Pathway for patients who require assessment in ED after a fall or collapse Note: - It can be used if the patient has also sustained a minor head injury
A Case of Spontaneous Isolated Celiac Artery Dissection with Pseudoaneurysm Formation
A Case of Spontaneous Isolated Celiac Artery Dissection with Pseudoaneurysm Formation John Kim MS3, Lamar Moree M.D., Michael Muehlberger M.D. 1 University of Central Florida College of Medicine, 2 Orlando
Cryptogenic Strokes: Evaluation and Management
Cryptogenic Strokes: Evaluation and Management 77 yo man with hypertension and hyperlipidemia developed onset of left hemiparesis and right gaze preference, last seen normal at 10:00 AM Brought to ZSFG
Medical Advisory Committee. Run Review
Nor Cal EMS Medical Advisory Committee Run Review September 2014 Eric M. Rudnick, MD, FACEP, FAAEM Medical Director Northern California EMS September 9, 2014 1 Case #1 Dispatched for a male with chest
OUTPATIENT SUMMARY LIST. Social / Family HX. Additional Information: USE A SECOND SHEET IF NECESSARY DO NOT WRITE ON BACK OF FORM.
Washington Institute of Surgery, LLC. 2311 M Street, N.W. Suite 501, Washington, DC 20037. Tel: (202) 775 9375 Fax: (202) 776 9088 Web: www.washingtoninstituteofsurgery.com OUTPATIENT SUMMARY LIST MR #: