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Clinical Medicine Conditions - Coggle Diagram

- - - - Cellulitis
    - - Infection/cellulitiis of the auricular cartliage, poor blood flow -> diff to inflate
        
        Ex: otisis, lacerations, piercings
    - - Pseudomona aeruginoas
      - Staph areus
      - Strep pyogenes
    - - Cipro PO
    - - Risk: abscess and necrosis
  - - - Hyperemia
      - Edema
      - Ecchymosis of Middle Ear
      - Mucosa
      - Medial Displacement of TM
      - Sanguineous Fluid in ME
      - TM Perforation
    - - Flying
      - Diving
      - Blast Injuries from Explosions
    - - Will resolve it self in 2-3 weeks as ET function improves and ME pressure equalizes
  - - - Otalgia
      - Fever
      - Otitis Media
    - - bullous lesions on TM w/ surrounding erythema
    - - Infection/inflammation of the TM w/ vesicular lesions
    - - Mycoplasma
    - - work up - rarely needed
    - - ABx: Erythromycin PO
      - F/U: May need vesicle drained
    - - Risk - immunocomp, otisis media, HIV
  - - - Asymptomatic or Hearing Loss
      - Dizziness
      - Otorrhea
    - - Whitish material behind TM
      - chronic Otorrhea
      - Conductive Hearing Loss
    - - Prolonged ET dysfunction
    - - Surgical removal and tympanoplasty
  - - - Unilateral hearing loss w/ deterioration of speech discrimination
    - - Tumor of CN VIII
    - - Gadolinium-enhanced MRI for Dx
    - - Surgical Excision
      - Sterotactic Radiation Therapy
  - - - Fever
      - Irritability
      - Apathy
      - Restlessness
      - Poor Feeding
      - Headache
    - - Bulging TM
      - Erythematous TM
      - Otorrhea
      - Inflammatory edema of respiratory mucosa
      - Obstruction of isthmus of Eustachian tube
      - Negative ME pressure
      - Secretion Buildup
    - - Viral URI
      - Virus and Bacteria in ME space
    - - Bacterial
        
        Streptococcus pneumnia
        
        H. influenza
        
        Moraxella catarrhalis
      - Viral
        
        RSV
        
        Rhinovirus
        
        Influenza Virus
        
        Adenovirus
- - - - Sudden onset of severe unilateral vision loss (Seconds), patient can barely count fingers
    - - Cherry Red Fovea
      - Constricted Arterioles (Boxcar Segmentation)
      - Pale central optic disc
    - - Occlusion (blockage) of the CRA causes global retinal ischemia, embolism
      - Embolism
      - Sickle Cell Disease
      - Coagulopathy
    - - TRUE EMERGENCY: CALL OPTHO!
      - Permanent vision loss if not restored within 90 minutes
      - Attempt to dislodge clot
        
        Ocular Massage
        
        Hemodialution with IVF
        
        Re-Breathing CO2 or breathing 95% O and 5% CO2 (Vasel Dilation)
      - Attempt to reduce IOP
        
        Decrease the production of aqueous humor through meds, anterior chamber paracentesis
      - Anticoagulation - Talk to Optho
      - Definitive care done by Optho
    - - Risk: age, H/O coagul, HTN, sickle cell, afib
      - Always eye exam before anything else
  - - - "Sudden onset of sever painless unilateral vision loss over secods"
    - - Fundoscopic Exam
        
        Retinal Hemorrhage
        
        Dilated totous retinal veins
        
        Cotton-wool spots
        
        Macular and Optic Edema
    - - Occlusion (Blockage) of the CRV
      - Emboli
      - Vasculitis
      - Sickle cell disease
      - Coagulopathy
    - - Call Optho
      - Consider Aspirin Therapy; Could include hemorrhage
      - Hemodilution w/ IVFs
      - Management of comorbidities
        
        HTN
    - - Risk: coagulopathy, HTN, age, glaucoma, DM
      - Proparacaine - gets rid of pain - Alcaine
  - - - Triad
        
        Photopsia
        
        Floater
        
        "Greying of vision" - Curtain pulled down over eye
    - - Anopsia - Missing Vision
      - Abnormal red reflex
      - Fundoscopic: Retina pulling away from tissue IOP is normal
    - - Retina peels off
    - - Emergency Optho Call: No know ED treatment to be beneficial
      - Surgical repair within 72 hours
      - Without rapid treatment, entire retina could detach -> Vision loss and blindness
    - - Risk: >50, fhx of retinal detachment, hx of myopia, eye trauma, h/o cataract surg"
      - V - Visual Acuity
  - - - Sudden loss of vision
      - Floaters
      - Smokey/Hazy vision
      - (Reddish?)
    - - Abnormal red reflex
      - Fundoscopic Exam
        
        Retina and optic nerve are obscured/cloudy -> red debris
    - - Bleeding into the vitreous humor
    - - Ultrasound: debris
    - - Consult Optho
      - Re-Exam over a few hours to see if goes down
        
        If not...
        
        Surgical Removal - Decided by Optho
      - Stop Anticoags
      - Avoid NSAIDs
      - Avoid strenuous activities
      - Sleep upright
      - Complication
        
        Corneal scarring
        
        Glaucoma
    - - Risk: DM, trauma, H/o retinal detachment, HTN, Cogulop, on anticoags
  - - - Fever
      - Chills
      - Headaches
      - Recent Infection
      - Decreased Vision
      - Proptosis
    - - Proptosis
      - Chemosis
      - +/- Facial Edema
      - Decreased EOM
      - Absent pupillary reflex
      - CN Palsies
    - - Staph aureos
      - Strep pneuomia
      - Gram negative bacilli
    - - WBC - Elevated
      - Blood Cultures
      - CT Head and Orgits with contrast
      - MRI / MRV
    - - Consult ID and Optho
      - Admit
      - ABx
      - Steroids (if asked)
      - Anticoagulation
    - - High mortality rate (30%)
      - Risk: Sinus, Dental, Throat, Face or Orbital Infection