Escolar Documentos
Profissional Documentos
Cultura Documentos
features of disease
week 1 (17/3/17)
Subject code 99584
Dr Cecile Chu
Cecile.chu@uts.edu.au
Rm 4.6.332
(Please email ahead to make appointment)
Todays outline
Who am I?
Introduction to the program
Taking a medical history
Role plays
Emergency medicine
Who am I?
When did they last visit, who did they see, why, what
treatment Good to see whether the previous treatment has worked
Past medical history
Medication list prevents adverse drug interactions
Allergies
Smoking, alcohol
Family history Genetic disorder: infuences how likely someone may have
a particular medical conditions
Social history diet, who they live with
eg if vegan: check for vitamin B12
OCCUPATION; is also important in the social history part
NOTE: need to fill out all the blank positions eg medication, previous examination they did before
How can I help you today?
Start with open questions let the patient tell you in their
own words their experience (dont talk for 1 min) Hi, how can I help you today?
Further clarify with more directed questions to help
achieve your agenda (specic symptom searching to
support/refute a diagnosis, explore alternative diagnosis)
Systematic review so you dont forget anything
Body systems Ask them in chronological order according to their body systems so that you dont forget anything
All history components
OPEN questions: is when you cant answer YES or NO. you need the patient to tell you what they have on their mind
Start with open questions
Timing duration, time of day eg headaches in the morning are more concerning than ones in the nigh
Exacerbating/relieving factors what makes it better
or worse/triggers what treatment have you tried already and has it worked
Severity on a scale of 1 to 10 what cant you do because of this strength of pain? TO GAIN A BETT
UNDERSTANDING OG OF THE SEVERITY OF PAIN
10 being the worst pain you can imagine
0 being no pain at all
Other useful questions for the
presenting complaint
look for patterns of the symptoms and check whether they fall under a particular categorie of the body systems
from Clinical Examination: A Systematic
Guide to Physical Disease 5th Edition.
Nicholas J Talley and Simon OConnor
from Clinical Examination: A Systematic
Guide to Physical Disease 5th Edition.
Nicholas J Talley and Simon OConnor
from Clinical Examination: A Systematic
Guide to Physical Disease 5th Edition.
Nicholas J Talley and Simon OConnor
from Clinical Examination: A Systematic
Guide to Physical Disease 5th Edition.
Nicholas J Talley and Simon OConnor
Then ll in all the gaps
http://www.druginfo.sl.nsw.gov.au/images/drugs/standard_drinks.jpg
Social history
Recreational drugs
Especially for the elderly
Who lives with you?
What do you need help with
Showering
Dressing
Eating
Cooking
Shopping
Cleaning
Any services
Any family nearby
Occupation can be very relevant e.g. musculoskeletal presentations,
coughing exposure to asbestos/farmers (Q fever)
Recent travel eg malaria if recent relevant travel and spiking temperatures
When relevant sexual history
Men who have sex with men (dont assume! Ask ALL men!)
Number of partners
Use of protection
Children daycare? (exposure to illnesses!)
Special paediatric considerations
http://www.nhs.uk/Conditions/cyanosis/
PublishingImages/
cyanosis_300x174_M1300068.jpg
Breathing
Warm peripheries
Capillary rell less than 2 seconds
Pulse, normal rate 50-100
Carotid pulse in the neck
Cardiopulmonary resuscitation
Lower half of sternum using heel of hand
Compress chest halfway
Rate of staying alive (100 bpm)
2 breaths per 30 compression (not absolutely necessary)
Improves survival before debrillation
For 2 minutes
Check for signs of life every 2 minutes
http://s297.photobucket.com/user/lisalabanana/media/cpr-1.jpg.html
Debrillation
AVPU
Alert
Responds to voice
Responds to pain
Unresponsive
Chest pain
Approach
Pale
Sweaty
Nausea and vomitting
Any past history of previous ischemic heart disease
angina, myocardial infarction, stenting, CABG
Everything is based on risk
Age (especially >60)
Smoking within the last year
Diabetes
Past history of stroke, cardiac disease, peripheral vascular
disease
Hypertension
Hypercholesterolaemia
Overweight/obesity
Sedentary lifestyle
Poor diet
Depression
Low socioeconomic status
Male
Deep vein thrombosis (clot)
Calf swelling
Erythema (redness)
Calf pain on dorsiexion (bend towards the dorsum/
back)
Unilateral (one sided)
Calf tenderness
Warmth
DVT or cellulitis?
DVT Cellulitis
Calf swelling Fever
Erythema Hot to touch
Calf pain on dorsiexion Induration (rmness)
Unilateral And all of the same signs and
Calf tenderness symptoms as DVT
Warmth And there could be an
Pitting oedema underlying DVT
Pulmonary embolus
Collapse DRSABCDE
Unilateral leg swelling and redness seek semi-urgent
medical attention
With the advice that any chest pain, cough, diculty
breathing should escalate to urgent medical attention
Asthma
Can be life threatening
Acute major airway bronchospasm leading to airway
obstruction
Pneumothorax
http://www.fpnotebook.com/_media/lungPtxComplete_PA.jpg
Acute asthma attack
Known asthmatic
Context of recent upper respiratory tract infection/
exposure to usual trigger
Diculty talking in full sentences
Breathless
Chest tightness
Coughing
Increased use of ventolin puer
Response - adults
Sit comfortably
12 pus of ventolin every 20 minutes, up to three
times
If no signicant improvement after rst 12 pus, call
an ambulance
If response but requiring 20 minutely ventolin, seek
urgent medical help (self-presenting to emergency is
appropriate)
Children under 5y.o.
Severe pain
Vomitting
Abdominal bloating
Obstipation (no atus or bowel motion)
Fever
Syncope (faint)
Seizure
Time seizure
Recovery position
Dont put anything in the mouth
Seek immediate medical attention, especially if seizure lasts
longer than 5 minutes
If lasts >5 min, urgent medical attention
Not to travel alone
If seizure recurs, immediate medical attention
If seizure terminates but patient does not regain consciousness
within 30 minutes, immediate medical attention
Recovery position
https://s-media-cache-ak0.pinimg.com/
originals/f0/28/7a/
f0287ad6e74041a1d89b4ea5f68a396b.jpg
Febrile convulsion
6 months to 6 years
In the context of fever
Aects both sides of the body
Lasts less than 10 minutes
Does not recur within 24 hours
Recovery within 30 minutes with no residual decits
Often a family history of febrile convulsions
Does not mean child with have epilepsy
Red ags any symptoms that is progressive