What is case presentation in MBBS

Appendix 2a Internal case studies

Transcript

1 Appendix 2a Internal case studies as of February 24, 2014

2 1. Pneumonia Febrile Inflammatory Lung Disease Symptoms: Dyspnoea; possibly rattling noises (damp); possibly cough; Tachycardia; Fever; Fatigue; Vigilance reduction; Therapy: O2; Storage; if necessary infusion; initiate further medical therapy Can be combined with: t4; T31; T45; as well as H2; H17; H24 2. Bronchitis Febrile Inflammatory Respiratory Disease Symptoms: Dyspnoea; Rattling noises (damp); possibly spasticity; To cough; Tachycardia; possibly fever; BG measurement diagnostics: RR; Pulse; Temperature; EKG; Auscultation; SaO2; Therapy: if necessary O2; Storage; initiate further medical therapy Can be combined with: T16; T24; T50; as well as H3; H20; H28 Appendix 2a Internal case studies 2

3 3. Obstructive Airway Disease Obstructive Airway Disease Symptoms: Dyspnoea; Stridor; Wheezing; Spasticity; possibly cough; BG measurement diagnostics: RR; Pulse; Temperature; EKG; Auscultation; SaO2; Therapy: O2; Storage; Instructions for lip brake; initiate further medical therapy Can be combined with: t18; T30; T47; as well as H1; H11; H25 4. Obstructive Airway Disease Obstructive Airway Disease Symptoms: dyspnoea; Stridor; Wheezing; Spasticity; To cough; Cyanosis; possibly fever; possibly limited vigilance therapy: O2; Storage; i.v. Access; Infusion; Medical therapy; possibly CPAP ventilation; initiate further medical therapy Can be combined with: t11; T29; T38; as well as H4; H15; H26 Appendix 2a Internal case studies 3

4 5. ACS with STEMI Acute Coronary Syndrome as ST Elevation Infarct Symptoms: dyspnoea; Chest tightness; Sweatiness; Paleness; Nausea; possibly radiating pain in upper abdomen, left arm; Lower jaw; Therapy: O2; Storage; i.v. Access; Infusion; Medical therapy; initiate further medical therapy Can be combined with: t14; T26; T49; as well as H7; H12; H20 6. ACS with Non - STEMI Acute coronary syndrome without ST elevation but with positive Trop-T test Symptoms: dyspnoea; Chest tightness; Sweatiness; Paleness; Nausea; possibly radiating pain in upper abdomen, left arm; Lower jaw; Therapy: O2; Storage; i.v. Access; Infusion; Medical therapy; initiate further medical therapy Can be combined with: t3; T15; T40; as well as H8; H17; H22 Appendix 2a Internal case studies 4

5 7. ACS in the sense of angina pectoris - for the first time acute coronary syndrome without ST elevation and without a corresponding history, improvement on nitro administration Symptoms: dyspnoea; Chest tightness; Nausea; Therapy: O2; Storage; i.v. Access; Infusion; Drug therapy (nitro administration with improvement); initiate further medical therapy Can be combined with: t7; T43; T48; as well as H5; H10; H13 8. Syncope Short-term impaired consciousness / unconsciousness from different or unclear cause (s) Symptoms: pallor; Sweatiness; possibly nausea; no vigilance restriction; no neurological failures Therapy: possibly O2; Storage; initiate further medical therapy Can be combined with: t5; T18; T34; as well as H3; H8; H21 Appendix 2a Internal case studies 5

6 9. Hyperventilation Rapid, deep inhalation and exhalation with respiratory alkalosis Symptoms: tachypnea; Restlessness, possibly paws position of the hands; Tingling paresthesia diagnostics: RR; Pulse; Temperature; Auscultation; SaO2; BG measurement Therapy: calm down; Storage; possibly rebreathing; if necessary arrange for further medical therapy Can be combined with: t9; T24; T45; as well as H1; H11; H Desiccosis Dehydration of various causes Symptoms: restricted vigilance; possibly neurological failures; standing skin folds; Therapy: if necessary O2; Storage; if necessary infusion; initiate further medical therapy Can be combined with: t8; T23; T28; as well as H2; H18; H26 Appendix 2a Internal case studies 6

