Signs and Symptoms of COPD
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Slipping Rib Syndrome
Slipping Rib Syndrome Jackie Dozier, BS Edited by Lisa E McMahon, MD FACS FAAP David M Notrica, MD FACS FAAP Case Presentation AA is a 12 year old female who presented with a 7 month history of right-sided chest/rib pain. She states that the pain was not preceded by trauma and she had never experienced pain like this before. She has been seen in the past by her pediatrician, chiropractor, and sports medicine physician for her pain. In May 2012, she was seen in the ER after having manipulations done on her ribs by a sports medicine physician. Pain at that time was constant throughout the day and kept her from sleeping. However, it was relieved with hydrocodone/acetaminophen in the ER. Case Presentation Over the following months, the pain became progressively worse and then constant. She also developed shortness of breath. She is a swimmer and says she has had difficulty practicing due to the pain and SOB. AA was seen by a pediatric surgeon and scheduled for an interventional pain management service consult for a test injection. Following good temporary relief by local injection, she was scheduled costal cartilage removal to treat her pain. What is Slipping Rib Syndrome? •Slipping Rib Syndrome (SRS) is caused by hypermobility of the anterior ends of the false rib costal cartilages, which leads to slipping of the affected rib under the superior adjacent rib. •SRS an lead to irritation of the intercostal nerve or strain of the muscles surrounding the rib. •SRS is often misdiagnosed and can lead to months or years of unresolved abdominal and/or thoracic pain. -
Breathing Better with a COPD Diagnosis
Difficulty Breathing Chronic Bronchitis Smoker’s Cough Chronic Coughing Wheezing Em- Chronic Obstructive Pulmonary Disease physema Shortness of Breath Feeling of Suffocation Excess Mucus Difficulty Breathing Chronic Bronchitis Smoker’s Cough Chronic Coughing Wheezing Emphysema Shor tness of Breath Feeling of Suffocation Excess Mucus Difficulty Breathing Chronic Bronchitis Smoker’s Cough Chronic Coughing Wheezing Emphysema Shortness of Breath Feeling of Suffocation Excess Mucus Difficulty Breathing Chronic Bronchitis Smoker’s Cough Chron- ic Coughing Wheezing Emphysema Shortness of Breath Feeling of Suffocation Excess Mu- cus DifficultyBreathing Breathing Chronic Bronchitis Better Smoker’s Cough Chronic Coughing Wheezing Emphysema Shortness of Breath Feeling of Suffocation Excess Mucus Difficulty Breathing Chronic Bronchitis Smoker’s Cough Chronic Coughing Wheezing Emphysema Shor tness of Breath Feeling of SuffocationWith Excess a COPDMucus Difficulty Diagnosis Breathing Chronic Bronchitis Smoker’s Cough Chronic Coughing Wheezing Emphysema Shortness of Breath Feeling of did you know? When COPD is severe, shortness of breath and other COPDdid you is the know? 4th leading cause of death in the symptomswhen you can get are in the diagnosed way of doing even the most UnitedCOPD States.is the 4th The leading disease cause kills ofmore death than in 120,000 basicwith tasks, copd such as doing light housework, taking a Americansthe United eachStates year—that’s and causes 1 serious, death every long-term 4 walk,There and are even many bathing things and that getting you can dressed. do to make minutes—anddisability. The causesnumber serious, of people long-term with COPDdisability. is COPDliving withdevelops COPD slowly, easier: and can worsen over time, increasing.The number More of people than 12with million COPD people is increasing. -
Rivaroxaban (Xarelto®)
Rivaroxaban (Xarelto®) To reduce your bleeding and clotting risk it is important that you attend follow-up appointments with your provider, and have blood tests done as your provider orders. What is rivaroxaban (Xarelto®)? • Rivaroxaban is also called Xarelto® • Rivaroxaban(Xarelto®) is used to reduce the risk of blood clots and stroke in people with an abnormal heart rhythm known as atrial fibrillation, in people who have had a blood clot, or in people who have undergone orthopedic surgery. o Blood clots can block a blood vessel cutting off blood supply to the area. o Rarely, clots can break into pieces and travel in the blood stream, lodging in the