Saturday, April 14, 2012

The Clinical Approach to the Acutely Ill Patient- history and examination


The Clinical Approach to the Acutely Ill Patient- history and examination


Diagnosis
The Use of Guidelines and Algorithms
The Emergency Setting
 History
Physical Examination
Primary Survey
Secondary Survey
Laboratory Testing
Imaging
Sonography
Plain Abdominal Films
Intravenous Pyelography
Computed Tomography
Magnetic Resonance Imaging
Chest X-Ray 


History: patient, family members, the rescue staff, or the operating team.

The AMPLE history (Allergies, Medications, Past medical history, time of Last meal, Events preceding the injury)

Urgent history:  localization, time dimension, intensity and mitigating التخفيف / inducing factors of the current problem

Physical Examination
Primary Survey
Vital signs of blood pressure, pulse rate, respiratory rate, temperature and general assessment of the patient (i.e. toxic or well appearing).  After the vital signs, the initial assessment follows.

Secondary Survey
If possible, the physical examination should be conducted in a systematic way in a fully exposed patient. In trauma patients, the risk of hypothermia must be considered even in the warmer months; nevertheless, it should not hinder complete exposure for examination and it will be reduced by warm infusions and by covering with external warming devices after assessment. With the exception of life-threatening emergencies requiring immediate evaluation and therapy, the secondary assessment should include organ systems other than
those assumed to be affected. This will allow the discovery of physical signs not necessarily linked to the working hypothesis, as well as those arising from any additional disease (e.g., discovering a melanoma in a patient presenting with renal colic).

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