| * trauma
Hello Mr XYZ ..May name is , I will see as your physician today ..I know that you had traumatized & I really feel very sorry fo you , I wonder if you can tolerate the pain for the nest minutues so that I will be able to help you ..
GUYS if you do not say this , the pt won't respond
BE CAREFUL NEVER ..never repeat on such pt a question or ask too much silly details on unrelavat things becz he or she will never reply you again .
So ...take History .. who did to you , was it a fight ot car accident .. how ? did you get a sharp or blunt objects ..
when ? who brought you to heere ?
where is the pain ? head , neck , chest abd, limbs .. we try to get severity of pain .. then ask about deficits like in head
visual ? hearing ? blood or discharge from the ears , nose , cough blood ?
then neck ? ROM ? unable to move your body ?
chest /// SOB ? location , sound with breathing , cough ..
abdomen ..also the same
ask if pat passed stool or urine if they coontain blood ..
limbs ask about pain , mobility , ROM
then PE ..well
MMSE ..I guess I would do only memory , oreitation ..I donot thinkI will have much time for other luxuries
may be rapid CN exam
hen turn pt to lt ..do the back while he is turned ..
look , touch , listen , tap ..do not forget the lowewr back & the spine with the CVA , then turn the pt supine & do the same for the chest from the front with the heart should also be touched & listened .
after that expose the abd . then look , lsten , touch
look for direct & rebound tenderness ..rigidity ..
then order a DRE may be also a PV if female ..
then do the limbs
I will rather look , touch then ask for active moevment .do the srength while that , after that I will check pulses in UL & LL then check the reflexes ..
may be for the stroy below Iwill order
HIV Ab Elisa
HBV , HCV screen
cervical swap cultr
Xrays , Abominal US ,
27 yoF was brough the the ER by the police 30 minutes after being attacked by 3 men .she was first beaten on her face & chest then they abducted her & raped her .she has headache 4/10 with no visual, hearing difficulty & no fluid or blood is coming from her nose or ears .she has sharp knife like 7/10 localised left lower chest pain which catches her when she breathes in .she has disffuse vague 4/10 abd.pain ,she did not have LOC , nor nausea, vomiting .no change in Bowel or urinary habbits.nor limb pain .PMH , PSH medication ,fah all -ve she smokes 1ppdfor 5 years , drinks 3beers per day for 5 years ,cage is 2/4 ,she is sexually active with 2 male prtenrs who enevr use condomes .
PE ..may be MMSE is ok
chest should be full
order as above
councel about the ,,,,,,
sex , smokng , drinking