Reviewer: S. Randhawa, M.D.Cardiology
Admission Note for SOB, CHF
Updated: 09/04/2009
Recommended Books
Recommended Books
Showing posts with label Cardiology. Show all posts
Showing posts with label Cardiology. Show all posts
Admission Notes: Cardiology
Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.
Cardiology
Admission Note for SOB, CHF
Reviewer: S. Randhawa, M.D.Cardiology
Admission Note for SOB, CHF
Admission Note for Syncope
DATE: ......
CHIEF COMPLAINT: Syncope x .... minutes or days
HISTORY OF PRESENT ILLNESS:
Onset -
Character -
Position - sitting , supine , standing (circle one)
It lasted ... min
Loss of consciousness -
Seizure activity -
Witnessed -
Confused after the event -
Incontinent of urine/bowel -
Injury -
Sx before the episode:
Lightheadedness -
Racing heart -
Chest pain -
Vision problems -
Nausea/Vomiting/Diarrhea -
Headache -
Abdominal pain -
Black/bloody stools -
Fever/chills -
SOB -
Similar symptoms before -
ER Tx given -
Advanced directives:
Reliability of the informant:
PAST MEDICAL HISTORY: (circle all that apply)
MI CAD CABG HTN CHF EF DM Hyperchol. Dilated CMP Pacemaker
Stroke Arrhythmias
Stress test -
2D-Echo -
Catheterization -
When - Where -
CA PUD PVD DVT COPD Asthma Gallstones EGD Colonoscopy
PAST SURGICAL HISTORY: (circle all that apply)
CABG Valve surgery
Cholecystectomy Hernia GSW Hysterectomy C-section
MEDICATIONS:
ALLERGY: NKDA
FMH:
CAD DM Stroke HTN CA
SOCIAL HISTORY: (circle all that apply)
Independent NH Lives w spouse son daughter
Alcohol - no heavy occasional last drink
Smoker: no
Illicit drugs - no cocaine heroin marijuana
REVIEW OF SYSTEMS: unremarkable apart from above symptoms
PHYSICAL EXAM:
VITALS:
Ortostatics -
SpO2 - Initial vitals -
GENERAL APPEARANCE:
WD/WN in NAD
SKIN: no rash
HEENT: NC/AT, PERRLA (B), moist MM, no epistaxis
NECK: Supple, no JVD +JVD
LUNGS: CTA (B) crackles L R B wheezing
HEART: Clear S1S2, RRR irregular murmur S D /6 S3
ABDOMEN: Soft, NT, ND, +BS
EXTREMITIES: no edema +edema
PERIPHERAL VASCULAR: palpable nonpalpable Doppler
NEURO:
AAO x 3, CN 2-12: non focal
MUSCLE STRENGHT: 5/5 (B), SENSATION: nonfocal
DTR: ++, CEREBELLAR: non focal
LABS:
N= L= B= INR- AG= LFT
Cardiac enzymes x 1-negative Mg++ TSH
BNpep - UA: Lipids: LDL HDL
Old CXR:
CXR:
Old EKG:
EKG on admission:
EKG later:
Telemetry monitor:
A R A R E P Q R S T
D R I I E E
CT head:
ASSESSMENT:
- Syncope due to
*vasovagal episode
*TIA
*Arrhythmia
*Seizure
PLAN:
- Telemetry
- Cardiac enzymes x 2 q 8hr
- EKG now and in AM
- 2D Echo
- Carotid duplex
- UA
- Home meds (check the list)
- Heparin 5000 U SQ BID or Lovenox 40 mg SQ daily
- Cardiology consult as an outpatient or inpatient
- Neurology consult as an outpatient or inpatient
Signature:
Published: 02/11/2005
Updated: 03/08/2009
CHIEF COMPLAINT: Syncope x .... minutes or days
HISTORY OF PRESENT ILLNESS:
Onset -
Character -
Position - sitting , supine , standing (circle one)
It lasted ... min
Loss of consciousness -
Seizure activity -
Witnessed -
Confused after the event -
Incontinent of urine/bowel -
Injury -
Sx before the episode:
Lightheadedness -
Racing heart -
Chest pain -
Vision problems -
Nausea/Vomiting/Diarrhea -
Headache -
Abdominal pain -
Black/bloody stools -
Fever/chills -
SOB -
Similar symptoms before -