7 11. Alcohol intoxication (slight) Excessive consumption of alcohol Symptoms: restlessness and or drowsiness; various vegetative symptoms; Diagnostics: RR; Pulse; Temperature; Auscultation; SaO2; BG measurement Therapy: calm down; Storage; if necessary arrange for further medical therapy Can be combined with: t10; T25; T48; as well as H9; H13; H Alcohol intoxication (severe) Excessive consumption of alcohol with vital risk Symptoms: drowsiness; possibly loss of protective reflexes; various vegetative symptoms; Respiratory depression therapy: positioning; O2; i.v. Access; Infusion; initiate further medical therapy Can be combined with: t6; T12; T31; as well as H10; H15; H25 Appendix 2a Internal case studies 7

8 13. Drug intoxication (slight) Ingestion of wrong or wrongly dosed medicaments for different reasons Symptoms: no restriction of vigilance; no neurological failures; Anxiety ; Uncertainty therapy: possibly O2; Storage; Calm down; initiate further medical therapy Can be combined with: t13; T21; T47; as well as H4; H11; H Medication intoxication (severe) Ingestion of wrong or wrongly dosed medication for different reasons Symptoms: reduced vigilance; possibly neurological failures; Anxiety ; Uncertainty; Possibly vegetative symptoms; Respiratory depression; Therapy: if necessary O2; Storage; i.v. Access; Infusion; if necessary airway securing; initiate further medical therapy Can be combined with: t2; T19; T33; as well as H6; H16; H27 Appendix 2a Internal case studies 8

9 15. Inhalative poisoning (slight) Inhalation of respiratory toxins Symptoms: possibly dyspnoea; To cough; Diagnostics: RR; Pulse; Temperature; EKG; Auscultation; SaO2; possibly co-measurement BG measurement therapy: possibly O2; Storage; Calm down; if necessary arrange for further medical therapy Can be combined with: t5; T23; T30; as well as H7; H21; H Inhalative poisoning (severe) Inhalation of respiratory toxins Symptoms: dyspnoea; To cough; possibly rattling noises Diagnostics: RR; Pulse; Temperature; EKG; Auscultation; SaO2; if necessary, co-measurement BG measurement Therapy: O2; Storage; i.v. Access; Infusion; if necessary airway securing; initiate further medical therapy Can be combined with: t3; T26; T39; as well as H12; H14; H22 Appendix 2a Internal case studies 9

10 17. Other intoxications (slight) Poisoning by other substances Symptoms: possibly vegetative symptoms; possibly neurological symptoms Therapy: possibly O2; Storage; Calm down; initiate further medical therapy Can be combined with: t10; T34; T45; as well as H6; H9; H Other intoxications (severe) Poisoning by other substances Symptoms: vegetative symptoms; possibly neurological symptoms, possibly respiratory depression Therapy: possibly O2; Storage; i.v. Access; Infusion; initiate further medical therapy Can be combined with: t17; T35; T44; as well as H10; H16; H26 Appendix 2a Internal case studies 10

11 19. Tachycarde arrhythmia Increased heart rate, rhythmic or arrhythmic Symptoms: possibly vegetative symptoms; possibly neurological symptoms; Dizziness; Palpitations; Therapy: if necessary O2; Storage; Calm down; initiate further medical therapy Can be combined with: t12; T39; T47; as well as H5; H18; H Tachycarde arrhythmia Increased heart rate, rhythmic or arrhythmic Symptoms: vegetative symptoms; possibly neurological symptoms; Dizziness; Palpitations; Vigilance disorders; Stenocardia; Sweatiness; Dyspnea Therapy: O2; Storage; i.v. Access; Infusion; if necessary medication; possibly cardioversion; initiate further medical therapy Can be combined with: t20; T22; T42; as well as H11; H17; H21 Appendix 2a Internal case studies 11

12 21. Bradycarde arrhythmia Decreased heart rate, rhythmic or arrhythmic Symptoms: possibly vegetative symptoms; possibly neurological symptoms; Dizziness; Therapy: O2; Storage; initiate further medical therapy Can be combined with: t27; T31; T36; as well as H15; H19; H Bradycarde arrhythmia Decreased heart rate, rhythmic or arrhythmic Symptoms: vegetative symptoms; possibly neurological symptoms; Dizziness; decreased vigilance; Paleness; Sweatiness; possibly cyanosis therapy: O2; Storage; i.v. Access; Infusion; if necessary medication; possibly external SM pacing; initiate further medical therapy Can be combined with: t15; T33; T42; as well as H4; H16; H18 Appendix 2a Internal case studies 12

