AMLS Graded A+

AMLS Graded A+ Left should pain ️Diaphragm irrition, ruptured spleen, myocardial jnfart Right should pain ️Liver irritation, gallbladder pain, diaphragm irrational Right scapular pin ️Liver and gallbladder Epigastric ️Stomach, lung, cardiac Umbilical ️Small intestine, appendix Back ️Aorta, stomach, pancreas Flanks to groin ️Kidney, uriter Perineal ️Bladder Suprapubic ️Bladder, colon Secondary survey ️Physical exam Rhonchi ️Coarse low pitched, may clear with cough Wheeze ️Whistling high pitch Bronchial ️Coarse, loud, heard with consolidation Rub ️Scratchy, high-pitched Crackles ️Fine crackling, high pitched Bronchovesicular ️Combination bronchial and vesicular normal on some areas Vesicular ️High pitched breezy Blood pressure ️Flow*resistance McBurney point ️Area over R side of ABD that is 3rd of the distance from anterior superior iliac spine to umbilicus. Tenderness acute appendicitis Rovsing sign ️Palp LLQ makes pain in RLQ indicates appendicitis Upper ABD ️T7, T8 and T9 Lower ABD ️T10 and T11 Cremasteric ️T12, L1 and L2 Planter ️L4, L5 S1 and S2 Babinski ️Check Nero in conscious pt. run pen along bottom of foot and toes move toward nose is a positive Neurogenic shock ️vasodilation Neurogenic shock ️Warm, dry, pink skin, Hypotension, Bradycardia and bradypnea, May have normal cap refill Septic Shock ️vasodilation Septic Shock ️Hypotension, Altered mental status, Hyper or hypothermic Anaphylaxis Shock ️vasodilation Anaphylaxis Shock ️Hypotension, Tachycardia, Anxiety, Urticaria, angioedema, Wheezing Hypovolemic Shock ️loss of plasma or blood Hypovolemic Shock ️Cool, pale, clammy skin, Hypotension - late sign, Altered mental status, Delayed cap refill Cardiogenic shock ️loss of pump function Cardiogenic shock ️Cool, clammy, pale skin. May also be cyanotic, Increased or decreased heart rate or dysrhythmia, Hypotension, Altered mental status, Decreased cap refill, May have pulmonary edema - crackles Obstructive shock ️tamponade, tension pneumo, pulmonary embolus Obstructive shock ️JVD, Tracheal deviation in pneumothorax, Muffled heart tones in tamponade, Pulsus pardoxus Compensated shock ️the renin-angiotension-aldosterone system is activated when the blood pressure drops. This causes an increase in preload through reabsorption of water and sodium. Increased preload will also increase afterload. COPD patients ️acute onset of SOB may have a pulmonary embolism Clinical findings of a pulmonary embolism ️Clear breath sounds, Sudden sharp, localized chest pain, Tachypnea, Hypotension (poor outcome), 12 lead changes Narcotic overdose ️causes respiratory acidosis Acute Respiratory Distress Syndrome (ARDS) ️caused a breakdown of the alveolar-capillary membrane. Indications for CPAP ️COPD, Asthma - if not responding to beta agonists, CHF CPAP ️use only in patients who can follow commands and clear their own airway secretions Respiratory Alkalosis ️may result from: Infections, fever & anxiety Respiratory Acidosis ️may result from: Narcotic overdose, Benzodiazepines, Pneumonia, Foreign body Ageing ️have a decreased lung compliance Left heart failure causes ️fluid back up in the lungs causing dyspnea at night or paroxysmal nocturnal dyspnea Asthma patients ️usually present with respiratory distress, no fever, increased expiratory phase of breathing, wheezing COPD patients ️may present with pursed lip breathing, increased respiratory effort upon exertion, rhonchi, no JVD, wheezing Pericarditis presentation ️ST elevation in all leads - global ST elevation Cardiac Tamponade S&S ️Low amplitude EKG, Muffled heart tones, Pulsus Paradoxus, Hypotension