ER Tx given -
Advanced directives:
Reliability of the informant:
PAST MEDICAL HISTORY: (circle all that apply)
MI CAD CABG HTN CHF EF DM Hyperchol. Dilated CMP Pacemaker
Stroke Arrhythmias
Stress test -
2D-Echo -
Catheterization -
When - Where -
CA PUD PVD DVT COPD Asthma Gallstones EGD Colonoscopy
PAST SURGICAL HISTORY: (circle all that apply)
CABG Valve surgery
Cholecystectomy Hernia GSW Hysterectomy C-section
MEDICATIONS:
ALLERGY: NKDA
FMH:
CAD DM Stroke HTN CA
SOCIAL HISTORY: (circle all that apply)
Independent NH Lives w spouse son daughter
Alcohol - no heavy occasional last drink
Smoker: no
Illicit drugs - no cocaine heroin marijuana
REVIEW OF SYSTEMS: unremarkable apart from above symptoms
PHYSICAL EXAM:
VITALS:
Ortostatics -
SpO2 - Initial vitals -
GENERAL APPEARANCE:
WD/WN in NAD
SKIN: no rash
HEENT: NC/AT, PERRLA (B), moist MM, no epistaxis
NECK: Supple, no JVD +JVD
LUNGS: CTA (B) crackles L R B wheezing
HEART: Clear S1S2, RRR irregular murmur S D /6 S3
ABDOMEN: Soft, NT, ND, +BS
EXTREMITIES: no edema +edema
PERIPHERAL VASCULAR: palpable nonpalpable Doppler
NEURO:
AAO x 3, CN 2-12: non focal
MUSCLE STRENGHT: 5/5 (B), SENSATION: nonfocal
DTR: ++, CEREBELLAR: non focal
LABS:
N= L= B= INR- AG= LFT
Cardiac enzymes x 1-negative Mg++ TSH
BNpep - UA: Lipids: LDL HDL
Old CXR:
CXR:
Old EKG:
EKG on admission:
EKG later:
Telemetry monitor:
A R A R E P Q R S T
D R I I E E
CT head:
ASSESSMENT:
- Syncope due to
*vasovagal episode
*TIA
*Arrhythmia
*Seizure
PLAN:
- Telemetry
- Cardiac enzymes x 2 q 8hr
- EKG now and in AM
- 2D Echo
- Carotid duplex
- UA
- Home meds (check the list)
- Heparin 5000 U SQ BID or Lovenox 40 mg SQ daily
- Cardiology consult as an outpatient or inpatient
- Neurology consult as an outpatient or inpatient
Signature:
Published: 02/11/2005
Updated: 03/08/2009
Admission Note for SOB, CHF
DATE: ...............
CHIEF COMPLAINT: SOB x ..... days
HISTORY OF PRESENT ILLNESS:
Onset -
Character -
Alleviating factors -
Time course -
Exacerbating factors -
Severity -
Nausea - , Vomiting - , SOB - , Sweating - , CP -
Similar SOB before -
PND - , Orthopnea - , DOE -,
Heart racing -
Fever/chills - , Cough - , Ankle swelling -
Claudication - , Headache - , Blackouts -
Blurred vision - , Sore throat - , Nasal discharge -
Lightheaded - , Dizzy -
Leg/calf pain - , Recent travel -
Abdominal pain - , Black/bloody stool -
Dysuria -
Noncompliance with meds - , diet - , fluids -
ER Tx given -
Urine output in ER -
PAST MEDICAL HISTORY:
MI CAD CABG HTN CHF EF DM Hyperchol. Dilated CMP Pacemaker
Stroke Arrhythmias
Stress test -
2D-Echo -
Catheterization -
When - Where -
CA PUD PVD DVT COPD Asthma Gallstones EGD Colonoscopy
PAST SURGICAL HISTORY:
CABG Valve surgery
Cholecystectomy Hernia GSW Hysterectomy C-section
MEDICATIONS:
ALLERGY: NKDA
FMH:
CAD DM Stroke HTN CA
SOCIAL HISTORY:
Independent NH Lives w spouse son daughter
Alcohol- no heavy occasional last drink
Smoker: no
Illicit drugs - no cocaine heroin marijuana
REVIEW OF SYSTEMS: unremarkable apart from the above symptoms
PHYSICAL EXAM:
VITALS:
SpO2- Initial vitals-
GENERAL APPEARANCE: WD/WN in NAD
SKIN: no rash
HEENT: NC/AT, PERRLA (B), moist MM, no epistaxis
NECK: Supple, no JVD +JVD
LUNGS: CTA (B) crackles L R B wheezing
