DOCSLIB.ORG

Physician Examination Procedures Manual

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Physician Examination Procedures Manual Physician Examination Procedures Manual September 2011 TABLE OF CONTENTS Chapter Page 1 OVERVIEW OF PHYSICIAN EXAMINATION .......................................... 1-1 1.1 The Role of the Physician in NHANES .............................................. 1-1 1.2 Medical Policy Regarding the Examination ....................................... 1-2 1.2.1 Presence in MEC during MEC Examinations ..................... 1-2 1.2.2 Response to Medical Emergencies ...................................... 1-3 1.2.3 Maintenance of Emergency Equipment and Supplies ......... 1-3 1.3 Physician Examination ....................................................................... 1-3 1.4 Maintenance of Physician’s Examination Room ................................ 1-4 2 EQUIPMENT AND SUPPLIES ...................................................................... 2-1 2.1 Description of Equipment & Supplies ................................................ 2-1 2.2 Inventory ............................................................................................. 2-1 2.3 Blood Pressure .................................................................................... 2-1 2.3.1 Blood Pressure Equipment .................................................. 2-2 2.3.2 Blood Pressure Supplies ...................................................... 2-3 2.3.3 Description of Blood Pressure Equipment and Supplies .... 2-3 2.3.4 Blood Pressure Supplies – Description ............................... 2-5 2.3 HPV Supplies ...................................................................................... 2-6 2.4 Office Supplies ................................................................................... 2-6 2.5 Emergency Supplies ........................................................................... 2-6 2.5.1 Emergency Box – Contents ................................................. 2-7 2.6 OSHA Bloodborne Pathogen Exposure Forms ................................... 2-8 2.7 Inventory ............................................................................................. 2-8 2.7.1 Equipment Set Up ............................................................... 2-8 2.7.2 Teardown Procedure ........................................................... 2-9 2.8 Handling Instructions for Mercury Manometers ................................ 2-9 2.8.1 Mercury Safety Considerations ........................................... 2-9 2.8.2 Required Procedure for Handling Spilled or Leaking Mercury ............................................................................... 2-10 3 PHYSICIAN PROTOCOL .............................................................................. 3-1 3.1 Heart Rate, Pulse, and Blood Pressure Measurements ....................... 3-1 iii TABLE OF CONTENTS (continued) Chapter Page 3.1.1 Procedures for Heart Rate, Pulse, and Blood Pressure Measurements ..................................................................... 3-2 3.1.2 Heart Rate Measurements for SPs through Age 4 ............... 3-2 3.1.3 Blood Pressure Premeasurement Procedure ........................ 3-3 3.1.4 Additional Blood Pressure Measurement Guidelines ......... 3-15 3.1.5 Data Entry Screens for Pulse and Blood Pressure ............... 3-18 3.2 Exclusion from Bronchodilator Based on Pulse and Irregular Beats ................................................................................................... 3-25 3.2.1 Blood Pressure Measurement Screens ................................ 3-29 3.2.2 Blood Pressure Edit Limits ................................................. 3-35 3.2.3 Blood Pressure Component Status and Comments ............. 3-36 3.2.4 Exclusion from Bronchodilator Based on Blood Pressure ............................................................................... 3-37 3.3 Shared Exclusion Questions ............................................................... 3-39 3.4 Sexually Transmitted Diseases (STD) and Human Immunodeficiency Virus (HIV) Testing ............................................. 3-47 3.4.1 Guidelines Affecting STD and HIV Test Result Reporting ............................................................................. 3-47 3.4.2 Gaining Cooperation for the HPV Swab ............................. 3-53 3.4.3 Discussing STD & HIV Testing and Instructing the SP How to Obtain Results ................................................... 3-55 3.4.4 Informed Consent Designation in ISIS ............................... 3-60 3.5 The Physicians’ Role in the Pubertal Maturation Interview Informed Consent ............................................................................... 3-65 3.5.1 Procedure for Changing the PM IC Exclusion .................... 3-69 3.6 The Physician Examination Application and Utilities ........................ 3-71 3.6.1 Review Functionalities ........................................................ 3-71 3.6.2 SP History ........................................................................... 3-71 3.6.3 Utilities Menu...................................................................... 3-75 3.7 Report Utility ...................................................................................... 3-79 3.7.1 SP Examinations ................................................................. 3-81 3.7.2 End of Section ..................................................................... 3-82 3.7.3 Close Examination Button .................................................. 3-82 3.7.4 Pausing an Examination ...................................................... 3-83 iv TABLE OF CONTENTS (continued) Chapter Page 4 REFERRALS ................................................................................................... 