Pulmonary symptoms are as soft as the dry cough from bronchitis (a self-limiting problem) to life-threatening pulmonary embolism or congestive heart failure.
I was employed full time for four years as a night-time house officer in a hospital in Rochester, N.Y. It was my job to care for patients who were sick enough to be in the hospital, yet not quite in the ICU – so I covered a respiratory wing of the hospital. This assignment presented meant I was in for an interesting learning curve when I first started. I felt inadequate in my assessment skills, and I mismanaged a number of patients, such as treating an asthma patient with Lasix, thinking it was CHF.
My respiratory medicine turning point
Then one day I hit a tipping point. I finally made it my quest to master this part of my job. I immediately started doing blood gasses (ABGs) and chest radiographs on all acute pulmonary complaints. I did a very detailed history and physical exam. I learned to apply laboratory data to take optimal care of these pulmonary patients. I took an amazing CME course called Fundamentals of Critical Care Support (FCCS.) It was from this quest for learning, and caring for scores of patients, that I developed the “HORID” approach to pulmonary patients. I still practice this way today, and I have taught it to literally thousands of providers.
When it comes to pulmonary complaints, you don’t want to make a “HORID” mistake. “HORID” is a mnemonic to the approach of the pulmonary patient. If you apply this mnemonic to any patient whose primary complaint is respiratory, you will follow a reasonable and logical evaluation.
D=Death! (From a PE or pneumothorax)
We’ll break down more details of HORID in upcoming posts here at CME4LIFE!
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