OMED 1401 - Advanced Patient Assessment (PATIENT APPROACH)

Question 1

What are the Acronyms for History Taking?

Answer 1

SAMPLER
Signs and Symptoms, Allergies, Medications, Past Medical History, Last Oral Intake, Risk Factors.
THE MEDICAL MODEL
Presenting Complaint, History of Presenting Complaint, On Examination, Past Medical History (Includes Surgical History), Drug and Allergy History, Family History and Social History, Review of System and Impression / Plan / Differential Diagnosis.

Question 2

What are the Review of Systems?

Answer 2

Respiratory
Cardiovascular
Gastrointestinal
GenitoUrinary
Neurological
Musculoskeletal
Endocrine
Psychiatric
Head, Eyes, Ears, Nose, Throat.

Question 3

What are the Specific Frameworks?

Answer 3

SOCRATES
OPQRST
JACCOL
MJTHREADS

Question 4

What is the Acronym OPQRST?

Answer 4

PAIN ASSESSMENT
O - Onset
P - Provokes
Q - Quality
R - Radiates
T - Timing

Question 5

What is the Acronym SOCRATES?

Answer 5

PAIN ASSESSMENT
S - Site
O - Onset
C - Character
R - Radiates
A - Associated Symptoms
T - Time
E - Excaberating Symptoms
S - Severity

Question 6

What is the Acronym JACCOL?

Answer 6

GENERAL ASSESSMENT
J - Jaundice
A - Anaemia
C - Finger Clubbing
C - Cyanosis
O - Oedema
L - Lymphoedema

Question 7

What is the Acronym MJTHREADS?

Answer 7

GENERAL ASSESSMENT
M - Myocardial Infarction
J - Jaundice
T - Tuberculosis
H - Hypertension
R - Rhematoid Arthritis
E - Eplilpesy
A - Asthma
D - Diabetes
S - Stroke

Question 8

What is NEWS2 and How does it Work?

Answer 8

Simple Scoring System on Physical Measurements
RR, SPO2, Systolic BP, PR, Temp, Consciousness
Scores represent the Extremes of Variation of the Measurement from the Norm.
Used Pre-hospital and in Hospital.
Adults Only.

Question 9

How to NEWS2?

Answer 9

For Each Parameter (Obsercation), Allocate the Corresponding Score.
Add all of the Parameter Scores Together to Achieve a Total Score, Including Level of Consciousness and Oxygen Use.
Check the Total Score within the Thresholds and Triggers table.
The Level of Response should be Noted.

Question 10

What are the Thresholds and Triggers for NEWS2?

Answer 10

Aggregate Score (0-4) - Low - Word Based Response
Red Score (Score of 3 in any Individual Parameter) - Low Medium - Urgent Word Based Response
Aggregate Score (5-6) - Medium - Key threshold for Urgent Response.
Aggregate Score 7 or More - High - Urgent or Emergency Response.

Question 11

What is a Red Flag?

Answer 11

Red Flags are Clinical Indicators of Possible Life Threatening or Serious Underlying Condition. Identification of Red Flags are of Paramount importance to Decision Making and may Require:
- Time Critical Conveyance
- Clinical Intervention
- Referral, Advice, Further Support.

Question 12

What is Meningococcal Septicaemia?

Answer 12

Pyrexia
Vomiting
Headache
Tachypnoea
Pain in Joints, Muscles and Limbs
Pale or Mottled Skin
Cold Hands and Feet

Question 13

What are the Red Flags for a Patient with Abdominal Pain?

Answer 13

Guarding
Rebound Tenderness
Dehydration
Rectal Bleeding
Vomiting Blood - Haematemesis
Unexplained Weight Loss
Anaemia
Acutely Systemically Unwell
Possible Pregnancy
Post Trauma

Question 14

What are the Red Flags for a Patient with Breathing Problems?

Answer 14

Central Cyanosis
Respiratory Distress - Use of Accessory Muscles
Fatigue/Exhaustion
Short of Breath with Chest Pain
Coughing up Blood - Haemoptysis
Abnormal Lung Sounds
Unresolved Wheeze
Unequal Breath Sounds
Recent Foreign Travel

Question 15

What is Meant by Clinical Decision Making?

Answer 15

Cognitive thought process which selects the most logical choice from a Number of Given Problems.

Question 16

What is Meant by Differential Diagnosis?

Answer 16

List of Possible Diagnoses drawn up after taking a full History an Performing both Mental State and Physical Examinations.

Question 17

What is Safety Netting?

Answer 17

A Way to Ensure that the Patient knows and understands your Findings and has been signposted to Further Help.
Way to Provide Information for Shared Decision Making.

Question 18

What is the Correct Environment for a Patient and What to Consider?

Answer 18

Patient Position:
Do you have 360 access to Patient?
Can the Patient be moved into a Controlled Environment?
Assessing the Patient Situation:
Emergency vs Urgent or Minor
Big Sick —> Time Critical
Trauma / Emergency Situations
Consider you Equipment
If you need all your Equipment at scene then you must Factor the time this takes when devising a plan for Removal.
The Physical Environment:
Poor Lighting, Clutter
On the Ambulance:
Overstocking
Arrangement of your Equipment
Physical Demands

Question 19

What is a Hoarding Disorder?

Answer 19

Where someone acquires an excessive number of items and stores them in a chaotic manner. The items can be of little or no monetary value and usually result in unmanageable amounts of Clutter.

Question 20

What are the Red Flags for a Neurological Episode?

Answer 20

Slurred Speech
Sudden Mood Changes
Sudden Memory Loss
Unequal dilation of Pupils
Sudden Weakness of Limbs
Tingling
Sudden Headaches
Sudden Loss of Consciousness

Question 21

What are the Red Flags for Cardiovascular Episodes?

Answer 21

Sudden, Sharp Chest Pain
Palpitations
Shortness of Breath - Body is Struggling to get another Oxygen around the Body.
Sudden Tingling/Numbness in the Arm - During a Heart Attack, a Coronary Artery becomes Blocked. This Blockage leads to a Lack of Blood Flow, which can Cause Left Arm Numbness.
Altered Level of Consciousness
Sweating
Cold/Clammy Skin - Blood Flow to the Body’s Tissues and Organs.
Cyanosis - Lack of Oxygen being Pumped around the Body.

Question 22

What are the Red Flags for a Gastrointestinal Episode?

Answer 22

Sudden Abdominal Pain
Diarrhoea
Vomiting
Constipation
Failure to Gain Weight
Lack of Bowel Sounds on Auscultation