Medical Midterm Reference Guide PDF

STUDY GUIDE FOR ME MIDTERM: What is the difference between differential diagnosis & working diagnosis? - Differential diagnosis is your list of potential diagnoses (more than 1) - Working diagnosis is you going down your list and narrowing it down High priority trauma Pt’s - Life threaten...

STUDY GUIDE FOR ME MIDTERM: What is the difference between differential diagnosis & working diagnosis? - Differential diagnosis is your list of potential diagnoses (more than 1) - Working diagnosis is you going down your list and narrowing it down High priority trauma Pt’s - Life threatening MOI (MVA, MVA where a passenger died,Intrusion/Ejection, GSW, Severe hemorrhage) - Multiple MOI’s - Falls greater than 20ft for adults Pediatric high priority trauma’s - Falls from 2-3x the child’s height - Falls greater than 10 ft w/ loss of consciousness - MVC/Bicycle collisions If behavior is altered or inappropriate for responsive medical Pt’s consider: - Hypoxia - Medical issue - Low Blood glucose (Hypoglycemia) - Hypothermia - Psychiatric emergency - Drug/Alcohol ingestion Altered Pt check 4 S’ & consider NOT: - Sugar - Sepsis - Stroke - Seizure - Narcan - Oxygen - Trauma Pt assessment includes: - Scene size up (BSI/PENMAN) - Primary assessment (AVPU, ABC’s, PEARRL, A&Ox, Chief complaint) - History taking (OPQRST, SAMPLE, HAM) - Secondary assessment (Baseline Vitals & EKG, Systemic physical exam, Focus on injury/affected body system) - Reassessment (Repeat primary, Vitals, Reassess C/C, Recheck interventions, Note & treat any changes to Pt’s condition) Factors that can cause pulse ox to misread? 1. Dark skin tone 2. Hypoperfusion 3. Nail Polish 4. Hypothermia 5. CO poisoning Different elements of skin assessment. 1. Turgor (elasticity of the skin, poor turgor will result in skin taking longer to return it original shape)(tenting of the skindue to dehydration) 2. Pitting (a dimple/pit on the skin after applying pressure) 3. Edema (Swelling due to fluid retention) 4. Color (Flush, Pale, Jaundice) 5. Dry/Diaphoretic 6. Mottled(Shock, disseminated intravascular coagulotherapy) Define Cyanosis: - Bluish skin/mucous membranes due to lack of perfusion (hypoperfusion), hypoxia What can cause pale skin? - Hypotension What are different lung sounds you can hear when auscultating? 1. Rales (Fluid in the Airways, Inflammation) 2. Crackle (Fluid in the Airways, Pneumonia, CHF, Bronchitis) 3. Absence (Pneumothorax, Pleural Effusion) 4. Ronchi (Bronchitis, COPD, Asthma, FBO) 5. Strider (Laryngeal Edema, Infections, Trauma) 6. Wheezing (Asthma, COPD, Allergic Reactions, Heart Failure) What are different breathing conditions?  1. Agonal 2. Ataxic/Biot (Related to ICP, brainstem injury) 3. Tachypnea(Rapid shallow breaths) 4. Bradypnea(Slow decreased breaths) 5. Apnea(Absence of breathing) 6. Cheyne-Stokes(Pre-death, brainstem injury, brain herniation) 7. Kussmaul(Acidosis, DKA) What is one of the main signs of meningitis? - Brudzinski Sign (hips and knees flex in response to neck flexion) (Photophobia) What is the cause of clubbing of fingers? - Hypoxia/Chronic respiratory disease What is the definition of throwing up blood? - Hematemesis(Bleeding ulcers, Esophageal tears ie. Mallory-Weis, Varices) - Hemoptysis(coughing up blood) What is the definition of an enlarged liver? - Hepatomegaly  What is the definition of Cullen Sign? - The Cullen sign refers to a clinical indicator of intra-abdominal bleeding, particularly in the context of ectopic pregnancy or ruptured ovarian cysts. It is characterized by ecchymosis (bruising) around the umbilicus What is the definition of Gray Turner? - Gray Turner sign refers to a clinical finding characterized by bruising (ecchymosis) along the flanks, indicating retroperitoneal hemorrhage. What is the definition of Battle Sign? - Battle sign refers to bruising over the mastoid process of the skull, which may indicate a skull fracture, particularly a basilar skull fracture. It is characterized by a discoloration behind the ear. What is the number in between the systolic and diastolic pressure? - Pulse Pressure - Systolic minus Diastolic = PP What is Referred pain? - Referred pain is a phenomenon where pain is perceived in a location different from its actual source. What is a common sign of appendicitis? - Rebound Tenderness - Guarding - Nausea and Vomiting - Loss of Appetite - Fever - RLQ pain(Mcburney’s point) - [Rupture results in; Peritonitis, Sepsis, Death] How do you evaluate for signs of Peritonitis? - Dunphy sign(ABD pain when coughing) - Rovsing sign(RLQ pain when palpating LLQ)  What fluids would you use for someone with a head injury? 