HEART: Clear S1S2, RRR irregular murmur S D /6 S3
ABDOMEN: Soft, NT, ND, +BS
EXTREMITIES: no edema +edema
PERIPHERAL VASCULAR: palpable nonpalpable Doppler
NEURO:
AAO x 3, CN 2-12: non focal
MUSCLE STRENGHT: 5/5 (B), SENSATION: nonfocal
DTR: ++, CEREBELLAR: non focal
LABS:
N= , L= , B= , INR- , AG= , LFT
Cardiac enzymes x 1 - , Mg++ , TSH
BNpep - , UA: , Lipids: LDL HDL
Old CXR:
CXR:
Old EKG:
EKG on admission:
A R A R E P Q R S T
D R I I E E
ASSESSMENT:
- SOB due to
*CHF exacerbation due to
uncontrolled HTN
R/O ischemia
Noncompliance
URTI
*Bronchitis
*R/O cardiac ischemia
*Pneumonia
PLAN:
- CPP x 1 more, 8 hr after the 1st one
- EKG in AM
- ASA
- O2 to keep SpO2 > 92%
- Lasix 40 mg IV BID
- Aerosols UD q 4 hr
- UA
- Urine toxic screen
- 2D Echo
- CBCD, BMP in AM
- Fasting lipids
- Tylenol 650 mg PO q 4-6 hr PRN pain
- Home meds
- Heparin 5000 U SQ BID
Signature:
Published: 02/11/2005
Updated: 03/08/2008
CHIEF COMPLAINT: SOB x ..... days
HISTORY OF PRESENT ILLNESS:
Onset -
Character -
Alleviating factors -
Time course -
Exacerbating factors -
Severity -
Nausea - , Vomiting - , SOB - , Sweating - , CP -
Similar SOB before -
PND - , Orthopnea - , DOE -,
Heart racing -
Fever/chills - , Cough - , Ankle swelling -
Claudication - , Headache - , Blackouts -
Blurred vision - , Sore throat - , Nasal discharge -
Lightheaded - , Dizzy -
Leg/calf pain - , Recent travel -
Abdominal pain - , Black/bloody stool -
Dysuria -
Noncompliance with meds - , diet - , fluids -
ER Tx given -
Urine output in ER -
PAST MEDICAL HISTORY:
MI CAD CABG HTN CHF EF DM Hyperchol. Dilated CMP Pacemaker
Stroke Arrhythmias
Stress test -
2D-Echo -
Catheterization -
When - Where -
CA PUD PVD DVT COPD Asthma Gallstones EGD Colonoscopy
PAST SURGICAL HISTORY:
CABG Valve surgery
Cholecystectomy Hernia GSW Hysterectomy C-section
MEDICATIONS:
ALLERGY: NKDA
FMH:
CAD DM Stroke HTN CA
SOCIAL HISTORY:
Independent NH Lives w spouse son daughter
Alcohol- no heavy occasional last drink
Smoker: no
Illicit drugs - no cocaine heroin marijuana
REVIEW OF SYSTEMS: unremarkable apart from the above symptoms
PHYSICAL EXAM:
VITALS:
SpO2- Initial vitals-
GENERAL APPEARANCE: WD/WN in NAD
SKIN: no rash
HEENT: NC/AT, PERRLA (B), moist MM, no epistaxis
NECK: Supple, no JVD +JVD
LUNGS: CTA (B) crackles L R B wheezing
HEART: Clear S1S2, RRR irregular murmur S D /6 S3
ABDOMEN: Soft, NT, ND, +BS
EXTREMITIES: no edema +edema
PERIPHERAL VASCULAR: palpable nonpalpable Doppler
NEURO:
AAO x 3, CN 2-12: non focal
MUSCLE STRENGHT: 5/5 (B), SENSATION: nonfocal
DTR: ++, CEREBELLAR: non focal
LABS:
N= , L= , B= , INR- , AG= , LFT
Cardiac enzymes x 1 - , Mg++ , TSH
BNpep - , UA: , Lipids: LDL HDL
Old CXR:
CXR:
Old EKG:
EKG on admission:
A R A R E P Q R S T
D R I I E E
ASSESSMENT:
- SOB due to
*CHF exacerbation due to
uncontrolled HTN
R/O ischemia
Noncompliance
URTI
*Bronchitis
*R/O cardiac ischemia
*Pneumonia
PLAN:
- CPP x 1 more, 8 hr after the 1st one
- EKG in AM
- ASA
- O2 to keep SpO2 > 92%
- Lasix 40 mg IV BID
- Aerosols UD q 4 hr
- UA
- Urine toxic screen
- 2D Echo
- CBCD, BMP in AM
- Fasting lipids
- Tylenol 650 mg PO q 4-6 hr PRN pain
- Home meds
- Heparin 5000 U SQ BID
Signature:
Published: 02/11/2005
Updated: 03/08/2008
Admission Note for Chest Pain (ICU Management)
DATE: ............
