11-06-2006, 03:19 PM
WOW
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
then HEENT
may be rapid CN exam
then neck
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 ..
DDX
Trauma
Drug abuse
Alcholism
Rape
Ix
may be for the stroy below Iwill order
PR ,
PV
Bhcg
HIV Ab Elisa
HBV , HCV screen
cervical swap cultr
Xrays , Abominal US ,
Pn
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
HEENT
chest should be full
abdomen also
order as above
councel about the ,,,,,,
sex , smokng , drinking
say bye
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
then HEENT
may be rapid CN exam
then neck
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 ..
DDX
Trauma
Drug abuse
Alcholism
Rape
Ix
may be for the stroy below Iwill order
PR ,
PV
Bhcg
HIV Ab Elisa
HBV , HCV screen
cervical swap cultr
Xrays , Abominal US ,
Pn
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
HEENT
chest should be full
abdomen also
order as above
councel about the ,,,,,,
sex , smokng , drinking
say bye