1. NS 2. Lactated Ringer ICP: Not affected by blood pressure - Increased ICP decreases CPP - W/ increased ICP ->body compensates by increasing MAP - CPP(Cerebral Perfusion Pressure): - CPP is the pressure of blood filling the arteries in the brain, delivering adequate oxygen & glucose MAP = (Systolic BP + 2 × Diastolic BP) ÷ 3 How many spinal nerves are there? - 31 - Cervical Region: 8 pairs (C1-C8) - Thoracic Region: 12 pairs (T1-T12) - Lumbar Region: 5 pairs (L1-L5) - Sacral Region: 5 pairs (S1-S5) - Coccygeal Region: 1 pair (Co1) What is a reflex arc? - The neural pathway that controls involuntary reflex action - 1)Sensory receptors detect stimulus - 2)Impulse generated - 3)Sensory neurons bring info to spinal cord(CNS) - 4)Motor neurons take impulse from CNS to effector organ - 5)Effector performs the action What is the main function of the Hippocampus? - Memory(long term)  What are a couple functions of the Vagus Nerve? - Decreased HR - Activates PSNS - Innervates pharynx & epiglottis - Parasympathetic innervation of organs in thorax & abdomen What is the definition of crunching sounds upon auscultation? - Boerhaave What is a common cause of sepsis in elderly patients? UTI What is a common symptom of Peritonitis? - Muscle Rigidity - Board-hard abdomen - Febrility(rise in temperature, relating to fever) - Tachycardia - Anorexia - Dehydration - Sepsis What is ascites associated with? - Cirrhosis (Liver Disease) - Presents as a distended abdomen due to fluid in the peritoneal cavity - Visible/Palpable fluid wave What is the Portal Vein? - The portal vein is a major blood vessel that carries blood from the gastrointestinal tract, spleen, and pancreas to the liver. - Also known as the hepatic portal vein which is the hepatic portal system - 90% of products of digestion are absorbed into the portal vein to transport to the liver What is the definition of Esophageal Varices? - Esophageal varices are enlarged, swollen veins in the esophagus that develop due to increased pressure in the portal vein, often as a result of  liver cirrhosis or other liver diseases. These varices can rupture and cause severe bleeding. - Hematemesis occurs What is a common finding in Murphy Sign? - Sharp pain when pressure is applied to RUQ (Gallbladder) How does alcohol affect blood clotting? - Alcohol has blood thinning properties so it can act as an anticoagulant Where is the number 1 indication location for Hypoxia? - Palms WEEK 4: Two major divisions of the digestive system: - Alimentary Canal: muscular tube that makes a pathway for food to travel through the body - Extends from mouth to anus (mouth/pharynx/esophagus/stomach/small intestine/large intestine/ rectum/anus - consists of 4 protective layers: MSMS - mucosa-(carries out secretion and absorption) - submucosa- (carries away absorbed materials) - muscular layer - (provides movement of the tube) - serosa-(protects underlying tissue) - accessory digestive organs: organs that produce and secrete enzymes and juices that are essential to the digestive process Accessory organs of the alimentary canal: - teeth - tongue - salivary glands - Liver - gallbladder - pancreas - spleen What are the functions of the digestive system? - Ingestion - Mechanical processing - Digestion - Secretion - Absorption - Excretion Process of digestion: The process of digestion involves various secretions from different organs that help break down food. - salivary glands: (these glands produce