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Comprehensive Assessment-Based Management in Medical Practice

Embrace systematic and open-minded patient evaluation from history to diagnosis while addressing treatable possibilities. Multitasking approach ensures considering all likely causes and complications for effective treatment. Stay attentive to symptoms like Shortness of Breath, Altered Mental Status, and Abdominal Pain. Explore various conditions - from respiratory issues to abdominal challenges while considering trauma, metabolic, and vascular factors.

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Comprehensive Assessment-Based Management in Medical Practice

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  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

  5. Count off by 4s

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

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

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

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

  10. 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

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

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

  13. 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

  14. 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

  15. 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)

  16. 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

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

  18. 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

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