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 hospitalization. It should include events during hospitalization 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 cardiography, 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 (number of pillows), paroxysmal nocturnal dyspnea, dyspnea on exertional, edema. Peripheral vascular disease symptoms: Claudication, transient ischemic attack, cerebral vascular accident. COPD exacerbation symptoms: Shortness of breath, fever, chills, wheezing, sputum production, hemoptysis (quantify), corticosteroid use, previous intubation.

Past medical history: Peptic ulcer disease, renal disease, diabetes, COPD.

Functional status prior to hospitalization. Medications: Dose and frequency. Use of nitroglycerine, beta-agonist, steroids. Allergies: Penicillin, contrast dye, aspirin; describe the specific reaction (eg, anaphylaxis, wheezing, rash, hypotension). Social history: Tobacco use, alcohol consumption, intravenous drug use. Review of systems: Review symptoms related to each organ system.

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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