CHIEF COMPLAINT: Chest pain x ............ minutes/hours/days
HISTORY OF PRESENT ILLNESS:
Site -
Onset -
Character -
Radiation -
Alleviating factors -
Time course -
Exacerbating factors -
Severity -
Nausea - , Vomiting - , SOB - , Sweating -
Similar chest pain (CP) before -
ER Tx given -
PND - , DOE - , Palpitations -
Fever/chills - , Cough - , Ankle swelling -
Claudication - , Headache - , Blackouts -
Recent travel -
Blurred vision - , Sore throat -
Abdominal pain - , Black/bloody stool -
Dysuria -
PAST MEDICAL HISTORY: (circle all that apply)
MI CAD CABG HTN CHF EF DM Hyperchol. Dilated CMP
Pacemaker
Stress test -
2D-Echo -
Catheterization -
When - Where -
Stroke CA PUD PVD DVT COPD Asthma Gallstones EGD (circle all that apply)
Colonoscopy
PAST SURGICAL HISTORY: (circle all that apply)
CABG Valve surgery
Cholecystectomy Hernia GSW Hysterectomy C-section
MEDICATIONS:
ALLERGY: NKDA
FMH: (circle all that apply)
CAD DM Stroke HTN CA
SOCIAL HISTORY: (circle all that apply)
Independent NH Lives w spouse son daughter
Alcohol - none heavy occasional last drink
Smoker - no
Illicit drugs - none cocaine heroin marijuana
REVIEW OF SYSTEMS: unremarkable apart from above symptoms
PHYSICAL EXAMINATION:
VITALS: Orthostatics-
SpO2 - Initial vitals -
GENERAL APPEARANCE: WD/WN in NAD
SKIN: no rash
HEENT: NC/AT, PERRLA (B), moist MM, no epistaxis
NECK: Supple, no JVD +JVD
LUNGS: CTA (B) crackles L R B wheezing
HEART: Clear S1S2, RRR irregular murmur S D /6 S3
ABDOMEN: Soft, NT, ND, +BS
Rectal exam:
EXTREMITIES: no edema +edema
PERIPHERAL VASCULAR: palpable nonpalpable Doppler
NEURO:
AAO x 3, CN 2-12: non focal
MUSCLE STRENGHT: 5/5 (B), SENSATION: nonfocal
DTR: ++, CEREBELLAR: non focal
LABS:
N= L= B= AG= LFT
Cardiac enzymes x 1 -
BNpep -
UA: Urine toxic screen -
CXR:
EKG:
A R A R E P Q R S T
D R I I E E
ASSESSMENT:
- CP due to
*CAD
*Muskuloskeletal CP - myofascial strain, costochondritis
*GERD
*Esophageal spasm
*Cocaine induced
*Pericarditis - unlikely
*Pneumonia - no infiltrate on CXR
CAD Risk factors: HTN Obesity PVD LDL FMH DM HDL Smoking Age (circle all that apply)
PLAN:
- Cardiac enzymes x 2 q 8 hr
- EKG now and in AM
- O2 to keep SpO2 higher than 92%
- ASA 325 mg PO QD
- Metoprolol 12.5 mg PO BID, hold for HR lower than 60 and SBP lower than 110
- Nitro IV drip start @ 6 mcg/min and titrate to chest pain, hold for SBP lower than 110
OR
- Nitro patch 0.4 mg TD daily
- Lovenox 1 mg/kg SQ Q 12 hr
OR
- Heparin 5000 U SQ BID
- Colace, Pepcid
- UA
- Urine toxic screen
- CBCD, BMP in AM
- Fasting lipids
- Morphine sulphate 2 mg IV q 2-4 hr PRN chest pain
- Tylenol 650 mg PO q 4-6 hr PRN headache
- Home meds (review and restart the appropriate meds)
- 2D Echo
- Cardiology consult
Signature:
CHIEF COMPLAINT: Chest pain x ............ minutes/hours/days