4-1 4.1 Medical Referrals ................................................................................ 4-1 4.2 Referral Levels .................................................................................... 4-2 4.2.1 Level 1 Referrals ................................................................. 4-3 4.2.2 Level 2 Referrals ................................................................. 4-3 4.2.3 Level 3 Referrals ................................................................. 4-4 4.3 Laboratory Referrals ........................................................................... 4-4 4.3.1 Pregnancy Referral Requirements ....................................... 4-4 4.3.2 Unmarried Minors Pregnancy Referrals ............................. 4-5 4.3.3 Complete Blood Count ........................................................ 4-6 4.4 Blood Pressure Referrals .................................................................... 4-11 4.4.1 Blood Pressure Referrals – Adults ...................................... 4-11 4.4.2 Blood Pressure Referrals – Children ................................... 4-14 4.5 Observation Referrals ......................................................................... 4-15 4.6 Mental Health Observation Referrals ................................................. 4-16 4.6.1 MEC Interviewer Depression Screening ............................. 4-16 4.6.2 Cognitive Functioning Referrals ......................................... 4-19 4.7 Spirometry Referral Evaluation .......................................................... 4-20 4.7.1 Level II Referral Evaluation for Participants with FEV1/FVC% ≤ 50% Predicted ........................................... 4-20 4.7.2 Level II Referral Evaluation for Participants with FEV1/FVC% ≤ Lower Limits of Normal ........................... 4-23 4.8 Physician Application Referral Procedures ........................................ 4-24 4.8.1 Data Entry Screens for Referrals ......................................... 4-25 4.8.2 Review Menu ...................................................................... 4-25 4.8.3 Review Box ......................................................................... 4-26 4.8.4 Review Other Sessions ........................................................ 4-27 4.8.5 Sessions Requiring Review ................................................. 4-27 4.8.6 Referral Review Inbox Screen ............................................ 4-28 4.8.7 Selecting SP for Detailed Referral Review ......................... 4-29 4.8.8 ISIS Message ....................................................................... 4-32 4.8.9 NHANES Release Form for SPs Refusing Referrals .......... 4-33 4.8.10 Review in Box for Pregnancy Details ................................. 4-35 v TABLE OF CONTENTS (continued) Chapter Page 4.8.11 Review in Box for CBC Details .......................................... 4-36 4.8.12 Review in Box – Blood Pressure Details ............................ 4-37 4.9 Observation Referrals ......................................................................... 4-39 4.9.1 Referral Letter ..................................................................... 4-41 4.9.2 Local Physician Pickup ....................................................... 4-42 4.9.3 Referral Address Information ............................................. 4-43 4.9.4 Referral Letter Review ........................................................ 4-44 4.9.5 Referral Letter ..................................................................... 4-45 5 SAFETY ISSUES AND EMERGENCY PROCEDURES .............................. 5-1 5.1 Safety in the Mobile Examination Center (MEC) .............................. 5-1 5.1.1 Elderly Sample Persons ....................................................... 5-1 5.1.2 Sample Persons in Wheelchairs
Load more

Recommended publications
  • The Stethoscope: Some Preliminary Investigations
    695 ORIGINAL ARTICLE The stethoscope: some preliminary investigations P D Welsby, G Parry, D Smith Postgrad Med J: first published as on 5 January 2004. Downloaded from ............................................................................................................................... See end of article for Postgrad Med J 2003;79:695–698 authors’ affiliations ....................... Correspondence to: Dr Philip D Welsby, Western General Hospital, Edinburgh EH4 2XU, UK; [email protected] Submitted 21 April 2003 Textbooks, clinicians, and medical teachers differ as to whether the stethoscope bell or diaphragm should Accepted 30 June 2003 be used for auscultating respiratory sounds at the chest wall. Logic and our results suggest that stethoscope ....................... diaphragms are more appropriate. HISTORICAL ASPECTS note is increased as the amplitude of the sound rises, Hippocrates advised ‘‘immediate auscultation’’ (the applica- resulting in masking of higher frequency components by tion of the ear to the patient’s chest) to hear ‘‘transmitted lower frequencies—‘‘turning up the volume accentuates the sounds from within’’. However, in 1816 a French doctor, base’’ as anyone with teenage children will have noted. Rene´The´ophile Hyacinth Laennec invented the stethoscope,1 Breath sounds are generated by turbulent air flow in the which thereafter became the identity symbol of the physician. trachea and proximal bronchi. Airflow in the small airways Laennec apparently had observed two children sending and alveoli is of lower velocity and laminar in type and is 6 signals to each other by scraping one end of a long piece of therefore silent. What is heard at the chest wall depends on solid wood with a pin, and listening with an ear pressed to the conductive and filtering effect of lung tissue and the the other end.2 Later, in 1816, Laennec was called to a young characteristics of the chest wall.
