Painful Calf Session 2

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Painful Calf Session 2 by Mind Map: Painful Calf Session 2

1. Step 6

1.1. Review session 1

1.2. Report new knowledge

1.2.1. DVT

1.2.1.1. mechanisim

1.2.1.2. risk factors

1.2.1.3. venous system in the leg

1.2.2. pulmonary embolisim

1.2.2.1. mechanisim

1.2.2.2. risk factors

1.2.2.3. diagnosis

1.3. 30 minutes

1.3.1. The scribe does not have to write in this step!

2. Step 8

2.1. Diagnostic decision

2.1.1. pulmonary embolism

2.2. Mechanism

2.2.1. deep and superficial venous thrombi

2.2.2. pregnancy

2.2.2.1. leads to iron deficinciey

2.2.3. injury

2.2.4. prolonged flight

2.2.5. smoking

2.2.6. obesity

2.2.7. family history

2.3. Presentation

2.3.1. left-sided pleuritic chest pain

2.3.2. tachypnea and tachycardia

2.4. Supporting data

2.4.1. trigger 1

2.4.1.1. US

2.4.1.1.1. superficial and deep thrombi

2.4.1.2. blood work

2.4.1.2.1. iron deficiency

2.4.2. trigger 2

2.4.2.1. VQ mismatch

2.4.2.1.1. high probability of PE

2.4.2.2. ABG

2.4.2.2.1. respiratory alkalosis

2.5. 10 minutes

3. Step 7

3.1. Inquiry plan and info gathering

3.1.1. History of presenting complain

3.1.1.1. trigger 1

3.1.1.1.1. swollen ankle before coming back to SA

3.1.1.1.2. pain associated with the swollen ankle

3.1.1.1.3. no infection

3.1.1.1.4. relief of the pain?

3.1.1.1.5. severty?

3.1.1.1.6. bilateral or uni?

3.1.1.1.7. first when she got out the car

3.1.1.1.8. worsen with walking

3.1.1.1.9. progressed untill became constant

3.1.1.1.10. seen by GP in ED

3.1.1.2. trigger 2

3.1.1.2.1. after prolonged sleep? exercise?

3.1.1.2.2. when started?

3.1.1.2.3. charactarestic?

3.1.1.2.4. exacerbated?

3.1.1.2.5. associated symptomes?

3.1.2. Previous medical / surgical history

3.1.2.1. pregnancy?

3.1.2.1.1. 32 weeks pregnant

3.1.2.1.2. she had one before

3.1.2.1.3. no regular prenatal visits

3.1.2.2. appendectomy at age 12

3.1.2.3. tried to be in diet for the last 10 years

3.1.3. Drug history / allergy

3.1.3.1. clear history

3.1.3.2. only SC morphin

3.1.4. Family history

3.1.4.1. father has Hypertension and gout

3.1.4.2. mother experienced clot in lung at 31

3.1.4.2.1. after delivery

3.1.4.3. sister 33 , brother 31 are well

3.1.5. Social / occupational history

3.1.5.1. previous as hair dresser

3.1.5.1.1. after first delivery worked at home

3.1.5.2. smoker

3.1.5.2.1. 10 per day

3.1.5.3. occasional drinker

3.1.6. Systemic review

3.1.7. Physical examination

3.1.7.1. trigger 1

3.1.7.1.1. palpation

3.1.7.1.2. pitting edema

3.1.7.1.3. mildly obese

3.1.7.1.4. discomfort and cant walk in her leg

3.1.7.1.5. vital signs

3.1.7.2. trigger 2

3.1.7.2.1. vital signs

3.1.8. tests results

3.1.8.1. trigger 1

3.1.8.1.1. US

3.1.8.1.2. blood work

3.1.8.2. trigger 2

3.1.8.2.1. VQ mismatch

3.1.8.2.2. ABG

3.2. 50 minutes