heart (causing a heart attack), the lungs (causing a pulmonary embolus), or in the brain (causing a stroke). • If you were previously on Warfarin/Coumadin® and you are starting Rivaroxaban(Xarelto®), do not continue taking warfarin. Rivaroxaban(Xarelto®) replaces warfarin. Xarelto 10mg tablet Xarelto 15mg tablet Xarelto 20mg tablet How should I take rivaroxaban (Xarelto®)? • Take Rivaroxaban(Xarelto®) exactly as prescribed by your doctor. • Rivaroxaban(Xarelto®) should be taken with food. • Rivaroxaban(Xarelto®) tablets may be crushed and mixed with applesauce to make the tablet easier to swallow. - 1 - • If you missed a dose: o Take it as soon as you remember on the same day. • Do not stop taking rivaroxaban suddenly without telling your doctor. This can put you at risk of having a stroke or a blood clot. • If you take too much rivaroxaban, call your doctor or the anticoagulation service. If you are experiencing any bleeding which you cannot get to stop, go to the nearest emergency room. -
BREATHLESSNESS ABSTRACT INTRODUCTION Dyspnoea, Also
EMERGENCY MEDICINE – WHAT THE FAMILY PHYSICIAN CAN TREAT UNIT NO. 4 BREATHLESSNESS In one study of 85 patients presenting to a pulmonary unit Psychiatric conditions appropriate context of the history, physical examination, and ischaemia. Serial measurements of cardiac biomarkers are inhaler (MDI). In severe asthma, patients should be transferred breathlessness. In such cases, it is prudent to start therapies for with a complaint of chronic dyspnoea, the initial impression Psychogenic causes for acute dyspnoea is a diagnosis of the consideration of dierential diagnosis. Random testing necessary as initial results can often be normal. to ED for further treatment with nebulised ipratropium multiple conditions in the initial resuscitative phase. For Dr Pothiawala Sohil of the aetiology of dyspnoea based upon the patient history exclusion, and organic causes must be ruled out rst before without a clear dierential diagnosis will delay appropriate bromide, intravenous magnesium, ketamine, IM adrenaline, example, for a patient with a past medical history of COPD and alone was correct in only 66 percent of cases.4 us, a considering this diagnosis (e.g., panic attack).5 management. e use of dyspnoea biomarker panels does not Brain natriuretic peptide (BNP) intubation, and inhalational anaesthesia as needed. congestive cardiac failure, the initial management of sudden systematic approach, comprising of adequate history and appear to improve accuracy beyond clinical assessment and is is used to diagnose heart failure, but it can also be elevated onset of dyspnoea may include therapies directed at both these ABSTRACT diagnostic studies, and provide recommendations for initial physical examination, followed by appropriate investigations focused testing.6, 7 in uid overload secondary to renal failure. -
Review of Systems – Clinician Documentation Aug 2019
Review of Systems – Clinician Documentation Aug 2019 WHAT YOU NEED TO KNOW: Review of Systems (ROS) is an inventory of body systems obtained by asking a series of questions to identify signs and/or symptoms the patient may be experiencing or has experienced. CMS and Payers have varying documentation audit focal points for clinical validation of services rendered. Points are not synonymous with symptoms. What are the systems recognized 1. Constitutional Symptoms (for example: fever, weight loss) for ROS? 2. Eyes 3. Ears, nose, mouth, throat 4. Cardiovascular 5. Respiratory 6. Gastrointestinal 7. Genitourinary What are the three types of ROS? 1. Problem pertinent 2. Extended 3. Complete What is required for each type 1. Problem Pertinent ROS inquires about the system directly related to the problem ROS? identified in the History of Physical Illness (HPI). 2. Extended ROS inquires about the system directly related to the problem(s) identified in the HPI and a limited number (two to nine) of additional systems. 3. Complete ROS inquires about the system(s) directly related to the problem(s) identified in the HPI plus all additional (minimum of ten) organ systems. You must individually document those systems with positive or pertinent negative responses. For the remaining systems, a notation indicating all other systems are negative is permissible. Documentation Requirements Documentation within the patient record should support the level of service billed. For every service billed, you must indicate the specific sign, symptom, or patient complaint that makes the service reasonable and medically necessary. It would be inappropriate and likely ruled not medically necessary to bill based on a full review of systems for a problem focused complaint. -
