approach to hypertension

Most patients presenting with hypertension are worried by the numbers on their blood pressure machines but don’t require immediate treatment. But we need to be on the lookout for specific causes and complications of hypertension. You can use the expanded ABCs approach to work through the body systems, looking for causes and complications of hypertension…

approach to nausea/vomiting

Vomiting is sometimes assumed to be of GI origin, and dismissed as gastroenteritis if accompanied by loose stool. But vomiting it is a non-specific symptom that can arise from any body system and requires a thorough approach to diagnose and treat its cause and complications. Use the expanded ABCs to work through all body systems.…

approach to fever

Fever is a symptom, of both infectious and non-infectious diseases, and we need a systematic approach to not miss either, and to resuscitate along the way A: ABCDEFGHIJKLMN Abscess, Angina Ludwid Bacterial tracheitis Croup Diphtheria Epiglottitis F G H I Johnson Kawasaki L Mono B: CHEST C H Effusion (malignant, parapneumonic) Sick pneumonia Tumour C:…

approach to weakness

Weakness has a broad differential and requires a broad approach A B: CHEST: Collapse: pneumo Hyperinflate: asthma/COPD Effusion Sick pneumonia Tumour C: CARDIOVASCULAR: Cardiac arrhythmia Around heart: pericardial effusion RV strain: PE Dysfunctional LV: ACS, CHF Incompetent valve Outflow: dissection Volume loss Abdominal bleed Soft tissue bleed Child-bearing: ectopic Urticarial anaphylaxis Lactate sepsis Addisons Rx…

approach to dizzy

Traditionally we were taught to separate dizziness into pre-syncope, vertigo and dysequilibrium as the first step towards a differential diagnosis. But studies have shown patients symptoms can’t be neatly separated into these three distinct categories. Instead we need a systematic approach to dizziness, emphasizing risk factors, associated symptoms and exacerbating factors–with ENT diagnoses at the…

approach to cough

When a patient presents with cough we often jump to the respiratory system, but we need to keep a broad systems-based approach A: ABCDEFGHIJKLMN Anaphylaxis Croup Diphtheria Foreign body Inhalation B Collapse: pneumothorax Hyperinflate: asthma/COPD Effusion Sick: pneumonia Tumour C: CARDIOVASCULAR RV strain: PE usually doesn’t present with cough, but can be cause of COPD…

approach to flank pain

With flank pain we often jump to renal causes like nephrolithiasis or pyelonephritis, but there are other causes to consider as well. Using the systems-based approach we can be more thorough A B: CHEST Effusion Sick pneumonia Tumour C: CARDIOVASCULAR DV strain: PE Outflow: dissection into renal artery Soft tissue bleed: AAA, retroperitoneal bleed Lactate: septic…

approach to back pain

The vast majority of patients with back pain have a benign diagnosis, but our job in the ER is not to miss the few with serious causes. This means our approach should put mechanical back pain at the bottom of our differential, as we do with other extremity complaints. Traditional “red flags” for back pain include…

approach to palpitations

Palpitations can be caused by the cardio-respiratory systems (a primary arrhythmia or secondary to other causes), systemic causes and exposures. A B: CHEST: palpitation from hypoxia Collapse Hyperinflate: COPD (also associated MAT) Effusion Sick pneumonia Tumour C: CARDIOVASCULAR: Cardiac arrhythmia: Heart rate (brady/tach) E (PR short/long, long QT) A R Tension (valvular) ST changes (PE, MI) Around…

approach to syncope

In a patient who faints, we need to consider both the cause and the consequences, which means running through all body systems–paying special attention to the CARDIOVASCULAR system. A C-spine injury B: CHEST Collapse lung (pneumothorax) from rib fracture C: CARDIOVASCULAR Cardiac arrhythmia: Heart rate (brady/tachyarrhtymias) Electrical (short PR, prolonged QT, trifascicular block) A R-wave…