    [Show full text]
  • General Physical Examination Skills for Ahps
    General Physical Examination Techniques for the Rheumatology Clinic This manual has been developed as an overview of the general examination of the rheumatology patient. Certain details have been specifically omitted because they have no relevance when examining a stable out patient in the rheumatology clinic. Vital Signs 1. Heart rate 2. Blood pressure 3. Weight 1. Heart Rate There are two things you want to document when assessing heart rate: The actual rate and the rhythm. Rate: count pulse for at least 15 – 30 seconds (e.g., if you count the rate for 15 seconds, multiply this result by 4 to determine heart rate). The radial pulse is most commonly used to assess the heart rate. With the pads of your index and middle fingers, compress the radial artery until a pulsation is detected. Normal 60-100 bpm Bradycardia <60 bpm Tachycardia >100 bpm 2. Heart Rhythm The rhythm should be regular. A regularly irregular rhythm is one where the pulse is irregular but there is a pattern to the irregularity. For example every third beat is dropped. An irregularly irregular rhythm is one where the pulse is irregular and there is no pattern to the irregularity. The classic example of this is atrial fibrillation. 3. Blood Pressure Blood pressure should be measured in both arms, and should include an assessment of orthostatic change How to measure the Brachial Artery Blood Pressure: • Patient should be relaxed, in a supine or sitting position, with the arms positioned correctly(at, not above, the level of the heart) • Remember that measurements should be taken bilaterally • Choice of appropriate cuff size for the patient is important to accuracy of measured blood pressure.
    [Show full text]
  • Essentials of Bedside Cardiology CONTEMPORARY CARDIOLOGY
    Essentials of Bedside Cardiology CONTEMPORARY CARDIOLOGY CHRISTOPHER P. CANNON, MD SERIES EDITOR Aging, Heart Disease and Its Management: Facts and Controversies, edited by Niloo M. Edwards, MD, Mathew S. Maurer, MD, and Rachel B. Wellner, MD, 2003 Peripheral Arterial Disease: Diagnosis and Treatment, edited by Jay D. Coffman, MD, and Robert T. Eberhardt, MD, 2003 Essentials ofBedside Cardiology: With a Complete Course in Heart Sounds and Munnurs on CD, Second Edition, by Jules Constant, MD, 2003 Primary Angioplasty in Acute Myocardial Infarction, edited by James E. Tcheng, MD,2002 Cardiogenic Shock: Diagnosis and Treatment, edited by David Hasdai, MD, Peter B. Berger, MD, Alexander Battler, MD, and David R. Holmes, Jr., MD, 2002 Management of Cardiac Arrhythmias, edited by Leonard I. Ganz, MD, 2002 Diabetes and Cardiovascular Disease, edited by Michael T. Johnstone and Aristidis Veves, MD, DSC, 2001 Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics, edited by William B. White, MD, 2001 Vascular Disease and Injury: Preclinical Research, edited by Daniell. Simon, MD, and Campbell Rogers, MD 2001 Preventive Cardiology: Strategies for the Prevention and Treatment of Coronary Artery Disease, edited by JoAnne Micale Foody, MD, 2001 Nitric Oxide and the Cardiovascular System, edited by Joseph Loscalzo, MD, phD and Joseph A. Vita, MD, 2000 Annotated Atlas of Electrocardiography: A Guide to Confident Interpretation, by Thomas M. Blake, MD, 1999 Platelet Glycoprotein lIb/IlIa Inhibitors in Cardiovascular Disease, edited by A. Michael Lincoff, MD, and Eric J. Topol, MD, 1999 Minimally Invasive Cardiac Surgery, edited by Mehmet C. Oz, MD and Daniel J. Goldstein, MD, 1999 Management ofAcute Coronary Syndromes, edited by Christopher P.