Pulmonary Vascular Complications of Liver Disease
American Thoracic Society PATIENT EDUCATION | INFORMATION SERIES Pulmonary Vascular Complications of Liver Disease People who have advanced liver disease can have complications Jaundice that affect the heart and lungs. It is not unusual for a person (yellow tint to skin with severe liver disease to have shortness of breath. Breathing and eyes) problems can occur because the person can’t take as big a breath due to large amounts of ascites (fluid in the abdomen) or pleural effusions (fluid build-up between the tissues that line the lung and chest) or a very large spleen and liver that pushes the diaphragm up. Breathing problems can also occur with Hepatomegaly liver disease from changes in the blood vessels and blood flow in the lungs. There are two well-recognized conditions that can result from liver disease: hepatopulmonary syndrome and portopulmonary hypertension. This fact sheet will review these Breathing two conditions and how they relate to liver disease. problems What is liver disease? the rest of your body. These toxins can damage blood vessels The liver is the second largest organ in the body and has many in your lungs leading to dilated (enlarged) or constricted important roles within the body including helping with digestion, (narrowed) vessels. Two different conditions can be seen in the metabolizing drugs, and storing nutrients. Its main job is to lungs that arise from liver disease: hepatopulmonary syndrome filter blood coming from the digestive tract and remove harmful and portopulmonary hypertension: CLIP AND COPY AND CLIP substances from it before passing it to the rest of the body. -
Types of Chest Pain Table
Types of Chest Pain This table explains some of the common causes, signs and symptoms of chest pain. Please remember that this information is a guide only. DO NOT USE FOR DIAGNOSIS. If symptoms persist, or you become unsure or concerned, please speak with your doctor. Name Cause of chest pain Symptoms of chest pain Location of pain How to relieve chest pain Angina Angina occurs when there isn't discomfort May be felt in the centre of Rest enough oxygen-rich blood flowing to tightness the chest or across the Anginine – dissolved part of your heart. Angina is caused pressure chest, into the throat or jaw, under the tongue by narrowed coronary arteries. squeezing down the arms, between the or heaviness shoulder blades Nitrolingual spray- dull ache Unstable angina may be sprayed under the unrelated to activity or Additional symptoms may include: tongue stress, comes on more nausea shortness of breath frequently or takes longer to strange feeling or ease tingling/numbness in the Angina symptoms can neck, back, arm, jaw or gradually get worse over 2 to 5 shoulders minutes. Angina usually lasts less light headedness than 15 minutes irregular heart beat Heart Attack A heart attack happens when plaque similar to angina however unable to pinpoint exact A heart attack is a cracks inside the narrowed coronary last longer than 15 minutes spot medical emergency. artery - causing a blood clot to form. and are not relieved by rest, May be felt in the centre of If the blood clot totally blocks the Anginine or Nitrolingual the chest or across the If pain is not relieved by artery, the heart muscle becomes spray chest, into the throat or jaw, Anginine or Nitrolingual damaged Additional symptoms may include: down the arms, between the spray in 10 to 15 minutes, nausea shoulder blades call 000 for an vomiting ambulance. -
Know the Warning Signs of a Heart Attack