saliva) - stomach: (secretes gastric juices) - liver: (produces bile, which is stored in the gallbladder) - Pancreas: (secrete a variety of enzymes) - small intestine ^^These organs^^ convert food into basic sugars, fatty acids, and amino acids. - These products then cross the intestinal wall, and travel through the portal vein to the liver. - Liver then further processes and stores or transports products to the heart - the circulatory system then nourishes all cells Abdomen: RUQ: gallbladder, liver, some of colon, and small intestine RLQ: appendix, cecum and ascending colon LUQ: stomach, spleen, some colon, and small intestine LLQ: descending and sigmoid parts of colon - Diaphragm located above abdominal cavity - pelvis located bottom of abdominal cavity Oral cavity: lined by the mucous membrane - consists of lips, cheeks, gums, teeth, and tongue - roof palates: Esophagus: - collapsible tube about 10 in. Long - extends from the end of pharynx to stomach - function: transports food from the mouth to stomach - uses Peristalsis to propel (push) food into the stomach Peristalsis: contractions of muscles Stomach: - hollow organ (where is it located?= LUQ) - stomach receives large large quantities of food, stores it and moves it to the small intestine into small portions - stomach converts food to mixed (through churning it with gastric juices), semisolid masses (chyme) Small intestine: - absorbs more than 90% of products of digestion into veins to transport to the liver - components include: - Duodenum: (1st part) receives food from the stomach - jejunum: (middle) major site of nutrient absorption - ileum: where chyme is prepared for entry into large intestine Large intestine: encircles the outer abdomen around small intestine - Main role: complete absorption of water - forms solid stool to pass out through anus components: - cecum - colon: (ascending/descending/transverse/ sigmoid) - rectum Cecums accessory organ: appendix (attached to cecum) Appendix: - small, saclike outcropping of colon - contains T and B lymphocytes - Secretes immunoglobulin A - storage site for non pathogenic (“good”) intestinal bacteria Liver: What are its functions?  - Maintains blood glucose - detoxifies the blood (toxins excreted in the urine) - manufacturing clotting factors - regulates for metabolism (processing nutrients) and storage (storing energy) Define portal vein: - Transports venous blood from the GI tract to the liver Gallbladder: - An outpouching from the bile ducts Bile: fluid produced by the liver stored in the gallbladder - When food enters the duodenum (the first part of the intestine), it stimulates/triggers the gallbladder to release bile. - The movement of bile is regulated by a muscle called the Sphincter of Oddi. When it is relaxed bile flows into the duodenum, when it is contracted it prevents bile from entering. Pancreas: - Endocrine functions: synthesis of glucagon, insulin & somatostatin - Exocrine functions: production of pancreatic digestive juices/enzymes (such as amylase/chymotrypsin/trypsin/carboxypeptidose) Digestion and absorption of nutrients: GI ASSESSMENT: what are some questions you would want to ask your questions: - dietary habits - discharge (what did your last stool look like? Was there any blood?) - types of pain Skin irregularities: scars: indicate past surgeries or trauma striae: stretch marks define asymmetric abdomen: uneven or irregular appearance of the abdomen Possible causes of this: - tumors/hernia/enlarged or distended abdomen/pregnancy Scaphoid abdomen: decreased abdominal volume Percuss abdomen: (tap on the abdomen) - abdomen should sound empty - Upper left/right should sound duller (due to the spleen, liver) types of pain: Visceral pain: internal organs (ex. Stomach, intestines….) deep, squeezing, cramp-like pain can be difficult to pinpoint exact location parietal pain: sharp, well localized somatic: sharp, aching, throbbing (usually associated with injury or damage to skin, muscles, bones, and connective tissues) referred: pain felt in different location from where the