HISTORY OF PRESENT ILLNESS:
Site -
Onset -
Character -
Radiation -
Alleviating factors -
Time course -
Exacerbating factors -
Severity -
Nausea - , Vomiting - , SOB - , Sweating -
Similar chest pain (CP) before -
ER Tx given -
PND - , DOE - , Palpitations -
Fever/chills - , Cough - , Ankle swelling -
Claudication - , Headache - , Blackouts -
Recent travel -
Blurred vision - , Sore throat -
Abdominal pain - , Black/bloody stool -
Dysuria -
PAST MEDICAL HISTORY: (circle all that apply)
MI CAD CABG HTN CHF EF DM Hyperchol. Dilated CMP
Pacemaker
Stress test -
2D-Echo -
Catheterization -
When - Where -
Stroke CA PUD PVD DVT COPD Asthma Gallstones EGD (circle all that apply)
Colonoscopy
PAST SURGICAL HISTORY: (circle all that apply)
CABG Valve surgery
Cholecystectomy Hernia GSW Hysterectomy C-section
MEDICATIONS:
ALLERGY: NKDA
FMH: (circle all that apply)
CAD DM Stroke HTN CA
SOCIAL HISTORY: (circle all that apply)
Independent NH Lives w spouse son daughter
Alcohol - none heavy occasional last drink
Smoker - no
Illicit drugs - none cocaine heroin marijuana
REVIEW OF SYSTEMS: unremarkable apart from above symptoms
PHYSICAL EXAMINATION:
VITALS: Orthostatics-
SpO2 - Initial vitals -
GENERAL APPEARANCE: WD/WN in NAD
SKIN: no rash
HEENT: NC/AT, PERRLA (B), moist MM, no epistaxis
NECK: Supple, no JVD +JVD
LUNGS: CTA (B) crackles L R B wheezing
HEART: Clear S1S2, RRR irregular murmur S D /6 S3
ABDOMEN: Soft, NT, ND, +BS
Rectal exam:
EXTREMITIES: no edema +edema
PERIPHERAL VASCULAR: palpable nonpalpable Doppler
NEURO:
AAO x 3, CN 2-12: non focal
MUSCLE STRENGHT: 5/5 (B), SENSATION: nonfocal
DTR: ++, CEREBELLAR: non focal
LABS:
N= L= B= AG= LFT
Cardiac enzymes x 1 -
BNpep -
UA: Urine toxic screen -
CXR:
EKG:
A R A R E P Q R S T
D R I I E E
ASSESSMENT:
- CP due to
*CAD
*Muskuloskeletal CP - myofascial strain, costochondritis
*GERD
*Esophageal spasm
*Cocaine induced
*Pericarditis - unlikely
*Pneumonia - no infiltrate on CXR
CAD Risk factors: HTN Obesity PVD LDL FMH DM HDL Smoking Age (circle all that apply)
PLAN:
- Cardiac enzymes x 2 q 8 hr
- EKG now and in AM
- O2 to keep SpO2 higher than 92%
- ASA 325 mg PO QD
- Metoprolol 12.5 mg PO BID, hold for HR lower than 60 and SBP lower than 110
- Nitro IV drip start @ 6 mcg/min and titrate to chest pain, hold for SBP lower than 110
OR
- Nitro patch 0.4 mg TD daily
- Lovenox 1 mg/kg SQ Q 12 hr
OR
- Heparin 5000 U SQ BID
- Colace, Pepcid
- UA
- Urine toxic screen
- CBCD, BMP in AM
- Fasting lipids
- Morphine sulphate 2 mg IV q 2-4 hr PRN chest pain
- Tylenol 650 mg PO q 4-6 hr PRN headache
- Home meds (review and restart the appropriate meds)
- 2D Echo
- Cardiology consult
Signature:
Published: 02/11//2005
Updated: 04/01/2010
Admission Note for Chest Pain (CP)
DATE: ......
