Sandbox/algo: Difference between revisions
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<span style="font-size:85%"> '''ACS:''' Acute coronary syndrome; '''AAA:''' Abdominal aortic aneurysm; '''RUQ:''' Right upper quadrant; '''RLQ:''' Right lower quadrant; '''LUQ:''' Left upper quadrant; '''LLQ:''' Left lower quadrant</span> | |||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | | | {{familytree | | | | | | | | | | | | | | A01 | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% "> '''Signs of [[peritonitis]] or [[shock]]'''<br> ❑ [[Fever]]<br> ❑ Abdominal tenderness<br> ❑ Abdominal gaurding<br> ❑ Rebound tenderness ([[blumberg sign]])<br> ❑ Diffuse abdominal rigidity<br> ❑ [[Confusion]]<br> ❑ Weakness<br> ❑ Low blood pressure <br> ❑ Decreased urine output<br> ❑ Tachycardia<br> </div>}} | ||
{{familytree | | | | | | | | | | |,|-|-|-|^|-|-|-|-|-|-|.| }} | |||
{{familytree | | | | | | | | | | C01 | | | | | | | | | C03 | | | | | | | |C01=No|C02=No|C03=Yes}} | |||
{{familytree | | | | | | | | | | |!| | | | | | | | | | |!| }} | |||
{{familytree | | | {{familytree | | | | | | | | | | D01 | | | | | | | | | D03 |D01=<div style="float: left; text-align: left; line-height: 150% "> '''Signs and symptoms suggestive of [[acute coronary syndrome]]''' ❑ Risk factors: >40 years, smoking, [[diabetes mellitus]], [[hypertension]], obesity and high [[cholesterol]]<br> ❑ [[Chest tightness]] radiating to the left arm and the left angel of the jaw<br> ❑ [[Diaphoresis]]<br> ❑ Shortness of breath<br> ❑ Sense of impending death<br> ❑ [[Nausea]] and [[vomiting]]<br> [[Acute coronary syndrome resident survival guide|For more details about management of ACS, click here]]<br> | ||
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'''Signs and symptoms suggestive of [[abdominal aortic aneurysm]]'''<br> ❑ Risk factors: smoking, alcohol, [[hypertension]], high familial prevelance (genetic influences)<br> ❑ Pulsating sensation of the abdomen<br> ❑ Palpable abdominal mass<br> ❑ If ruptured: [[hypovolemic shock]], [[hypotension]], [[tachycardia]], [[cyanosis]], and [[altered mental status]] </div>|D03=<div style="float: left; text-align: left; line-height: 150% ">❑ Initiate resuscitation <br> ❑ Obtain immediate surgical consultation <br> ❑ Perform bedside ultrasound (evaluate aorta, hemoperitoneum, pericardium and inferior vena cava) <br> ❑ Obtain indicated tests and studies (e.g. x-ray, ECG, lactate, lipase and LFTs) </div>}} | |||
{{familytree | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | G01 |^|-| G02 | | | | | | | | |G01=No|G02=Yes}} | |||
{{familytree | | | | | | | | |!| | | | |!| | | | |}} | |||
{{familytree | | | | | | | | |!| | | | F01 | | | | | | | | | | | |F01=<div style="float: left; text-align: left; line-height: 150% ">❑ Surgical consultation <br> ❑ Bedside ultrasound <br> ❑ Abdominal CT<br> [[Abdominal aortic aneurysm|For more details about management of AAA, click here]] </div>}} | |||
{{familytree | | | | | | | | H01 | | | | | | | | | | | |H01=<div style="float: left; text-align: left; line-height: 150% "> '''Signs and symptoms syggestive of [[mesenteric ischemia]]''' <br> ❑ [[Abdominal pain]] out of proportion to examination<br> ❑ Bloody stools<br> ❑ [[Shock]]<br> ❑ [[Metabolic acidosis]] with [[dehydration]] </div>}} | |||
{{familytree | | | | | | |,|-|^|-|-| I01 | | | | | |I01=Yes}} | |||
{{familytree | | | | | | {{familytree | | | | | | L01 | | | | |!| | | | | | |L01=No}} | ||
{{familytree | | | | | | |!| | | | | J01 | | | | | |J01=<div style="float: left; text-align: left; line-height: 150% ">❑ Surgical consultation <br> ❑ Abdominal CT<br> [[Intestinal ischemia resident survival guide|For more details about management of mesenteric ischemia, click here]] </div>}} | |||