13 23. Hypertensive emergency Increased blood pressure> 140 systolic and <200 symptoms: possibly vegetative symptoms; possibly neurological symptoms; Dizziness; Red head; Palpitation; Anxiety therapy: possibly O2; Storage; Calm down; To advise; if necessary arrange for further medical therapy Can be combined with: t7; T16; T37; as well as H1; H8; H Hypertensive emergency Increased blood pressure> 200 systolic Symptoms: possibly vegetative symptoms; possibly neurological symptoms; Dizziness; Red head; Palpitation; Anxiety; Sweatiness; Dyspnea; Therapy: if necessary O2; Storage; Calm down; i.v. Access; Infusion; if necessary medication; initiate further medical therapy Can be combined with: t2; T11; T46; as well as H7; H13; H22 Appendix 2a Internal case studies 13

14 25. Community-acquired infection e.g. Meningitis as a bacterial infection Symptoms: possibly vegetative symptoms; possibly neurological symptoms; Dizziness; Stiff neck; Meningism; A headache; Fever therapy: if necessary O2; Storage; possibly i.v. Access; if necessary infusion; initiate further medical therapy; Observance of hygiene (infection transport) Can be combined with: t4; T18; T48; as well as H3; H12; H biliary colic Colic pain caused by blockage of the bile duct by a stone Symptoms: colic pain right OB; possibly vegetative symptoms; Restlessness; Therapy: if necessary O2; Storage; possibly i.v. Access; if necessary infusion; if necessary medication; initiate further medical therapy; Can be combined with: T13; T28; T41; as well as H8; H20; H28 Appendix 2a Internal case studies 14

15 27. Renal colic Colic-like pain caused by occlusion of the ureter by a stone Symptoms: Colic-like pain lumbar region, possibly radiating into the inguinal canal; possibly vegetative symptoms; Restlessness; Therapy: if necessary O2; Storage; possibly i.v. Access; if necessary infusion; if necessary medication; initiate further medical therapy; Can be combined with: t9; T36; T49; as well as H5; H14; H Gastroenterological Disease Disease of the gastrointestinal tract Symptoms: abdominal pain; possibly nausea and / or vomiting; possibly diarrhea; Therapy: if necessary O2; Storage; Calm down; arrange for further medical therapy if necessary; Can be combined with: t21; T30; T39; as well as H2; H6; H19 Appendix 2a Internal case studies 15

16 29. Gastroenterological bleeding Bleeding in the gastrointestinal tract Symptoms: possibly abdominal pain; possibly bloody vomiting; possibly tarry stool; no circulatory symptoms Therapy: possibly O2; Storage; Calm down; possibly i.v. Access; if necessary infusion; initiate further medical therapy; Can be combined with: t25; T34; T50; as well as H9; H15; H Gastroenterological bleeding (massive) Bleeding in the gastrointestinal tract Symptoms: possibly abdominal pain; bloody vomiting; Tarry stools and or bloody stools; Paleness; Sweatiness; Therapy: if necessary O2; Storage; i.v. Access; Infusion; initiate further medical therapy; Can be combined with: t8; T20; T35; as well as H4; H10; H24 Appendix 2a Internal case studies 16

17 31. Hypoglycaemia Hypoglycaemia Symptoms: Vigilance disorder up to unconsciousness; Sweatiness; possibly restlessness; if necessary aggression therapy: if necessary O2; Storage; possibly i.v. Access; if necessary infusion; if necessary medication; initiate further medical therapy; Can be combined with: t1; T11; T42; as well as H12; H14; H Hyperglycaemia Increased sugar content in the blood Symptoms: possibly slight vigilance disorder; dry skin; possibly abdominal pain, increased thirst; possibly restlessness; Therapy: if necessary O2; Storage; possibly i.v. Access; if necessary infusion; initiate further medical therapy; Can be combined with: t16; T36; T43; as well as H2; H13; H21 Appendix 2a Internal case studies 17

18 33. Hyperglycemia (severe) Increased sugar content of the blood with coma diabeticum (hyperosmolar or ketoacidotic coma) Symptoms: vigilance disorder up to unconsciousness; cracked tongue; dry skin; increased thirst; possibly restlessness; Therapy: if necessary O2; Storage; i.v. Access; Infusion; initiate further medical therapy; Can be combined with: t6; T14; T26; as well as H17; H18; H Heart failure Reduced heart rate with congestion Symptoms: Dyspnea has been increasing for days on exertion; Lower leg edema; Therapy: if necessary O2; Storage; Calm down; possibly i.v. Access; if necessary infusion; initiate further medical therapy; Can be combined with: t27; T31; T50; as well as H1; H6; H23 Appendix 2a Internal case studies 18