CHIEF COMPLAINT: Chest pain x .... minutes/hours/days
HISTORY OF PRESENT ILLNESS:
Site -
Onset -
Character -
Radiation -
Alleviating factors -
Time course -
Exacerbating factors -
Severity -
Nausea -, Vomiting -, SOB -, Sweating -
Similar CP before -
ER Tx given -
PND -, DOE -, Palpitations -
Fever/chills - , Cough - , Ankle swelling -
Claudication - , Headache - , Blackouts -
Recent tavel -
Blurred vision -, Sore throat -
Abdominal pain - , Black/bloody stool -
Dysuria -
PAST MEDICAL HISTORY: (circle all that apply)
MI CAD CABG HTN CHF EF DM Hyperchol. Dilated CMP
Stress test -
2D-Echo -
Catheterization -
When - Where -
Stroke CA PUD PVD DVT COPD Asthma Gallstones EGD
Colonoscopy
PAST SURGICAL HISTORY: (circle all that apply)
CABG Valve surgery
Cholecystectomy Hernia GSW Hysterectomy C-section
MEDICATIONS:
ALLERGY: NKDA
FMH: (circle all that apply)
CAD DM Stroke HTN CA
SOCIAL HISTORY: (circle all that apply)
Independent NH Lives w spouse son daughter
Alcohol - none heavy occasional last drink
Smoker - no
Illicit drugs - none cocaine heroin marijuana
Sedentary -
REVIEW OF SYSTEMS: unremarkable apart from above symptoms
PHYSICAL EXAM:
VITALS: Orthostatics -
SpO2 - Initial vitals -
GENERAL APPEARANCE: WD/WN in NAD
SKIN: no rash
HEENT: NC/AT, PERRLA (B), moist MM, no epistaxis
NECK: Supple, no JVD +JVD
LUNGS: CTA (B) crackles L R B wheezing
HEART: Clear S1S2, RRR irregular murmur S D /6 S3
ABDOMEN: Soft, NT, ND, +BS
Rectal exam:
EXTREMITIES: no edema +edema
PERIPHERAL VASCULAR: palpable nonpalpable Doppler
NEURO:
AAO x 3, CN 2-12: non focal
MUSCLE STRENGHT: 5/5 (B), SENSATION: nonfocal
DTR: ++, CEREBELLAR: non focal
LABS:
N= L= B= AG= LFT
Cardiac enzymes x 1-
BNpep -
CXR:
EKG:
A R A R E P Q R S T
D R I I E E
ASSESSMENT:
- Chest pain due to
*CAD
*Muskuloskeletal CP - myofascial strain, costochondritis
*GERD
*Esophageal spasm
*Cocaine induced
*Pericarditis - unlikely
*Pneumonia - no infiltrate on CXR
CAD Risk (circle all that apply): HTN Obesity PVD LDL FMH DM HDL Smoking Age Sedentary
PLAN:
- cardiac enzymes x 2 q 8 hr
- EKG now and in AM
- ASA
- Metoprolol 12.5 mg PO BID, hold for HR lower than 55 bpm
- O2 by NC to keep SpO2 greater than 92%
- UA
- Urine toxic screen
- CBCD, BMP in AM
- Fasting lipids
- Morphine 2 mg IV q 2-4 hr PRN chest pain
- Tylenol 650 mg PO q 4-6 hr PRN headache
- Home meds (check list)
- Heparin 5000 U SQ BID
- 2D Echo
- Cardiology consult
Signature:
Published: 02/11/2005
Updated: 03/08/2009
CHIEF COMPLAINT: Chest pain x .... minutes/hours/days
HISTORY OF PRESENT ILLNESS:
Site -
Onset -
Character -
Radiation -
Alleviating factors -
Time course -
Exacerbating factors -
Severity -
Nausea -, Vomiting -, SOB -, Sweating -
Similar CP before -
ER Tx given -
PND -, DOE -, Palpitations -
Fever/chills - , Cough - , Ankle swelling -
Claudication - , Headache - , Blackouts -
Recent tavel -
Blurred vision -, Sore throat -
Abdominal pain - , Black/bloody stool -
Dysuria -
PAST MEDICAL HISTORY: (circle all that apply)
MI CAD CABG HTN CHF EF DM Hyperchol. Dilated CMP
Stress test -
2D-Echo -
Catheterization -
When - Where -
Stroke CA PUD PVD DVT COPD Asthma Gallstones EGD
Colonoscopy
PAST SURGICAL HISTORY: (circle all that apply)
CABG Valve surgery
Cholecystectomy Hernia GSW Hysterectomy C-section
MEDICATIONS:
ALLERGY: NKDA
FMH: (circle all that apply)
CAD DM Stroke HTN CA
SOCIAL HISTORY: (circle all that apply)
Independent NH Lives w spouse son daughter