{{familytree | | | | | | K01 | | | | | | | | | | |K01=<div style="float: left; text-align: left; line-height: 150% "> '''Signs and symptoms suggestive of [[bowel obstruction]] or [[perforation|Intestinal perforation]]'''<br> ❑ Diffuse tenderness with distention<br> ❑ Persistent [[vomiting]]<br> ❑ [[Rigidity]] with absent bowel sounds<br> ❑ Fecal [[vomiting]]<br> ❑ [[Dehydration]] and [[electrolyte abnormalities]] </div> }} | |||
{{familytree | | | | | {{familytree | | | | | |,|^|-|-|-|-|-|-|-|-|-|-|-|-|-|.| | | | }} | ||
{{familytree | | | | | |!| | | | | | | | | | | | | | | M01 | |M01=Yes}} | |||
{{familytree | | | | | N01 | | | | | | | | | | | | | | |!| | |N01=No}} | |||
{{familytree | | | {{familytree | | | | | |!| | | | | | | | | | | | | | | M02 | |M02=<div style="float: left; text-align: left; line-height: 150% "> '''Abdominal x-ray series'''<br> ❑ ''Presence of free air:'' Consult surgery<br> ❑ ''Presence of obstruction:'' Order abdominal CT<br> ❑ ''Absent free air and absent obstruction:'' Order abdominal CT </div>}} | ||
{{familytree | | | | | N02 | | | | | | | | | | | | | | | | | | | | | |N02=Where is pain localized}} | |||
{{familytree | |,|-|-|-|+|-|-|-|v|-|-|-|v|-|-|.| | | | | | | | | | | | | | | |}} | |||
{{familytree | | | | | | {{familytree | N03 | | N04 | | N05 | | N06 | | N07 | | | | | | | | | | | | | |N03=[[Right upper quadrant abdominal pain resident survival guide|RUQ pain]]|N04=[[Right lower quadrant abdominal pain resident survival guide|RLQ pain]]|N05=[[Left upper quadrant abdominal pain resident survival guide|LUQ pain]]|N06=[[Epigastric pain resident survival guide|Epigastric pain]]|N07=[[Hypogastric pain resident survival guide|Hypogastric pain]]}} | ||
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | |||
{{familytree/end}} | |||
<br> | |||
<br> | |||
==Approach to a female of child-bearing age== | |||
{{familytree/start |summary=Sample 1}} | |||
{{familytree | | | | | | | | | A01 | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% "> '''Signs of [[peritonitis]] or [[shock]]'''<br> ❑ [[Fever]]<br> ❑ Abdominal tenderness<br> ❑ Abdominal gaurding<br> ❑ Rebound tenderness ([[blumberg sign]])<br> ❑ Diffuse abdominal rigidity<br> ❑ [[Confusion]]<br> ❑ Weakness<br> ❑ Low blood pressure <br> ❑ Decreased urine output<br> ❑ Tachycardia<br> </div>}} | |||
{{familytree | | | | | |,|-|-|-|^|-|-|-|-|-|-|-|-|.| | }} | |||
{{familytree | | | | | B01 | | | | | | | | | | | B02 | | |B01=No|B02=Yes}} | |||
{{familytree | | | | | |!| | | | | | | | | | | | |!| | | }} | |||
{{familytree | | | | | C01 | | | | | | | | | | | C02 | | |C01='''Pregnant:''' Perform a pregnancy test|C02=<div style="float: left; text-align: left; line-height: 150% ">❑ Initiate resuscitation <br> ❑ Obtain immediate surgical consultation <br> ❑ Perform bedside ultrasound (evaluate aorta, hemoperitoneum, pericardium and inferior vena cava) <br> ❑ Obtain indicated tests and studies (e.g. x-ray, ECG, lactate, lipase and LFTs) </div>}} | |||
{{familytree | | | | |,|^|-|-|-|-|-|-|-|.| | | | | | | }} | |||
{{familytree | | | D01 | | | | | | | | E01 | | | | | |D01=No|E01=Yes}} | |||
{{familytree | | | |!| | | | | | | | | |!| | | | | | | }} | |||
{{familytree | | | I01 |-| J01 | | | | F01 | | | | | |I01=Unilateral adnexal tenderness|J01=Yes|F01=<div style="float: left; text-align: left; line-height: 150% ">❑ Perform ultrasound examination (consider [[ectopic pregnancy]], [[appendicitis]]) <br> ❑ Perform sterile pelvic examination (not in third trimester [[vaginal bleeding]]) <br> ❑ Obtain quantitative HCG and other needed lab tests <br> ❑ Obtain OB/Gyn and surgery consultation if indicated </div>}} | |||
{{familytree | | |!| | | | |!| | | | |,|^|-|.| | | | | }} | |||
