Academic Day Seminars

ADS #3 – Patient Assessment

This session is one that I foresee myself referring to a great deal for the remainder of this year, and perhaps even thereafter during my practice as a clinician.

My biggest take home point from this ADS that I hope to really incorporate as soon as possible is: Assess each condition and drug in a head to toe approach with a thorough review of systems. This will help with monitoring, investigations, interventions, etc.

This will help me ensure that I haven’t forgotten anything when I work up my patient. This ADS also helped me realize why certain thought processes in my OEE rotation did not go as smoothly as I would’ve liked, something that I will certainly focus on during my clinical orientation (and for all of my DPC rotations).

Some ROS interesting things that I learned today:

Vitals

  • Mean Arterial Pressure (MAP) = (2*diastolic + systolic)/3
    • The mean is calcualted by dividing the sum by 3, because one spends twice as much time in diastole compared to systole.
  • Orthopenia – how many pillows they need to sleep on (to be elevated to not experience SOB that night).

Neuro: (investigations here are filled with acronyms galore)

  • GCS: Glasgow Coma scale; assessing consciousness.
    • when taking GCS its important to know which body systems contribute to the GCS score (e.g. eyes, movement, etc.)
  • MMSE: impt to have the pt be able to read, hear and know the language
    • If they take a while to answer you can adjust their score (e.g. if they say the right date, but doesn’t really seem like they know it, then you would continue to subtract the point).
  • Pain: PQRST: Provoking/Paliation, Quality, Radiating, Severity, Timing
  • Psych: ASEPTICE
  • Mood: SIGECAPS

EENT

Cardiovascular (I need to be able to recall some simple bio/anatomy that is filed somewhere far far far away in my brain.. time to dig out those old memories!)

  • S1, S2, S3 are the most noted in the chart (not as much for S4).
  • QTc is the QT interval, corrected for the rate. (qtdrugs.org)
  • TTE is done first, less invasive, but less accurate. If it doesn’t give enough info then they will change to a TEE. e.g. in endocarditis

Liver:

  • GGT goes up 18hrs after binge drinking and stays up for a month (helps for diagnosis of alcoholism)
  • Why PT vs. PTT: PT measures factor VII (7), shortest clotting factor 1/2 life. so from a liver function perspective your PT will go out of whack before your PTT.

Renal:

  • Look at trends and where they generally lie in term of CrCl, have they doubled/tripled their creatinine? Age? Size? Urine output? etc.

Endocrine:

  • Drug Induced hyperglycemia: SGAs, steroids, thiazides,
  • Drug induced hypoglycemia: sulfonylurea, insulin, salicylates, alcohol,
  • Drug induced hypothyroidism: amiodarone, lithium, iodine
  • Drug induced hyperthyroidism: amiodarone

Hematology

  • Leukocytosis (inc. WBC) drug causes: steroids (usually just at start of tx, or w/ super high dose…this effect should taper off after a couple days)
  • Leukopenia drug causes: chemo, radiation, linezolid, clozapine
  • Drug induced thrombocytosis: vinca alkaloids, adrenaline
  • Drug induced thrombocytopenia: heparin, VPA, linezolid, ranitidine, etc.

MSK

Skin

Each body system was a great review of information, and even more so great clinical relevance was added to some knowledge that we already had to help us be more proficient when we apply this during our DPC rotations.

Can’t wait to tie all this info together tomorrow during our final ADS (Clinical Patient Workup and Therapeutic Thought Process) of our orientation week!

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