Alcohol - none heavy occasional last drink
Smoker - no
Illicit drugs - none cocaine heroin marijuana
Sedentary -
REVIEW OF SYSTEMS: unremarkable apart from above symptoms
PHYSICAL EXAM:
VITALS: Orthostatics -
SpO2 - Initial vitals -
GENERAL APPEARANCE: WD/WN in NAD
SKIN: no rash
HEENT: NC/AT, PERRLA (B), moist MM, no epistaxis
NECK: Supple, no JVD +JVD
LUNGS: CTA (B) crackles L R B wheezing
HEART: Clear S1S2, RRR irregular murmur S D /6 S3
ABDOMEN: Soft, NT, ND, +BS
Rectal exam:
EXTREMITIES: no edema +edema
PERIPHERAL VASCULAR: palpable nonpalpable Doppler
NEURO:
AAO x 3, CN 2-12: non focal
MUSCLE STRENGHT: 5/5 (B), SENSATION: nonfocal
DTR: ++, CEREBELLAR: non focal
LABS:
N= L= B= AG= LFT
Cardiac enzymes x 1-
BNpep -
CXR:
EKG:
A R A R E P Q R S T
D R I I E E
ASSESSMENT:
- Chest pain due to
*CAD
*Muskuloskeletal CP - myofascial strain, costochondritis
*GERD
*Esophageal spasm
*Cocaine induced
*Pericarditis - unlikely
*Pneumonia - no infiltrate on CXR
CAD Risk (circle all that apply): HTN Obesity PVD LDL FMH DM HDL Smoking Age Sedentary
PLAN:
- cardiac enzymes x 2 q 8 hr
- EKG now and in AM
- ASA
- Metoprolol 12.5 mg PO BID, hold for HR lower than 55 bpm
- O2 by NC to keep SpO2 greater than 92%
- UA
- Urine toxic screen
- CBCD, BMP in AM
- Fasting lipids
- Morphine 2 mg IV q 2-4 hr PRN chest pain
- Tylenol 650 mg PO q 4-6 hr PRN headache
- Home meds (check list)
- Heparin 5000 U SQ BID
- 2D Echo
- Cardiology consult
Signature:
Published: 02/11/2005
Updated: 03/08/2009
A Systematic Approach to Electrocardiogram (EKG) Interpretation by Using 2 Mnemonics
Author: V. Dimov, M.D., Published in the Proceedings of the 3rd Annual Cleveland Clinic Perioperative Medicine Summit, CCJM.
This is a 2-step approach remembered by 2 mnemonics:
Step 1: Evaluate all elements of the EKG systematically: A RARE PQRST.
Step 2: Differential diagnosis. Look for diseases that may have caused the abnormalities noted in step 1: DR III EEE !
This systematic approach to reading electrocardiograms (ECGs or EKGs) works every time, just like a machine. By using it, you will not miss any major abnormalities in electrocardiograms (EKGs).
What is the meaning of the mnemonics?
A RARE PQRST:
Age, e.g. a 60-yo patient is likely have a different pathology from a 30-yo patient
Rate, e.g. fast or slow?
Axis, e.g. left or right?
Rhythm, e.g. regular or irregular?
Evaluate each EKG element as follows:
P wave, e.g. peaked or absent? PR interval - short or prolonged?
Q wave, e.g. deep Q wave? QT inerval - - short or prolonged?
R wave, e.g. tall? look at QRS complex width for RBBB or LBBB
ST segment, e.g. elevation or depression?
T wave, e.g. peaked or inverted? U wave?
DR III EEE:
Drugs , e.g. Digoxin, tricyclic antidepressants
Rhythm and rate abnormalities, e.g. AV block of 1,2,3 degree, AFib, SVT? Interval prolongation?
Ischemia?
Infarct? Deep Q wave?
Infection, e.g. pericarditis
Enlargement, e.g. LVH, RVH, left or right atrium enlargement?
Electrolyte disturbances, e.g. hyperkalemia, hypokalemia, hypercalcemia,
Endocrine causes, e.g. hypothyroidism
How to use this approach in practice?
Look at the EKG and write down on a piece of paper:
A R A R E P Q R S T
D R I I I E E E
Circle the abnormalities you discover in step 1 -- A RARE PQRST. Then, connect and try to explain these abnormalities by looking at the list of possible etiologies presented in step 2 -- DR III EEE. That's it!