{{familytree | | L01 | | | K01 | | G01 | | G02 | | | |L01=No|K01=<div style="float: left; text-align: left; line-height: 150% "> '''''Rule out [[ovarian torsion]] or [[ovarian cyst]] by ultrasonography.'''''<br> '''Signs and symptoms suggestive of [[ovarian torsion]] or cyst:'''<br> ❑ Unilateral lower abdominal pain <br> ❑ [[Nausea]] and [[vomiting]]<br> ❑ Uterine bleeding <br> ❑ Irregular periods <br> ❑ Constitutional symptoms as fatigue or headaches </div>|G01=Intrauterine pregnancy|G02=<div style="float: left; text-align: left; line-height: 150% "> '''Ectopic pregnancy:''' <br> ❑ Risk factors: [[PID]], [[infertility]], usage of intrauterine device, tubal surgery, intrauterine surgery (eg, dilation and curettage)<br> ❑ [[Vaginal bleeding]]<br> ❑ [[Nausea]], [[vomiting]] and [[diarrhea]]<br> ❑ Abdominal distension<br> ❑ [[Hemorrhagic shock]] </div>}} | |||
{{familytree | | |!| | | | | | | | |!| | | |!| | | | | }} | |||
{{familytree | | M01 | | | | | | | H01 | | H02 | | | |M01=<div style="float: left; text-align: left; line-height: 150% ">'''Clinical [[pelvic inflammatory disease]]:'''<br> ❑ [[Fever]] <br> ❑ Cervical motion tenderness <br> ❑ Lower abdominal pain <br> ❑ [[Vaginal discharge]] <br> ❑ Painful intercourse <br> ❑ Irregular mesntrual bleeding </div>|H01=<div style="float: left; text-align: left; line-height: 150% ">❑ Assess appendix with US <br> ❑ Obtain OB/Gyn and surgery consultation as indicated </div>|H02=Obtain OB/Gyn consultation}} | |||
{{familytree | |,|^|-|-|-|-|-|.| | | | | | | | | | }} | |||
{{familytree | N01 | | | | | N02 | | | | | | | | |N01=No|N02=Yes}} | |||
{{familytree | |!| | | | | | |!| | | | | | | | | | }} | |||
{{familytree | O01 | | | | | O02 | | | | | | | | |O01=Predominant [[Right lower quadrant abdominal pain resident survival guide|RLQ pain]]|O02=Toxic appearing or persistent vomiting}} | |||
{{familytree | | | | | | | |,|^|.| | | | | | | | | }} | |||
{{familytree | | | | | | P01 | | P02 | | | | | | |P01=No|P02=Yes}} | |||
{{familytree | | | | | | |!| | | |!| | | | | | | | }} | |||
{{familytree | | | | | | Q01 | | Q02 | | | | | | |Q01=Adminster antibiotics as an outpatient|Q02=Admit, start IV antibiotics and consult gynaecology}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | | | | }} | |||
{{familytree/end}} | {{familytree/end}} |
Latest revision as of 20:41, 20 March 2014
ACS: Acute coronary syndrome; AAA: Abdominal aortic aneurysm; RUQ: Right upper quadrant; RLQ: Right lower quadrant; LUQ: Left upper quadrant; LLQ: Left lower quadrant
Signs of peritonitis or shock ❑ Fever ❑ Abdominal tenderness ❑ Abdominal gaurding ❑ Rebound tenderness (blumberg sign) ❑ Diffuse abdominal rigidity ❑ Confusion ❑ Weakness ❑ Low blood pressure ❑ Decreased urine output ❑ Tachycardia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Signs and symptoms suggestive of acute coronary syndrome ❑ Risk factors: >40 years, smoking, diabetes mellitus, hypertension, obesity and high cholesterol ❑ Chest tightness radiating to the left arm and the left angel of the jaw ❑ Diaphoresis ❑ Shortness of breath ❑ Sense of impending death ❑ Nausea and vomiting For more details about management of ACS, click here Signs and symptoms suggestive of abdominal aortic aneurysm ❑ Risk factors: smoking, alcohol, hypertension, high familial prevelance (genetic influences) ❑ Pulsating sensation of the abdomen ❑ Palpable abdominal mass ❑ If ruptured: hypovolemic shock, hypotension, tachycardia, cyanosis, and altered mental status | ❑ Initiate resuscitation ❑ Obtain immediate surgical consultation ❑ Perform bedside ultrasound (evaluate aorta, hemoperitoneum, pericardium and inferior vena cava) ❑ Obtain indicated tests and studies (e.g. x-ray, ECG, lactate, lipase and LFTs) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Surgical consultation ❑ Bedside ultrasound ❑ Abdominal CT For more details about management of AAA, click here | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Signs and symptoms syggestive of mesenteric ischemia ❑ Abdominal pain out of proportion to examination ❑ Bloody stools ❑ Shock ❑ Metabolic acidosis with dehydration | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Surgical consultation ❑ Abdominal CT For more details about management of mesenteric ischemia, click here | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Signs and symptoms suggestive of bowel obstruction or Intestinal perforation ❑ Diffuse tenderness with distention ❑ Persistent vomiting ❑ Rigidity with absent bowel sounds ❑ Fecal vomiting ❑ Dehydration and electrolyte abnormalities | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abdominal x-ray series ❑ Presence of free air: Consult surgery ❑ Presence of obstruction: Order abdominal CT ❑ Absent free air and absent obstruction: Order abdominal CT | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Where is pain localized | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
RUQ pain | RLQ pain | LUQ pain | Epigastric pain | Hypogastric pain | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Approach to a female of child-bearing age
Signs of peritonitis or shock ❑ Fever ❑ Abdominal tenderness ❑ Abdominal gaurding ❑ Rebound tenderness (blumberg sign) ❑ Diffuse abdominal rigidity ❑ Confusion ❑ Weakness ❑ Low blood pressure ❑ Decreased urine output ❑ Tachycardia | |||||||||||||||||||||||||||||||||||||||||||||
No | Yes | ||||||||||||||||||||||||||||||||||||||||||||
Pregnant: Perform a pregnancy test | ❑ Initiate resuscitation ❑ Obtain immediate surgical consultation ❑ Perform bedside ultrasound (evaluate aorta, hemoperitoneum, pericardium and inferior vena cava) ❑ Obtain indicated tests and studies (e.g. x-ray, ECG, lactate, lipase and LFTs) | ||||||||||||||||||||||||||||||||||||||||||||
No | Yes | ||||||||||||||||||||||||||||||||||||||||||||
Unilateral adnexal tenderness | Yes | ❑ Perform ultrasound examination (consider ectopic pregnancy, appendicitis) ❑ Perform sterile pelvic examination (not in third trimester vaginal bleeding) ❑ Obtain quantitative HCG and other needed lab tests ❑ Obtain OB/Gyn and surgery consultation if indicated | |||||||||||||||||||||||||||||||||||||||||||
No | Rule out ovarian torsion or ovarian cyst by ultrasonography. Signs and symptoms suggestive of ovarian torsion or cyst: ❑ Unilateral lower abdominal pain ❑ Nausea and vomiting ❑ Uterine bleeding ❑ Irregular periods ❑ Constitutional symptoms as fatigue or headaches | Intrauterine pregnancy | Ectopic pregnancy: ❑ Risk factors: PID, infertility, usage of intrauterine device, tubal surgery, intrauterine surgery (eg, dilation and curettage) ❑ Vaginal bleeding ❑ Nausea, vomiting and diarrhea ❑ Abdominal distension ❑ Hemorrhagic shock | ||||||||||||||||||||||||||||||||||||||||||
Clinical pelvic inflammatory disease: ❑ Fever ❑ Cervical motion tenderness ❑ Lower abdominal pain ❑ Vaginal discharge ❑ Painful intercourse ❑ Irregular mesntrual bleeding | ❑ Assess appendix with US ❑ Obtain OB/Gyn and surgery consultation as indicated | Obtain OB/Gyn consultation | |||||||||||||||||||||||||||||||||||||||||||
No | Yes | ||||||||||||||||||||||||||||||||||||||||||||
Predominant RLQ pain | Toxic appearing or persistent vomiting | ||||||||||||||||||||||||||||||||||||||||||||
No | Yes | ||||||||||||||||||||||||||||||||||||||||||||
Adminster antibiotics as an outpatient | Admit, start IV antibiotics and consult gynaecology | ||||||||||||||||||||||||||||||||||||||||||||