Clinical Clues
A patient is pale, cool, diaphoretic and has delayed capillary refill. What broad physiologic problem should you immediately consider?
Poor perfusion/shock.
Name four causes of altered mental status.
Hypoglycemia
Stroke
Seizure
Toxicologic
Sepsis
Hypoxia
Metabolic
Electrolyte
Dyspneic patient. What is your immediate assessment priority?
Airway/breathing/oxygenation/ventilation.
What should guide oxygen therapy?
Patient assessment and oxygenation/ventilation status, consistent with local protocol.
Patient says, "I have anxiety." Should you stop looking for a medical cause?
NO!
A dyspneic patient is speaking in one-word responses and becoming increasingly fatigued. What does this suggest?
Severe respiratory distress with possible impending ventilatory failure.
Name four causes of dyspnea.
CHF
COPD/asthma
Pneumonia
PE
Pneumothorax
ACS
Metabolic
Altered patient. What bedside measurement should be obtained early?
Blood glucose.
Why do we reassess after medication?
To evaluate effectiveness and adverse effects.
True/ False: Normal vital signs rule out serious illness.
False.
Why isn't one abnormal vital sign enough to diagnose a patient?
Vital signs must be interpreted within the entire clinical picture and trended.
Abdominal pain + shock. Give three diagnoses you absolutely don't want to miss.
AAA
GI hemorrhage
Sepsis
ACS
Ectopic pregnancy when applicable
Concerning chest discomfort. What diagnostic tool should be considered early?
12-lead ECG.
What's dangerous about treating solely because a patient has a familiar diagnosis?
The diagnosis may be wrong, or another condition may be present.
True/False: Your Patient improves after glucose; therefore, hypoglycemia was the only problem.
False.
Chest discomfort + hypotension + altered mental status + diaphoresis. What should drive your immediate priorities?
Recognition and treatment of life threats/poor perfusion while continuing diagnostic assessment.
Why shouldn't you anchor on the first plausible diagnosis?
Because new evidence may contradict the initial hypothesis.
Patient deteriorates after an intervention. What should you do before simply repeating the intervention?
Reassess and determine why the patient isn't responding.
Hypotensive patient with suspected cardiogenic pulmonary edema. What should guide treatment?
Assessment of airway, breathing and perfusion; hemodynamics; local protocol; appropriate medical control.
True/False: Your Patient has a history of CHF and is short of breath. Therefore, today's problem is CHF.
False.
A patient initially appears stable but becomes altered and hypotensive. What clinical judgment principle is most important?
Reassessment and revision of the clinical impression as the patient's condition changes.
Fever + tachycardia + hypotension + altered mental status. Give two competing hypotheses and one finding that could help distinguish them.
Accept reasonable answers with appropriate rationale.
Patient is in shock and the cause is unclear. What is the safest cognitive approach?
Treat immediate threats, maintain a broad differential, gather targeted information, reassess and revise.
Can treatment response help with diagnosis?
Yes, it provides additional clinical information—but response alone does not prove the diagnosis.
What is premature closure?
Stopping the diagnostic search after finding a plausible explanation despite potentially contradictory evidence.