actual problem/injury is Define rebound tenderness: - Parietal pain, (pressing down on patient then quickly release, if patient experiences increased pain upon release that is known as rebound tenderness) Management of pain, nausea, and vomiting: - N/V (antiemetics such as Zofran) - pain meds include: - morphine - ketorolac - Fentanyl - memorizing hydrochloride Fluid resuscitation: - patients who are dehydrated; your goal is to refill cellular space. Degree of hemodynamic stability will indicate the use of: - hypotonic: for stable patients (this will move fluids from the vascular space into the interstitial and then the intracellular space; refilling the cells (because they are dehydrated) - isotonic: for unstable patients (this would be needed to Rex-and the vascular space first, that is priority over rehydrating cells because it is life threatening to have a decrease in blood volume) What would you give to your patients if their blood pressure can not be controlled? - dopamine - NE - epinephrine cholecystitis: - gallbladder inflammation - Patients likely experience pain after eating fatty foods Hypovolemia:caused by dehydration from vomiting and/or diarrhea - body shifts water from inside cells to interstitial space and into vascular space to maintain adequate fluid volume in blood vessels (electrolyte levels affected) Hyponatremia: Low sodium (swelling of cells) hypernatremia: high sodium (shrinking of cells caused by excessive water loss) Hyperkalemia: high potassium hypokalemia: low potassium levels other causes of hypovolemia: - Hemorrhage - Bleeding - signs of shock a drop in blood pressure indicates significant volume loss GI bleeding: Upper GI bleeding: causes Melena lower GI bleeding: causes hematochezia (bloody stool) Treatment: - fluid resuscitation - Establish IV line - 1,000 ml isotonic solution Esophagogastric varices: swollen veins in the esophagus causes: - pressure increases in blood vessels surrounding the esophagus and stomach - Blood flow to the lover is blocked - blood backs up into portal vessels (portal hypertension) - Hep. C primary cause (inflammation of the liver caused by the hep.c virus) Initial presentation: - fatigue - jaundice - anorexia  - pruritus - abdominal pain - N/V What happens when they rupture? - USE PPE, BLOOD EVERYWHERE - patients will experience discomfort in the throat - severe dysphagia (difficulty swallowing) - hematemesis (vomiting blood) - hypotension - signs of shock Mallory Weiss: tear or laceration of the mucous membrane - Generally due to severe vomiting - severe bleeding - Mallory Weiss presents w/bleeding In extreme cases: S/s of shock epigastric abdominal pain Hematemesis Melena - aimed at managing the loss of blood Boerhaave syndrome: - rupture of the esophagus due to repeated vomiting - tear travels through the wall of esophagus creating a hole - More often in men - presents with upper chest pain - Very little bleeding - aimed at managing for potential sepsis Both Mallory Weiss and Boerhave: - linked with vomiting Peptic Ulcer disease and Gastritis: PUD: - Erosion of mucus that lines the stomach and duodenum - occurs over weeks, months, years ; gastritis:  - stomach is inflamed - Erosions have not occured S/S: - in both conditions; burning/gnawing pain in epigastrium - will disappear after eating but will appear within a few hours - nausea/vomiting/belching/ heartburn/ dyspepsia/ fatigue/ anemia Zollinger Ellison syndrome: - tumors within the pancreas and duodenum cause increased gastric acid production GERD: (gastroesophageal reflux disease) Hemorrhoids: - swelling and inflammation of vascular cushions surrounding rectum can result to lower GI bleeding caused by increased rectal pressure or irritation two types: internal: painless but can prolapse external: painful and tend to have an area of swelling and clot formation S/S: - hematochezia/ rectal itching/small mass on rectum Anal fissure: (also known as anal ulcer) - Small tear in the lining of the anus - usually caused due to passing large, hard stools possible other causes: - Crohn disease/trauma/ human immunodeficiency virus/ anorectal cancer Painful defecation/ light bleeding because of the pain, it delays the patient to pass stool which causes the stool to be larger and harder and more painful (vicious cycle) Esophagitis: inflammation of esophagus Caused by: infectious process or by reflux of gastric secretions into esophagus effects: irritation and swelling/ dyspepsia (upper abdomen discomfort, often after eating/drinking)/ choking S/S: - abdominal and chest pain when lying flat  - dyspepsia - water brash (bitter taste of acid) - dysphagia (difficulty swallowing) - odynophagia ( painful swallowing) Management: Due to the chest pain treat it as an MI until further notice Tracheoesophageal fistula: connection between esophagus and trachea - Allows food to move into lungs - Fatal if uncorrected If TEF is due to cancer: patient will present - cough/fever/aspiration/excessive gas If patient has had a tracheostomy may present with: - Decreased LOC - fever - sepsis - cough Fistula: opening between two portions of the body or between a body part sand outside of the body Esophageal stricture or stenosis: - abnormal narrowing of structure causes: - inflammation/ tumors/ infection/ acid reflux May present with: - volumes of secretions/ difficulty in breathing/ dysphagia (processing to odynophagia / inability to speak management: - AIRWAY - consider glucagon for those who have an obstruction - be prepared to assist with oral secretions WEEK 5: EMERGENCIES Inflammation of all parts of the GI tract said to have? - inflammatory bowel disease (IBD); covers both ulcerative colitis and crohn disease What does inflammation do to your body? - damages GI tract wall - places patients at greater risk for cancer Hepatic encephalopathy - Brain impairment due to dimished liver function Causes: increased levels of ammonia/ diminished cellular energy supplies/ change in blood brain barrier S/s: can range from mild memory loss to coma - attention deficits (difficulty maintaining focus, staying on task) - impaired complex reasoning (having difficulty understanding, making decisions, solving problems) - bradykinesia (slowness of movement) - shuffling gait (walking while dragging feet, think zombie) - tremor Cirrhosis: - Early liver failure first stage: think flu like s/s - joint aches/weakness/fatigue/Nausea/vomiting/Anorexia/pruritus/easy bruising second stage: more extensive liver damage - alcoholic stool/dark urine/ ascites/ hepatomegaly (enlarged liver) management: - avoid lactated ringer solution Ulcerative colitis: - inflammation of the colon - causes a thinning of intestinal wall and weakened rectum - peaks ages 15-25 and 55-65 - often in women than men S/S: - gradual onset of blood diarrhea/ discharge of mucus via rectum/ mild to severe abdominal pain/ tenesmus (feeling of rectal fullness)/ skin lesions Crohn disease: - inflammatory bowel disorder - similar to ulcerative colitis, but involves the whole GI tract especially the ileum S/S: - chronic abdominal pain/rectal bleeding/ weight loss/ skin problems Rectal abscess: - caused when ducts carrying mucus to rectal area become blocked (allowed bacteria to grow, spread to anus) (common in men)  - collection of pus in the tissues around the recetum or anus S/S: - rectal pain w/defecation/ rectal drainage/ fever/ constipation Management: - avoid fowlers place them in lateral position more comfort Pancreatitis: - inflammation of the pancreas - occurs when tube carrying enzymes become blocked S/S: - sharp epigastric pain/ pain radiating to back/ nausea/ vomiting/ fever/ muscle spasms Acute Gastroenteritis: (stomach bug) - inflammation of stomach and intestines typically resulting from an infection - conditions involving infection w/fever, abdominal pain, diarrhea, N/V S/S: - diarrhea/ nausea/ vomiting/ anorexia (due to loss of appetite) Mesenteric ischemia: Neoplasms: - medical term for growth or tumors - caused by errors during cellular production categorization: - benign (not harmful/non cancerous) - malignant (cancerous/spreads) - primary (specific organ/ tissue) - metastatic (cancer cells go from primary tumor and form in other organs) Tumors of the colon: - colon cancer - colorectal cancer Right side colon cancer: - bleeding - diarrhea left side colon cancer: trend to cause obstruction S/S:  - rectal bleeding/ abdominal pain/ anemia/ change in bowel habits pancreatic tumor: - majority of malignancies (cancer growth) occur in exocrine cells - many of these patients will have a living will S/S: - malaise (discomfort)/ nausea/ vomiting/ midepigastric pain/ back pain/ anorexia/ weight loss Abdominal wall hernia: - organ/structure protrusion into adjacent cavity Caused by: - obesity/ heavy lifting/ standing for long periods/ straining during bowel movements/ COPD visceral pain: referred pain: WEEK 6: NEUROLOGICAL EMERGENCIES Differences between CNS and PNS - what they are responsible for Lobes: F-POT - Frontal: Thinking / planning / problem solving / emotional / behavioral / decisions / sexual behavior - Parietal: -sensory (feel pain) / -perception (sizes / distance) / -language (speech) / numbers / number memorization - Occipital: -vision and color - Temporal: - speech comprehension / facial recognition / sensations(smell, taste, touch, sight) Nerves: - What do they do? - Send impulses to the brain ( sensations such as pain, touch and temp.) - convey commands (from brain to body) - muscle movements - signal discomfort/pain  brainstem: what does it consist of? (Connects cerebrum and spinal cord) - Mid-brain: Reticular activating system(RAS) - Level of consciousness - Pons: means bridge to higher brain - Respiratory pattern and depth - Medulla: HR, BP, RR (rate only), reflex (coughing, vomiting, sneezing and swallowing) Hypothalamus: controls pleasure, thirst, hunger Limbic system: generates anger and rage prefrontal cortex: mediates all emotions What are some methods of painful stimuli? - Finger pressure - pressure to supraorbital foramen What must patients have to respond to pain? - Intact spinal cord - intact PNS - functioning brain What are the four nerves responsible for airway control: - trigeminal: (chewing) - glossopharyngeal:(swallowing) - vagus: (gag reflex) (decreased HR) - hypoglossal: (movements of tongue) Posturing: - decorticate: stiff, bent arms, clenched fists, legs out straight - decerebrate: arms/legs straight out, toes pointed downward Define trismus and what could this indicate? - clenched teeth - this could indicate: seizure in progress/head injury/cerebral hypoxia Cushing reflex: a sign of ICP - decreased pulse rate - decreased RR - widened pulse pressure What is ICP? - Rise in pressure within the skull that can affect the brain and its functions - Think “High pressure inside cranium”, this then puts loads of pressure on the brain, eventually squashing your brain stem. Causes of ICP: - brain injury - tumors - swelling - build up CSF - What happens when your ICP rises? - Blood flow to brain diminishes - heart increases contraction force - systolic pressure rises - ability to send signals is damaged - diastole falls - ability to control RR and PR is damaged, so they both decrease (which then you can look at the Cushing reflex, explains why your PR and RR decrease) S/S of ICP: - Cushing reflex - detroriate or decerebate posturing - biot respirations (quick, shallow breaths followed by periods of apnea) - apneustic respirations (prolonged respirations followed by a very short or absent exhalation) - cheyne-stokes - unresponsive - dilated pupils or anisocoria (dif. Pupil sizes) What would you administer to your ICP patients? - NS or lactated ringer solution - NO SOLUTIONS CONTAINING DEXTROSE Ptosis: drooping/sagging of eyelids (common in Bell’s palsy or stroke) Hallucinations: “seeing or hearing things that aren’t there” delusions: “having false beliefs” someone believing everyone is out to get them psychosis: a condition in which involves both hallucinations and delusions, making it hard for them to distinguish what is real and what isn't - ensure your safety - these patients are unpredictable reflex: involuntary response to a specific stimulus corneal reflex: involuntary blinking response when something touches or irritates the cornea of the eye - this reflex helps protect them eye from trauma tap patients eyes; if they dont blink or twitch assume gag or cough reflex is not intact What is one common thing you want to check in all AMS patients? - BLOOD GLUCOSE LEVEL normal: 60-120 mmHg below 10: fatal below 30 mmHg or above 300 mmHg will cause confusion Body movement: hemiparesis: weakness of one side of the body hemiplegia: paralysis of one side FROM MOISES: GU Outline · Urinary tract infections are a leading cause of visits to the ED. Some of the key signs and symptoms to look for are painful urination, frequent urination, and difficulty urinating. Pain can be in the suprapubic area, flank, and urine may be foul smelling and cloudy. This can lead to sepsis, especially in older populations. Urinary catheters can lead to an increase in urinary tract infections, especially in elderly patients and those dependent on indwelling foley catheters. · Renal Calculi (Kidney stones) are common. It happens as a result of excess insoluble salts or uric acid crystallization. Signs and symptoms include flank pain that may radiate to the groin as the stone passes through the ureter. Patient may also present with hematuria (blood in the urine). · Acute Kidney Injury (AKI): a sudden decrease in the rate of filtration through the glomeruli. This is a serious condition, usually seen in critically ill patients. Hypoperfusion to the kidneys from hypovolemia (i.e. dehydration, trauma, shock, sepsis, and heart failure) can lead to an AKI. · Rhabdomyolysis (also known as rhabdo) can also contribute to an AKI. As muscle (myoglobin) continues to break down, over time the fibers will damage the tubules. Be weary of patients who are under physical strain either from exercise or a physical injury, crush injury, or other trauma. These patients require close monitoring of vitals, EKG, and copious amounts of fluid for a better clinical prognosis. · Chronic Kidney Disease (CKD): A common condition amongst patients. As the kidney undergo damage and scarring, the nephrons stop functioning properly. Over time they shrink and their ability to filter and create urine decreases. While most of the time these patients do not have any specific signs and symptoms that may lead you to treat CKD, watch for secondary symptoms because of the fluid build up. Look for pitting edema, hypertension, lethargy, AMS (if electrolyte imbalance is off), among some of the more common symptoms. · End Stage Renal Disease (ESRD): Patients with ESRD no longer have functioning kidneys, or very little function in their filtration. These patients will typically require dialysis (whether hemodialysis or peritoneal) to help them filter the toxin build up in their bodies. They can become easily fluid overloaded, present with uremic frost, hyperkalemia (a true emergency), and AMS. Patients on hemodialysis (HD), must go to a specialized treatment center (dialysis center) to have their blood filtered and fluid removed (watch for hypotension). Their access site on their arms, chest, or suprapubic area may become infected (always check these sights in an altered patient who appears septic). Patients who get HD can be susceptible to an air embolism, though rare, may occur and can be fatal. These patients must be immediately transported as an air embolism may be fatal. · Benign Prostate Hypertrophy (BPH): typically a non-cancerous enlargement of the prostate gland that is common amongst older men. These patients are usually given a medication like Flomax (Tamsulosin) an alpha-1A and alpha 1-B drug that relaxes the muscles around the bladder and prostate gland to help them urinate normally. · Testicular Torsion: a true genitourinary emergency. More common in younger males, can happen spontaneously or with trauma. A testicle will become twisted on the spermatic cord, leading to a decrease in blood flow to the testicle. Usually unilateral, with scrotal pain and swelling.