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Brenner, Safani - Critical Care and Cardiac Medicine

Brenner, Safani - Critical Care and Cardiac Medicine -...

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Critical Care and Cardiac Medicine Current Clinical Strategies 2005 Edition Matthew Brenner, MD Associate Professor of Medicine Pulmonary and Critical Care Division University of California, Irvine Michael Safani, PharmD Assistant Clinical Professor School of Pharmacy University of California, San Francisco Current Clinical Strategies Publishing www.ccspublishing.com/ccs Digital Book and Updates Purchasers of this book may download the digital book and updates for Palm, Pocket PC, Windows and Macintosh. The digital books can be downloaded at the Current Clinical Strategies Publishing Internet site: www.ccspublishing.com/ccs/cc.htm. 27071 Cabot Road Laguna Hills, California 92653 Phone: 800-331-8227 E-Mail: [email protected] Copyright © 2005 Current Clinical Strategies Publishing. All rights reserved. This book, or any parts thereof, may not be reproduced or stored in an information retrieval network without the written permission of the publisher. The reader is advised to consult the drug package insert and other references before using any therapeutic agent. No liability exists, expressed or implied, for errors or omissions in this text. Printed in USA ISBN 1-929622-55-4
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Critical and Cardiac Care Patient Management T. Scott Gallacher, MD, MS Critical Care History and Physical Examination Chief complaint: Reason for admission to the ICU. History of present illness: This section should included pertinent chronological events leading up to the hospi- talization. It should include events during hospitaliza- tion and eventual admission to the ICU. Prior cardiac history: Angina (stable, unstable, changes in frequency), exacerbating factors (exertional, rest angina). History of myocardial infarction, heart failure, coronary artery bypass graft surgery, angioplasty. Previous exercise treadmill testing, ECHO, ejection fraction. Request old ECG, ECHO, impedance cardiog- raphy, stress test results, and angiographic studies. Chest pain characteristics: A.Pain: Quality of pain, pressure, squeezing, tightness B.Onset of pain: Exertional, awakening from sleep, relationship to activities of daily living (ADLs), such as eating, walking, bathing, and grooming. C.Severity and quality: Pressure, tightness, sharp, pleuritic D.Radiation: Arm, jaw, shoulder E.Associated symptoms: Diaphoresis, dyspnea, back pain, GI symptoms. F.Duration: Minutes, hours, days. G.Relieving factors: Nitroclycerine, rest. Cardiac risk factors: Age, male, diabetes, hypercholesteremia, low HDL, hypertension, smoking, previous coronary artery disease, family history of arteriosclerosis (eg,myocardial infarction in males less than 50 years old, stroke). Congestive heart failure symptoms: Orthopnea (num- ber of pillows), paroxysmal nocturnal dyspnea, dyspnea on exertional, edema. Peripheral vascular disease symptoms : Claudication, transient ischemic attack, cerebral vascular accident.
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