    [Show full text]
  • Monitoring Anesthetic Depth
    ANESTHETIC MONITORING Lyon Lee DVM PhD DACVA MONITORING ANESTHETIC DEPTH • The central nervous system is progressively depressed under general anesthesia. • Different stages of anesthesia will accompany different physiological reflexes and responses (see table below, Guedel’s signs and stages). Table 1. Guedel’s (1937) Signs and Stages of Anesthesia based on ‘Ether’ anesthesia in cats. Stages Description 1 Inducement, excitement, pupils constricted, voluntary struggling Obtunded reflexes, pupil diameters start to dilate, still excited, 2 involuntary struggling 3 Planes There are three planes- light, medium, and deep More decreased reflexes, pupils constricted, brisk palpebral reflex, Light corneal reflex, absence of swallowing reflex, lacrimation still present, no involuntary muscle movement. Ideal plane for most invasive procedures, pupils dilated, loss of pain, Medium loss of palpebral reflex, corneal reflexes present. Respiratory depression, severe muscle relaxation, bradycardia, no Deep (early overdose) reflexes (palpebral, corneal), pupils dilated Very deep anesthesia. Respiration ceases, cardiovascular function 4 depresses and death ensues immediately. • Due to arrival of newer inhalation anesthetics and concurrent use of injectable anesthetics and neuromuscular blockers the above classic signs do not fit well in most circumstances. • Modern concept has two stages simply dividing it into ‘awake’ and ‘unconscious’. • One should recognize and familiarize the reflexes with different physiologic signs to avoid any untoward side effects and complications • The system must be continuously monitored, and not neglected in favor of other signs of anesthesia. • Take all the information into account, not just one sign of anesthetic depth. • A major problem faced by all anesthetists is to avoid both ‘too light’ anesthesia with the risk of sudden violent movement and the dangerous ‘too deep’ anesthesia stage.
    [Show full text]
  • Blood Pressure (BP) Measurements in Adults
    Page 5 Blood Pressure (BP) Measurements in Adults Ramesh Khanna, MD Karl D. Nolph, MD Chair in Nephrology Professor of Medicine Director, Division of Nephrology University of Missouri-Columbia Uncontrolled high blood pressure is present in every 3rd person in the American community and is attributed to be a major risk factor for progression of chronic kidney disease, coronary artery disease, and stroke. Therefore, blood pressure recording is the most common measurements at home and by healthcare professionals in all of clinical medicine. It might come as a surprise that majority of recordings are done in a less than ideal circumstances and consequently performed inaccurately. BP measurements using mercury sphygmomanometer by a trained health care professional is the gold standard for clinical assessment of blood pressures. The appearance of the 1st Korotkoff sound signals the systolic blood pressure and the disappearance of the 5th sound denotes the diastolic blood pressure. The hypertension experts believe and have increasing evidence to suggest that this method frequently either over diagnose hypertension or fail to recognize masked hypertension (blood pressure that is normal in the physician’s office setting but high at other times including at home). The four commonly recognized reasons for this are: Avoidable inaccuracies in the methods, The inherent variability of blood pressure; and The tendency for blood pressure to increase in the presence of a health care professional (the so-called white coat effect). Failure to standardize blood pressure measurement dos and don’ts. It is believed and also to some extent evidence based that the health care providers including physicians often do not follow established guidelines for blood pressure measurement.