19 35. Heart failure (severe) Decreased heart rate with back pressure in the lungs - pulmonary edema Symptoms: massive dyspnoea with wet rattling noises; Lower leg edema; possibly cyanosis; Therapy: O2; Storage; i.v. Access; Infusion; if necessary medication; if necessary airway securing; possibly CPAP ventilation; initiate further medical therapy; Can be combined with: t1; T17; T37; as well as H7; H10; H Resuscitation cardiovascular standstill for various causes, potentially reversible Symptoms: unconscious; Apnea; Asystole, pulseless EMD; pulseless ventricular tachycardia or ventricular fibrillation Therapy: resuscitation according to current recommendations Can be combined with: t19; T22; T44; as well as H3; H15; H17 Appendix 2a Internal case studies 19

20 37. Cardiogenic shock Heart pump failure with poor perfusion of all organs; Symptoms: limited vigilance; Dyspnea; Paleness; Sweatiness; RR: low; Peripheral pulse not palpable Therapy: O2; Storage; i.v. Access; if necessary infusion; if necessary medication; if necessary airway securing; initiate further medical therapy; Can be combined with: t29; T38; T46; as well as H16; H22; H Allergy Excessive immune reaction of the body Symptoms: allergic rash; Pruritus; possibly quink edema; no circulatory reaction Therapy: possibly O2; Storage; Reassurance; possibly i.v. Access; if necessary infusion; if necessary medication; if necessary airway securing; initiate further medical therapy; Can be combined with: t10; T39; T41; as well as H5; H20; H25 Appendix 2a Internal case studies 20

21 39. Allergy with anaphylactic shock Excessive immune reaction of the body with shock reaction Symptoms: allergic rash; Pruritus; possibly quink edema; Bronchospasm; Circulatory reaction Therapy: possibly O2; Storage; i.v. Access; Infusion; if necessary medication; if necessary airway securing; initiate further medical therapy; Can be combined with: t2; T14; T32; as well as H3; H11; H Thrombosis Venous occlusion e.g. on the lower extremity Symptoms: pain in the affected leg, swelling and livid discoloration of the affected leg Therapy: O2 if necessary; Storage; Reassurance; initiate further medical therapy; Can be combined with: t5; T21; T27; as well as H2; H8; H28 Appendix 2a Internal case studies 21

22 41. Arterial occlusion Arterial occlusion e.g. on the leg symptoms: pain in the affected leg, pallor and paresthesia in the affected leg; Coldness and lack of pulse in the affected leg Therapy: O2 if necessary; Storage; Reassurance; possibly i.v. Access; if necessary infusion; initiate further medical therapy; Can be combined with: t4; T12; T28; as well as H1; H5; H Pulmonary embolism Arterial occlusion of the pulmonary circulation Symptoms: chest pain, acute dyspnoea; Cyanosis; possibly circulatory impairment Therapy: O2; Storage; Reassurance; i.v. Access; Infusion; if necessary medication; initiate further medical therapy; Can be combined with: t6; T13; T35; as well as H12; H20; H24 Appendix 2a Internal case studies 22

23 Possible scenarios for testing social skills (H x): 1. Patient does not speak German 2. Patient is demented 3. Patient is a minor 4. Patient cares for a relative 5. Patient is drunk 6. Patient has a personality disorder 7. Patient is of a different belief, which does not allow certain medical measures. 8. The patient does not want to go to a hospital 9. Relatives are drunk 10. Relatives cannot give reasonable information 11. Relatives are anxious 12. Relatives cannot stay alone (children / old people etc.) 13. Relatives are aggressive 14. Many onlookers who know everything better 15. Helpers who impose themselves 16. Living wills 17. General practitioner on site 18. Patient is palliative patient 19. Home care is not guaranteed 20. Patient is very demanding (distant wish from KH.) 21. Adequate handling First aiders 22. Patient is deaf and / or dumb Annex 2a Internal case studies 23

24 23. The patient is depressed or has suicidal tendencies 24. The patient is blind 25. The patient is uncooperative 26. Other third parties on site 27. The patient has a disability 28. The patient is obese Appendix 2a Internal case studies 24