An example:
A systematic approach to the EKG of a patient with AFib (click to enlarge).
References
Proceedings of the 3rd Annual Perioperative Medicine Summit, Cleveland Clinic, September 10-12, 2007, CCJM.
Imaging: Electrocardiograms, X-rays, CT scans
ECG Wave-Maven by the Harvard Medical School and Beth Israel Deaconess Medical Center.
The lost art of electrocardiography - DoctorRW.blogspot.
Reading an EKG - UAB.edu.
ECG scribbles. An Approach. Anaesthetist.com.
APDIM E-Learning Task Force: Cardiac Auscultation, Chest X-Rays, Electrocardiograms, Patient Images (Dermatology), Pulmonary Function Tests, 2009.
Can't-Miss ECG Findings, Life-Threatening Conditions: Slideshow. Medscape, 2009.
Audio
Audio lecture: Basics of EKG. Dr. Dwight Dishmon. Podcasting Project for the UT Internal Medicine Residency Program, 2006.
Video
ECG Video part 1: For Med Students studying the basics of reading an electrocardiogram, from the University of Wisconsin.
ECG Video part 2.
Created: 05/15/2003
Updated: 07/05/2009
This is a 2-step approach remembered by 2 mnemonics:
Step 1: Evaluate all elements of the EKG systematically: A RARE PQRST.
Step 2: Differential diagnosis. Look for diseases that may have caused the abnormalities noted in step 1: DR III EEE !
This systematic approach to reading electrocardiograms (ECGs or EKGs) works every time, just like a machine. By using it, you will not miss any major abnormalities in electrocardiograms (EKGs).
What is the meaning of the mnemonics?
A RARE PQRST:
Age, e.g. a 60-yo patient is likely have a different pathology from a 30-yo patient
Rate, e.g. fast or slow?
Axis, e.g. left or right?
Rhythm, e.g. regular or irregular?
Evaluate each EKG element as follows:
P wave, e.g. peaked or absent? PR interval - short or prolonged?
Q wave, e.g. deep Q wave? QT inerval - - short or prolonged?
R wave, e.g. tall? look at QRS complex width for RBBB or LBBB
ST segment, e.g. elevation or depression?
T wave, e.g. peaked or inverted? U wave?
DR III EEE:
Drugs , e.g. Digoxin, tricyclic antidepressants
Rhythm and rate abnormalities, e.g. AV block of 1,2,3 degree, AFib, SVT? Interval prolongation?
Ischemia?
Infarct? Deep Q wave?
Infection, e.g. pericarditis
Enlargement, e.g. LVH, RVH, left or right atrium enlargement?
Electrolyte disturbances, e.g. hyperkalemia, hypokalemia, hypercalcemia,
Endocrine causes, e.g. hypothyroidism
How to use this approach in practice?
Look at the EKG and write down on a piece of paper:
A R A R E P Q R S T
D R I I I E E E
Circle the abnormalities you discover in step 1 -- A RARE PQRST. Then, connect and try to explain these abnormalities by looking at the list of possible etiologies presented in step 2 -- DR III EEE. That's it!
An example:
A systematic approach to the EKG of a patient with AFib (click to enlarge).
References
Proceedings of the 3rd Annual Perioperative Medicine Summit, Cleveland Clinic, September 10-12, 2007, CCJM.
Imaging: Electrocardiograms, X-rays, CT scans
ECG Wave-Maven by the Harvard Medical School and Beth Israel Deaconess Medical Center.
The lost art of electrocardiography - DoctorRW.blogspot.
Reading an EKG - UAB.edu.
ECG scribbles. An Approach. Anaesthetist.com.
APDIM E-Learning Task Force: Cardiac Auscultation, Chest X-Rays, Electrocardiograms, Patient Images (Dermatology), Pulmonary Function Tests, 2009.
Can't-Miss ECG Findings, Life-Threatening Conditions: Slideshow. Medscape, 2009.
Audio
Audio lecture: Basics of EKG. Dr. Dwight Dishmon. Podcasting Project for the UT Internal Medicine Residency Program, 2006.
Video
ECG Video part 1: For Med Students studying the basics of reading an electrocardiogram, from the University of Wisconsin.
ECG Video part 2.
Created: 05/15/2003
Updated: 07/05/2009
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