    [Show full text]
  • Blood Pressure Year 1 Year 2 Core Clinical/Year 3+
    Blood Pressure Year 1 Year 2 Core Clinical/Year 3+ Do Do • Patient at rest for 5 minutes • Measure postural BP and pulse in patients with a • Arm at heart level history suggestive of volume depletion or • Correct size cuff- bladder encircles 80% of arm syncope • Center of cuff aligns with brachial artery -Measure BP and pulse in supine position • Cuff wrapped snugly on bare arm with lower -Slowly have patient rise and stand (lie them down edge 2-3 cm above antecubital fossa promptly if symptoms of lightheadedness occur) • Palpate radial artery, inflate cuff to 70 mmHg, -Measure BP and pulse after 1 minute of standing then increase in 10 mmHg increments to 30 mmHg above point where radial pulse disappears. Know Deflate slowly until pulse returns; this is the • Normally when a person stands fluid shifts to approximate systolic pressure. lower extremities causing a compensatory rise in • Auscultate the Korotkoff sounds pulse by up to 10 bpm with BP dropping slightly -place bell lightly in antecubital fossa • Positive postural vital signs are defined as -inflate BP to 20-30mmHg above SBP as determined symptoms of lightheadedness and/or a drop in by palpation SBP of 20 mmHg with standing -deflate cuff at rate 2mmHg/second while auscultating • Know variations in BP cuff sizes -first faint tapping (Phase I Korotkoff) = SBP; • A lack of rise in pulse in a patient with an Disappearance of sound (Phase V Korotkoff)=DBP orthostatic drop in pressure is a clue that the Know cause is neurologic or related or related to -Korotkoff sounds are lower pitch, better heard by bell medications (eg.
    [Show full text]
  • Does This Patient Have Aortic Regurgitation?
    THE RATIONAL CLINICAL EXAMINATION Does This Patient Have Aortic Regurgitation? Niteesh K. Choudhry, MD Objective To review evidence as to the precision and accuracy of clinical examina- Edward E. Etchells, MD, MSc tion for aortic regurgitation (AR). Methods We conducted a structured MEDLINE search of English-language articles CLINICAL SCENARIO (January 1966-July 1997), manually reviewed all reference lists of potentially relevant You are asked to see a 59-year-old articles, and contacted authors of relevant studies for additional information. Each study woman with liver cirrhosis who will be (n = 16) was independently reviewed by both authors and graded for methodological undergoing sclerotherapy for esopha- quality. geal varices. When she was examined by Results Most studies assessed cardiologists as examiners. Cardiologists’ precision for her primary care physician, she had a detecting diastolic murmurs was moderate using audiotapes (k = 0.51) and was good pulse pressure of 70 mm Hg. The pri- in the clinical setting (simple agreement, 94%). The most useful finding for ruling in mary care physician is concerned about AR is the presence of an early diastolic murmur (positive likelihood ratio [LR], 8.8- the possibility of aortic regurgitation 32.0 [95% confidence interval {CI}, 2.8-32 to 16-63] for detecting mild or greater AR (AR) and asks you whether endocardi- and 4.0-8.3 [95% CI, 2.5-6.9 to 6.2-11] for detecting moderate or greater AR) (2 tis prophylaxis is necessary for sclero- grade A studies). The most useful finding for ruling out AR is the absence of early di- astolic murmur (negative LR, 0.2-0.3 [95% CI, 0.1-0.3 to 0.2-0.4) for mild or greater therapy.
