Sandbox/algo: Difference between revisions
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{{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 | | | | | | | | | |!| | | | | | | | | | | | | | | 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 | | | | | | | | | N02 | | | | | | | | | | | | | | | | | | | | | |N02=Where is pain localized}} | ||
{{familytree | | | | | | | | {{familytree | | | | |,|-|-|v|-|^|-|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 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | ||
{{familytree/end}} | {{familytree/end}} | ||
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{{familytree/start |summary=Sample 1}} | {{familytree/start |summary=Sample 1}} | ||
{{familytree | | | | | | | | | A01 | | | | | | | | | | |A01= | {{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 | | | | | |,|-|-|-|^|-|-|-|-|-|-|-|-|.| | }} | ||
{{familytree | | | | | B01 | | | | | | | | | | | B02 | | |B01=No|B02=Yes}} | {{familytree | | | | | B01 | | | | | | | | | | | B02 | | |B01=No|B02=Yes}} | ||
{{familytree | | | | | |!| | | | | | | | | | | | |!| | | }} | {{familytree | | | | | |!| | | | | | | | | | | | |!| | | }} | ||
{{familytree | | | | | C01 | | | | | | | | | | | C02 | | |C01=Pregnant|C02=<div style="float: left; text-align: left; line-height: 150% ">❑ | {{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 | | | | |,|^|-|-|-|-|-|-|-|.| | | | | | | }} | ||
{{familytree | | | D01 | | | | | | | | E01 | | | | | |D01=No|E01=Yes}} | {{familytree | | | D01 | | | | | | | | E01 | | | | | |D01=No|E01=Yes}} | ||
{{familytree | | | |!| | | | | | | | | |!| | | | | | | }} | {{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 | {{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 | | |!| | | | |!| | | | |,|^|-|.| | | | | }} | ||
{{familytree | | L01 | | | K01 | | G01 | | G02 | | | |L01=No|K01= | {{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 | | |!| | | | | | | | |!| | | |!| | | | | }} | ||
{{familytree | | M01 | | | | | | | H01 | | H02 | | | |M01=Clinical [[pelvic inflammatory disease]]|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 | | 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 | |,|^|-|-|-|-|-|.| | | | | | | | | | }} | ||
{{familytree | N01 | | | | | N02 | | | | | | | | |N01=No|N02=Yes}} | {{familytree | N01 | | | | | N02 | | | | | | | | |N01=No|N02=Yes}} | ||
{{familytree | |!| | | | | | |!| | | | | | | | | | }} | {{familytree | |!| | | | | | |!| | | | | | | | | | }} | ||
{{familytree | O01 | | | | | O02 | | | | | | | | |O01=Predominant [[ | {{familytree | O01 | | | | | O02 | | | | | | | | |O01=Predominant [[Right lower quadrant abdominal pain resident survival guide|RLQ pain]]|O02=Toxic appearing or persistent vomiting}} | ||
{{familytree | | | | | | | |,|^|.| | | | | | | | | }} | {{familytree | | | | | | | |,|^|.| | | | | | | | | }} | ||
{{familytree | | | | | | P01 | | P02 | | | | | | |P01=No|P02=Yes}} | {{familytree | | | | | | P01 | | P02 | | | | | | |P01=No|P02=Yes}} | ||
{{familytree | | | | | | |!| | | |!| | | | | | | | }} | {{familytree | | | | | | |!| | | |!| | | | | | | | }} | ||
{{familytree | | | | | | Q01 | | Q02 | | | | | | |Q01=Adminster antibiotics as an outpatient|Q02=Admit, start IV antibiotics and consult | {{familytree | | | | | | Q01 | | Q02 | | | | | | |Q01=Adminster antibiotics as an outpatient|Q02=Admit, start IV antibiotics and consult gynaecology}} | ||
{{familytree | | | | | | | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | | | | | | | | | | | | | | | }} | ||
{{familytree/end}} | {{familytree/end}} |
Revision as of 20:15, 19 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 | ||||||||||||||||||||||||||||||||||||||||||||