Toolkit No. 22 Know the Warning Signs of a Heart Attack What is a heart attack? A heart attack happens when the blood vessels that go to your heart get blocked by fatty deposits or a blood clot. When this happens, the blood supply is reduced or cut off. Then oxygen and other materials can’t get through to your heart , hurting your heart muscle. Another name for a heart attack is myocardial infarction, or MI. If you have diabetes, you’re at risk for a heart attack. What are the warning signs of a heart attack? The warning signs include • chest pain or discomfort, tightness, pressure, or fullness. Call 9-1-1 right away if you have warning signs of This might feel like indigestion or heartburn. a heart attack. Getting help can help save your life. • discomfort in one or both of your arms, your back, jaw, neck, or stomach • shortness of breath • help blood flow in your heart • sweating • reduce chest pain • indigestion or nausea or vomiting These steps work best within an hour of the first warning • tiredness, fainting, or feeling light-headed signs of a heart attack. You may not have all of these signs, and they may come How are the signs of a heart attack and go. The most common warning sign for both men and women is chest pain. But women are more likely to different for people with diabetes? have some of the other warning signs. If you have chest Diabetes can affect your nerves and make heart attacks pain that doesn’t go away after you rest for a few painless or “silent.” A silent heart attack means that you minutes , you might be having a heart attack. -
Scleroderma Education Program Chapter 7 Heart, Lungs and Kidneys
Scleroderma Education Program Chapter 7 Heart, Lungs and Kidneys Chapter 7- 1 Chapter Highlights 1. Heart Disease in Scleroderma -What the heart does -What can go wrong 2. Lung Disease in Scleroderma -What the lungs do -What can go wrong – symptoms of lung disease 3. Kidney/Renal Disease in Scleroderma -What the kidneys do -What can go wrong This seventh chapter usually takes about 15 minutes. Chapter 7- 2 Remember: Many of the things discussed in this chapter are scary. No one with Scleroderma will have all or even most of the problems described in this manual. We want to include most of the problems that could develop in Scleroderma so that all patients will feel informed. It’s important to discuss your concerns with your doctor. Heart Disease in Scleroderma Who Develops Heart Disease Many people with Scleroderma do not develop heart disease. Some do. If there is a problem with the heart, the person with Scleroderma may be totally unaware of it at first. That's because there are usually no symptoms of heart disease in the early stages of Scleroderma. Doctors use tests to find out if the heart has been affected. What the Heart Does The heart pumps blood to the body and to the lungs The circulatory system is made up of 2 parts: 1. Circulation to the body (Systemic) This part sends blood to the body and oxygen to the organs 2. Circulation to the lungs - (Pulmonary) This part sends blood to the lungs to get oxygen. The heart has 4 chambers: - 2 upper chambers (atria). -
Cognitive Effects of Hypercapnia on Immersed Working Divers Alaleh Selkirk
Susquehanna University Scholarly Commons Psychology Faculty Publications 10-2010 Cognitive effects of hypercapnia on immersed working divers Alaleh Selkirk James F. Briggs Susquehanna University Barbara Shykoff Follow this and additional works at: http://scholarlycommons.susqu.edu/psyc_fac_pubs Part of the Psychology Commons Recommended Citation Selkirk, A., Briggs, J. F., & Shykoff, B. (2010). Cognitive effects of hypercapnia on immersed working divers (NEDU TR 10-15). Panama City, FL: Navy Experimental Diving Unit. This Article is brought to you for free and open access by Scholarly Commons. It has been accepted for inclusion in Psychology Faculty Publications by an authorized administrator of Scholarly Commons. For more information, please contact [email protected]. Navy Experimental Diving Unit TA 09-01 321 Bullfinch Rd. NEDU TR 10-15 Panama City, FL 32407-7015 October 2010 COGNITIVE EFFECTS OF HYPERCAPNIA ON IMMERSED WORKING DIVERS Navy Experimental Diving Unit Authors: LT Alaleh Selkirk, PhD Distribution Statement A: Barbara Shykoff, PhD Approved for public release; James Briggs, PhD distribution is unlimited. UNCLASSIFIED SECURITY CLASSIFICATION OF THIS PAGE REPORT DOCUMENTATION PAGE 1a. REPORT SECURITY CLASSIFICATION 1b. RESTRICTIVE MARKINGS Unclassified 3. DISTRIBUTION/AVAILABILITY OF REPORT 2a. SECURITY CLASSIFICATION AUTHORITY DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited. 2b. DECLASSIFICATION/DOWNGRADING AUTHORITY 4. PERFORMING ORGANIZATION REPORT NUMBER(S) 5. MONITORING ORGANIZATION REPORT NUMBER(S) NEDU Technical Report No. 10-15 6a. NAME OF PERFORMING 6b. OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION ORGANIZATION (If Applicable) Navy Experimental Diving Unit 6c. ADDRESS (City, State, and ZIP Code) 7b. ADDRESS (City, State, and Zip Code) 321 Bullfinch Road, Panama City, FL 32407-7015 8a. -