    [Show full text]
  • A Review of Pericardial Diseases: Clinical, ECG and Hemodynamic Features and Management
    REVIEW SHAM IK AIKAT, MD SASAN GHAFFARI, MD Department of Cardiology, Cleveland Clinic Department of Cardiology, Cleveland Clinic A review of pericardial diseases: Clinical, ECG and hemodynamic features and management ABSTRACT ECAUSE PERICARDIAL DISEASES are com- mon and often misdiagnosed, physi- Pericardial diseases are common, have multiple causes, and cians need to he familiar with their presenta- are often misdiagnosed. Physicians need to recognize the tions and distinguishing features. characteristic and distinguishing features of the three most This article reviews the clinical features, important pericardial conditions: acute pericarditis, cardiac diagnosis, and management of acute pericardi- tamponade, and constrictive pericarditis. In these tis, cardiac tamponade, and constrictive peri- conditions, proper diagnosis and appropriate management carditis. can significantly reduce morbidity and mortality. • THE PERICARDIUM KEY POINTS The pericardium envelopes the heart, extend- ing on to the adventitia of the great vessels. It Acute pericarditis is an important part of the differential is 1 to 2 mm thick and consists of an outer and diagnosis of chest pain syndromes and needs to be an inner layer. The tough, fibrous outer layer is distinguished from acute myocardial infarction both called the parietal pericardium, and the serous clinically and electrocardiographically. inner layer is called the visceral pericardium. The parietal and visceral pericardium are sep- Suspect pericardial tamponade in any patient with acute arated by fluid: 15 to 50 mL of an ultrafiltrate dyspnea, especially in the presence of a pericardial rub, of plasma that acts as a lubricant.1-2 elevated jugular venous pressure, and hypotension. The pericardium limits excessive cardiac movement and acute cardiac distension.
    [Show full text]
  • BTS Guideline for Oxygen Use in Adults in Healthcare and Emergency
    BTS guideline BTS guideline for oxygen use in adults in healthcare Thorax: first published as 10.1136/thoraxjnl-2016-209729 on 15 May 2017. Downloaded from and emergency settings BRO’Driscoll,1,2 L S Howard,3 J Earis,4 V Mak,5 on behalf of the British Thoracic Society Emergency Oxygen Guideline Group ▸ Additional material is EXECUTIVE SUMMARY OF THE GUIDELINE appropriate oxygen therapy can be started in the published online only. To view Philosophy of the guideline event of unexpected clinical deterioration with please visit the journal online ▸ (http://dx.doi.org/10.1136/ Oxygen is a treatment for hypoxaemia, not hypoxaemia and also to ensure that the oxim- thoraxjnl-2016-209729). breathlessness. Oxygen has not been proven to etry section of the early warning score (EWS) 1 have any consistent effect on the sensation of can be scored appropriately. Respiratory Medicine, Salford ▸ Royal Foundation NHS Trust, breathlessness in non-hypoxaemic patients. The target saturation should be written (or Salford, UK ▸ The essence of this guideline can be summarised ringed) on the drug chart or entered in an elec- 2Manchester Academic Health simply as a requirement for oxygen to be prescribed tronic prescribing system (guidance on figure 1 Sciences Centre (MAHSC), according to a target saturation range and for those (chart 1)). Manchester, UK 3Hammersmith Hospital, who administer oxygen therapy to monitor the Imperial College Healthcare patient and keep within the target saturation range. 3 Oxygen administration NHS Trust, London, UK ▸ The guideline recommends aiming to achieve ▸ Oxygen should be administered by staff who are 4 University of Liverpool, normal or near-normal oxygen saturation for all trained in oxygen administration.
