Assessment Based Management

1. Assessment Based Management (WHAT?)

2. What's That Mean? • The approach/assessment of every patient. • Systematic. • Not necessarily “protocol” driven. • Open minded. • Looking at all reasonable possibilities. • Treatable possibilities. • Multitasking (treating as your thinking)

3. Information • History, history, history • Exam • Physical • Emotional • Environmental • Diagnosis (working/field) • Re-examine

4. Complications • Environment • Preconceived ideas • Prejudice • Others opinions • Distracting injuries/issues • Safety considerations

6. Count off by 4s

7. Shortness of Breath • Altered Mental Status • Abdominal Pain • Chest Pain

8. SOB • Asthma • COPD Pneumonia • Emphysema • Bronchitis • Pneumothorax • Hemothorax • Pulmonary Embolism • MI • Congestive Heart Failure • Pulmonary Edema • Anaphylaxis

9. Cystic Fibrosis • Bronchiolitis • Adenocarcinoma of the lung • Amyotrophic Lateral sclerosis • Pulmonary Hamartoma • Mesothelioma • Myasthenia Gravis • Pulmonary Arterial Hypertension • Sucking Chest Injury • Flail Chest SOB

10. Pulmonary Contusion • Influenza viruses • ARDS (Acute Respiratory Distress Syndrome) • Croup • Epiglottis • RSV (Respiratory Syncytial Virus) • Tuberculosis • Respiratory Distress Syndrome • Adenoviruses • Atelectasis SOB

11. Asbestosis • Flavoring Related Lung Disease • Goodpasture’s Syndrome • Histoplasmosis • Hot Tub Lung • Interstitial lung disease • Hantavirus Pulmonary Syndrome • Silicosis • Human Metapneumovirus (HMPV) • Radiation Fibrosis SOB

12. SOB • Trauma • Decreased O2 • Running • Scared • Hurt (pain) 46

13. AMS • Drug toxicity/Overdose • Metabolic • Structural • Infectious • Psychiatric • Endocrine • Pulmonary • Oncologic • Cardiovascular • GI • Renal

15. Abdominal Pain • Gastrointestinal • Inflammatory: gastroenteritis, appendicitis, gastritis, esophagitis, diverticulitis, Crohn's disease, ulcerative colitis, microscopic colitis • Obstruction: hernia, intussusception, volvulus, post-surgical adhesions, tumours, superior mesenteric artery syndrome, severe constipation • Vascular: embolism, thrombosis, hemorrhage, sickle cell disease, abdominal angina, blood vessel compression (such as celiac artery compression syndrome) • Digestive: peptic ulcer, lactose intolerance, celiac sprue, Jasohnstritis • Bile system • Inflammatory: cholecystitis, cholangitis • Obstruction: cholelithiasis, tumours • Liver • Inflammatory: hepatitis, liver abscess • Pancreatic • Inflammatory: pancreatitis

16. Renal and urological • Inflammation: pyelonephritis, bladder infection • Obstruction: kidney stones, urolithiasis, Urinary retention, tumours • Vascular: left renal vein entrapment • Gynecological or obstetric • Inflammatory: pelvic inflammatory disease • Mechanical: ovarian torsion • Endocrinological: menstruation, Mittelschmerz • Tumors: endometriosis, fibroids, ovarian cyst, ovarian cancer • Pregnancy: ruptured ectopic pregnancy, threatened abortion

17. Abdominal wall • muscle strain or trauma • muscular infection • neurogenic pain: herpes zoster, radiculitis in Lyme disease, abdominal cutaneous nerve entrapment syndrome (ACNES), tabes dorsalis • Referred pain • from the thorax: pneumonia, pulmonary embolism, ischemic heart disease, pericarditis • from the spine: radiculitis • From the genitals: testicular torsion • Metabolic disturbance • uremia, diabetic ketoacidosis, porphyria, C1-esterase inhibitor deficiency, adrenal insufficiency,lead poisoning, black widow spider bite, narcotic withdrawal • Blood vessels • aortic dissection, abdominal aortic aneurysm • Immune system • sarcoidosis • vasculitis • familial Mediterranean fever • Idiopathic • irritable bowel syndrome (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent abdominal pain)

18. Traumatic : • blunt or perforating trauma to the stomach, bowel, spleen, liver, or kidney • Inflammatory : • Infections such as appendicitis, cholecystitis, pancreatitis, pyelonephritis, pelvic inflammatory disease, hepatitis, mesenteric adenitis, or a subdiaphragmatic abscess • Perforation of a peptic ulcer, a diverticulum, or the caecum • Complications of inflammatory bowel disease such as Crohn's disease or ulcerative colitis • Mechanical : • Small bowel obstruction secondary to adhesions caused by previous surgeries, intussusception, hernias, benign or malignant neoplasms • Large bowel obstruction caused by colorectal cancer, inflammatory bowel disease, volvulus, fecal impaction or hernia • Vascular : • occlusive intestinal ischemia, usually caused by thromboembolism of the superior mesenteric artery 105

19. CHEST PAIN • Acute coronary syndrome • Angina • Myocardial infarction • Aortic dissection • Pulmonary embolism • Pneumonia • Hemothorax • Pneumothorax • Tension pneumothorax • Arrhythmia

20. Carbon Monoxide • Sarcoidosis • Lead Poisoning • Upper gastrointestinal ailments, for example: • Gastroesophageal reflux disease (GERD) • Hiatus hernia • Disorders of the esophagus • Functional Dyspepsia • Problems of outer chest structures • Costochondritis • Spinal nerve problem • Fibromyalgia • Chest wall problems and breast conditions • Herpes zoster (shingles) • Psychological • Panic attack • Anxiety • Clinical depression • Somatization disorder • Hypochondria • Hyperventilation • Da costa's syndrome • Bornholm disease • Precordial catch syndrome • Pleurisy 31