Family Medicine
⛲ Generalities of Family Medicine 🔒
- 🥚 BASICS
- ❌ ERRORS in family medicine
- 📦 PACKAGES of the HEALTH CARE SERVICES
- 👈🏼 REMOVAL from PRACTICE
- 🏡 HOMEVISITS
🔍 Symptom-based Workup
- 🌬️ Chronic Cough
- 🧰 Chest pain
- 💨 Dyspnea
![[Crab icons & Süßigkeiten Icons & Baby Icons, by Freepik - Flaticon]](https://images.spr.so/cdn-cgi/imagedelivery/j42No7y-dcokJuNgXeA0ig/4befdb6a-3bc6-4200-ae71-d4292d82141b/SCR-20221102-q5l/w=1920,quality=90,fit=scale-down)
“vomit island 🌈🏝️🤮“
- 🚧 obstructive (GOO, ileus, volvolus, strangulated hernia, pyloric stenosis, tumor, achalasia)
- 🏗️ non-obstructive “functional”
- 🔥 inflammatory (appendicitis, pancreatitis, cholecystitis, gastritis, hepatitis, peritonitis)
- 🦠infectious
(GERD, IBS, Peptic ulcer)
(Gastroenteritis ⇒ viral, bacterial + toxins, food poisoning)
- ↑ ICP
- 🎾 mass (i.e. tumor)
- ❌stroke:
- ischemic
- hemorrhagic (trauma)
- 🦠infection (menigitis, encephalitis)
- 👂🏼Vestibular pathology
- Meniers
- infectious (vestib. neuritis, labyrhntitis)
- tumor (schwannoma)
- ⚡Migraine
- Psych
• Anorexia nervosa • Anxiety • Depression • Bulimia nervosa
- 🦀 Radio + chemo
- 🌸 Digoxin + (other anti-arrhythmics)
- 🌈 Opioids
- 🍺 Ethanol
- 🧪 Toxins: Arsenic, organophosphates/pesticides, ricin
- NSAIDs, AB, Anticonvulsants
- Inferior MI
- endocrine:
- 🤰pregnancy
- 🦋thyroid + parathyroid
- 📐 adrenals
- metabolic:
- 🍬 DKA
- 🥐 Uremia
- 🍤 → 🚧 + 🔥 (obstruction // pancreatitis, peritonitis)
- 🧠 → ❌ + 🦠 (stroke // menigitis, encephalitis)
- 💊 → Toxins + Drugs
- ❤️ → MI
- 🍬 + 📐 (DKA // Adrenal crisis)
- Check + correct Complications (dehydration, Acid-Base, electroly)
- Etiologly: Search + Tx
- Empiric Tx (anti-emetics)→ if Ø Etiology found
ILEUS
- 💥pain + 🎈distension
- preceeds 🤮vomiting!
Pain:
- 🩺↓ or ↑ bowel sounds
- if tumor → weight loss
GASTROPARESIS + GOA
🎈 bloating + 💦succussion splash, ⏰🤮late vomiting + early satiety
- GERD signs: retrosternal pain, reflux,..
- ulcer → gnawing pain, related to eating (depending if duodenal or gastric)
- epigastric pain/tenderness → pancreatitis or ulcer
- pancreatitis → radiates back
- right upper + aprupt onset → cholecystitis
- jaundice → hepatitis
- fever
- diarrhea
- +/- bloody (bacterial)
- myalgias, malaise, headache → viral
⇒ ❗ DEHYDRATION + AB + ELECTROLYTES
FND + cranial nerve signs
headche, stiffneck (menigitis)
vertigo (vestibular)
cyclic
calluses on dorsal finger 📷 → self infuced vomiting (bullemia)
signs of depression + anxiety
- squeezing chest pain / pressure
- dyspnea
- autonomic signs..
- etc…
- heat intolerance
- ↑metabolic function (HR, BP, peristalsis, etc)
- graves → myxedema + exopthalmos
- goiter
- 🤒fever
- ❤️ → arrhythmia + hypotension → shock
- 🧠 altered mental status
- nausea/vomiting
- 🌊 fluid
- 🎺BB
- Symptomatic: Beta-Blocker → Propranolol, atenolol
- 🌝 steroids
- 🚫Thyroid-hormone synthesis blocker
- Methimazole → generally prefered because not hepatotoxic, but teratogenic (MethMatzle)
- PTU (propyl-thio-uracil) → in pregnancy, hepatotoxic but not teratogenic, and in Thyroidstorm because block periph. conversion T4→T3. 🔫
hypotension ⇒ shock
(precipitated by stress [i.e. infection, surgery])
if chronic insuff → weakness, anorexia, orthostasis, weight loss, fatigue
- fluids
- steroids: hydrocortison/dexamethasone
- signs of DM (3 P’s)
- coma
- acidosis
⇒ 🏥 !!
Insulin
Volume replacement
Correct Acid-base + electrolytes
DOTAA
- Duration
- Onset
- Timing related to..
- Appearance of vomit
- Assoc. symptoms + signs
(acute/chronic)
(aprupt, acute, insidious)
(before eating, directly after, hours after
(undigested food, partially digested, bile, feculent, large volume).
(see above)
- CBC
- Inflammatory
- Electrolytes + AB
- Enzymes: Liver, pancreas
- Pregnancy test !
- tox screen if suspected
- thyroid hormones, adrenal hormones, ketone-bodies, uric acid
- Xray → obstruction
- US → inflammation
- EGD → pyloric + ulcer
- +/- barium
- manometry
- MRI / CT
- echo + ekg
- Ondasetron (5-HT3 Antagonist)
- Metoclopramide + Haloperidol + Phenotiazine (D2-Antagonist)
- Scopolamine (Anti-cholinergic)
- Antihistamines
- Aprepritant (Neurokinin-1-Rezeptor-Antagonisten)
- PREVENTION: Scopolamin ⇒ Scopoderm patch 1,5 mg
- phenothiazine
- antihistamines
Prevention of travel sickness: Scopoderm patch (1.5 mg) ➡️ helps with nausea, vomiting, vertigo ➡️ apply 6 hours before journey or the evening before ➡️ provides up to 72-hour protection.
Aprepritant + Ondasetron + Dexamethasone!
OR
Metoclopramide + Dexamethasone
haloperidol, benzos
extrapyramidal signs
dystonia (continuous spasms and muscle contractions), akathisia (may manifest as motor restlessness), parkinsonism characteristic symptoms such as rigidity, bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements)
both: drowsiness
anticholinergic: dry mouth visual disturbance
prenatal vitamins → may ↓ severity of n+v
- ginger
- Ø iron supplement
- if persistant vomiting:
- PPI (Omeprazol/Rabeprazol) or
- H2-blocker (Ranitidine)
- Metoclopramide
- Ondasetron
- if morning sickness ⇒ DICLEGIS (=Doxylamine (antihistamine) + Vitamin B6 (pyridoxine)
- ⚖️ Unintentional weight loss
- 🍠 Hepato-Spleno-Megaly
- 🦵🏼 Extremity & Joint Pain
🐣 Pediatrics 🔒
- 👩🏽🍼Newborn care
- 👂🏼 Ear pain & Hearing loss
- 🧣 Sore throat
- 🎙️ Stridor
- 🫁 Crackles
- 💩 Diarrhea & Abdominal pain
- 💦 Edema
- 🌡️ Fever
- 🧰 Chest pain