    [Show full text]
  • Simbaby™ Specs
    SimBaby™ Specs Normal & Difficult Airway • Airway opening acquired by head tilt, chin lift and jaw trust • Oropharyngeal and nasopharyngeal airways • Bag-Valve-Mask ventilation • Orotracheal and nasotracheal intubation • Sellick Maneuver • LMA insertion • Endotracheal tube insertion • Fiberoptic intubation • Gastric tube insertion • Variable lung compliance • Variable airway resistance • Tongue edema • Laryngospasm • Pharyngeal swelling • Decreased lung compliance • Right mainstem intubation • Gastric distention Pulmonary System • Spontaneous breathing with variable rate, depth and regularity • Bilateral and unilateral chest rise and fall • CO2 exhalation • Normal and abnormal breath sounds – bilateral • Lung Sounds: Normal, course crackles, fine crackles, stridor, wheezes and rhonchi • Oxygen saturation • See-saw respiration • Retractions • Pneumothorax • Unilateral chest movement • Unilateral breath sounds • Unilateral needle thoracentesis mid-clavicular • Unilateral chest tube insertion Cardiovascular System • Extensive ECG library with rate from 20-360 • CPR compressions generate palpable pulses, blood pressure waveform, and generate artifacts on ECG • Heart Sounds:Normal, systolic murmur, holosystolic murmur, diastolic murmur, continuous murmur and gallop • Blood pressure (BP) measured manually by auscultation of Korotkoff sounds • Pulses: Unilateral radial and brachial pulse and bilateral femoral pulses synchronized with ECG • Pulse strength variable with BP • Display of cardiac rhythms via 3-lead ECG monitoring • 12-lead dynamic
    [Show full text]
  • Blood Pressure Measurement Standardization Protocol
    Blood Pressure Measurement Standardization Protocol www. hearthighway.org 801-538-6141 We would like to extend a special Thank You to Dr. Roy Gandolfi for his help in editing this manual. This manual was funded in part by the Centers for Disease Control and Prevention through the Utah Heart Disease and Stroke Prevention Program, cooperative agreement number U50/CCU821337-05. The contents of this report are solely the responsibility of the authors and do not represent the opinions of the CDC Revised July 2006 Table of Contents 1. What is Blood Pressure? 2 2. Hypertension Overview 4 3. Non-Modifiable Risk Factors 5 4. Modifiable Risk Factors 6 5. Importance of Accuracy 8 6. Knowing the Equipment 9 7. Automated Blood Pressure Cuffs 11 8. Mercury Manometers 12 9. Pulse Obliteration Technique 13 10. Treatment and Referral for Adults 19 11. Treatment and Referral for Individuals over age 60 21 12. Treatment and Referral for Children 23 13. References 26 Appendices A: Following the DASH Diet B: Weigh In For Better Health C: Algorithm for Treatment of Hypertension D: Blood Pressure Levels by Gender, Age and Height Percentile E: CDC Growth Chart for Boys F: CDC Growth Chart for Girls G: Blood Pressure Management Quiz H: Blood Pressure Practicum 1 What is Blood Pressure? Key Abbreviations BP- Blood Pressure SBP- Systolic Blood Pressure DBP- Diastolic Blood Pressure JNC7- Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure CVD- Cardiovascular Disease BMI- Body Mass Index ABPM- Ambulatory Blood Pressure Monitoring ACE- Angiotensin-converting enzyme β-blockers- Beta-blockers LVH- Left Ventricular Hypertrophy Definitions Blood Pressure- measurement of the force exerted by blood against the walls of the arteries.
    [Show full text]
  • Bouncebacks Crit Care CHAPTER 11 – 63 Yo Man Fall
    BOUNCEBACKS! AVOID SERIOUS MISTAKES IN THE ED 31 Cases, 482 pages 10 Cases, 320 pages 28 Cases, 410 pages 30 Cases, 663 pages Praise for Bouncebacks! Bouncebacks! is a collection of cases that all emergency physicians dread, or should. - Academic Emergency Medicine, 2007 I would recommend this book for both residents and practicing physicians. For residency programs it can serve as an adjunct to case discussions and as a model for morbidity and mortality conference. For practicing emergency physicians it can provide excellent continuing education as an engaging and occasionally terrifying reminder of the high risk cases that masquerade as benign problems. - Annals of Emergency Medicine, 2007 Bouncebacks! Medical and Legal takes the reader along an enlightening educational journey beginning with deceptively well patient visits, followed by the feared patient “bouncebacks” with their unexpected bad outcomes, and ultimately revealing the courtroom proceedings that arose from the encounters… Bouncebacks! Medical and Legal should be mandatory reading for all involved in emergency medicine. - Annals of Emergency Medicine, 2012 Bouncebacks! Medical and Legal is an insightful and pragmatic analysis of emergency department malpractice litigation. The authors provide the reader with interpretive perspectives from all sides of patient care—the holistic view ultimately evaluated by a jury. The lessons presented are a good reminder for any practicing physician. - JAMA, 2012 After reading these 28 cases, I feel that I am less likely to miss similar patients in the ED. I highly recommend this as a book for anyone who cares for pediatric patients, and as a great teaching tool for residents and fellows. - The Journal of Emergency Medicine, 2016 The Bouncebacks! series is available from Anadem, Inc.
    [Show full text]