Acute Dyspnea in the Office ROGER J
Acute Dyspnea in the Office ROGER J. ZOOROB, M.D., M.P.H., and JAMES S. CAMPBELL, M.D. Louisiana State University School of Medicine, Kenner, Louisiana Respiratory difficulty is a common presenting complaint in the outpatient primary care set- ting. Because patients may first seek care by calling their physician’s office, telephone triage plays a role in the early management of dyspnea. Once the patient is in the office, the initial goal of assessment is to determine the severity of the dyspnea with respect to the need for oxygenation and intubation. Unstable patients typically present with abnormal vital signs, altered mental status, hypoxia, or unstable arrhythmia, and require supplemental oxygen, intravenous access and, possibly, intubation. Subsequent management depends on the dif- ferential diagnosis established by a proper history, physical examination, and ancillary stud- ies. Dyspnea is most commonly caused by respiratory and cardiac disorders. Other causes may be upper airway obstruction, metabolic acidosis, a psychogenic disorder, or a neuro- muscular condition. Differential diagnoses in children include bronchiolitis, croup, epiglotti- tis, and foreign body aspiration. Pertinent history findings include cough, sore throat, chest pain, edema, and orthopnea. The physical examination should focus on vital signs and the heart, lungs, neck, and lower extremities. Significant physical signs are fever, rales, wheez- ing, cyanosis, stridor, or absent breath sounds. Diagnostic work-up includes pulse oximetry, complete blood count, electrocardiography, and chest radiography. If the patient is admitted to the emergency department or hospital, blood gases, ventilation-perfusion scan, D-dimer tests, and spiral computed tomography can help clarify the diagnosis. In a stable patient, management depends on the underlying etiology of the dyspnea. -
Respiratory Emergencies 16
PART 9 Medicine CHAPTER Respiratory Emergencies 16 The following items provide an overview to the purpose and content of this chapter. The Standard and Competency are from the National EMS Education Standards. STANDARD • Medicine (Content Area: Respiratory) COMPETENCY • Applies fundamental knowledge to provide basic emergency care and transporta- tion based on assessment findings for an acutely ill patient. OBJECTIVES • After reading this chapter, you should be able to: 16-1. Define key terms introduced in this chapter. i. Cystic fibrosis 16-2. Explain the importance of being able to quickly rec- j. Poisonous exposures ognize and treat patients with respiratory emergencies. k. Viral respiratory infections 16-3. Describe the structure and function of the respiratory 16-9. As allowed by your scope of practice, demonstrate system, including: administering or assisting a patient with self- a. Upper airway administration of bronchodilators by metered-dose b. Lower airway inhaler and/or small-volume nebulizer. c. Gas exchange 16-10. Differentiate between short-acting beta2 agonists d. Inspiratory and expiratory centers in the medulla appropriate for prehospital use and respiratory medi- and pons cations that are not intended for emergency use. 16-4. Demonstrate the assessment of breath sounds. 16-11. Describe special considerations in the assessment and 16-5. Describe the characteristics of abnormal breath management of pediatric and geriatric patients with sounds, including: respiratory emergencies, including: a. Wheezing a. Differences in anatomy and physiology b. Rhonchi b. Causes of respiratory emergencies c. Crackles (rales) c. Differences in management 16-6. Explain the relationship between dyspnea and 16-12. Employ an assessment-based approach in order to hypoxia.