Taking a History Week 2 Part 2 CP1 - The History Of The Presenting Complaint

so welcome back to part two

off

discussion about this to take taking election.

Taking a history for clinical examination is part of your C P one model here in G C u.

So initially, if you haven't watched first presentation

which covered

the instruction aims and why we take a history,

I'm in a bit about presenting complaint

and I suggest you go back and watch that now so

that you've got a foundation for this next part here.

But the next 15 minutes or so, we're going

to speak through the history of the presenting complain on.

We're gonna look at a couple of assessment tools that we can use in order to help us

make sure that we're taking our, ah, Fala and correct history for these patients.

Okay, there's a wealth of Miller Any material on the V l E alongside this

which hopefully she'll help you Now this in reality

for students perhaps the most challenging thing. And I'm gonna show you two models

this morning

to give you a chance to talk to. I'm going to show you

old carts

on Socrates.

It does not particularly matter which model you use,

mainly that

your patient and your mentor,

in the case of the assessment, could see that there's a structure being used okay,

and that will asking the correct question to make sure

we gather all of the information that we need,

so that further would do. I'm going to

look for

So here's where we are.

So we've

to say we've made our introductions.

We've asked briefly for that first open ended question.

Tell us a bit about what's been going on today

on giving you, hopefully

an inkling as to the chief complaint, what's being described?

Okay, you're seeing the paramedic literature in things like

practise that

they speak about models

of assessment.

These can really be used not just for

paying that information gathering of all phases.

Okay, so this first one is the one I particularly like.

It may not necessarily work for you,

but as I talk for it, hopefully and I'll give you an example.

Hopefully, you'll see of this measures with you.

We're going to practise this on Monday.

We're gonna practise both sections to see what works

like I say, Don't be concerned.

So first I'm going to ask our patient.

So when a patient has appeared.

He's given up

chest pain at the minute, and it won't go away

to. The first thing we're going to ask you is are often set.

Okay? When did our chest pain, for example?

First, Come on, Has it come on suddenly over

seconds, minutes, hours, days

or weeks.

Now the important thing about this question,

it also gives your time famous, too.

Perhaps if they had got any interventions that they would

normally take for this if these interventions have been effective,

like medication,

but don't love yourself into the onset of its sudden onset chest pain,

Well, it's been testing for the last few weeks.

Therefore, it's not particularly serious.

We

have to find his.

Nothing is completely concrete with this,

with assessment of things like chest pain and shortness of breath. And actually,

because I find that really serious conditions and red flag conditions

have a longer on set time,

then some of what we traditionally think really acute conditions

to asking your patient when it came on in terms of seconds, minutes, hours, weeks,

stage months

is really, really important to do so.

Our second part is on location,

so this is really important to work out where are paying its

okay. And in this case, it might be

you might ask your patient. So tell me a bit about where you're paying these.

At this moment in time,

you can get them to point if they're able to.

And that works especially well for paediatrics and Children.

He's

going to point to where it hurts.

But we were. Sometimes you can have episodes of what we call

third pain.

Okay, but you have pain that starts in one area

on moves across to another.

No. Okay.

It's also really important to note that necessary because they've got pain

in one area doesn't mean that they don't have a condition,

its government and another.

So things like appendicitis, which will speak about later on in this semester,

may present with short of paying, for example,

where's some cardiac pain may present? Not so much with just central chest payment.

More like a heaviness across the shoulders. Okay,

so we need to work out where our pain is, and where are symptoms are?

How long has it been going on?

Is our next question. So though we spoke about the onset of this episode here

has this particular episode been going on for, like,

a few minutes, a few hours, a few days?

Okay, because once again, alongside I wanna set we need to make sure that we're

clarifying this correctly.

For example,

transplanted from bothering you intermittently for six

months is probably slightly less serious.

And just when there's something come on really, really

strong and really, really

shortage up

the next actually characteristics.

So in terms of characteristics would think, What does it feel like?

This is where we can use our describing. Once

three terms of describing words were looking for

types of words that can lead us to assistant.

So we're looking for paying this

sharp.

That's heavy.

That's crushing in the case of central chest pain,

because there's a weight on your chest.

Four.

Is it paying? That's really, really pinpoint.

You can feel it quite between your ribs, for example.

Okay, these

characteristics for pain and as we work through this model will work out

what

types of pain

can equate till what types of conditions,

depending on the system you're examining.

So what is it for you like? Is really, really important. Okay.

Interestingly enough,

there's a lot of evidence there to show when we're thinking about.

For example, cardiac payment would be quite a few weeks

and that actually

central question chest pain doesn't present in all of our cases.

And it's more like a heaviness, like someone sat on your chest or

occasional, as I say cost both shoulders and

along with some other symptoms.

Okay,

when we think about as well as a prison complaint, we move on down through,

we've got to think about what makes it

worse.

That's aggravating.

So is it that this pain gets worse when they get up

on move when they walk up the stairs when they lie flat?

Okay,

people won't naturally do lots of things to make the pain worse,

because we don't like a human being in pain

in the first place and will probably find it

easier to work out what may alleviate this paint

going on our second section. We've got alleviating.

That means what makes our paying better

make. It may not necessarily make it go away,

but what makes it better now that might be an algae easier that might be thinking,

perhaps tomorrow ibuprofen

Okay, also might be things like

the positioning

use of hot compressions or

movement stretching. And as we go through, we speak about paying.

In a couple of weeks, we'll speak about

ways that you can

perhaps dig a little bit deeper into that.

Okay,

Our next step in this this journey is treatments.

OK, so have they taken anything so far?

Are they under any treatment for this pain in the past?

Has anything they've had so far made the pain worse or made their pain better?

The taking example of chest pain We've got to be very, very wary that

just because they've had a positive response to you

GT N for example, such a clich? Tri nitrate chest pains.

But it doesn't necessarily mean that the pain is just on general

in nature. But it's really good to see that if paying that's responsive to

mild and Rhodesia with no further source of

serious side effects, perhaps could be

assessed a little bit easier.

But have they taken anything for that also help you when you think about

what energies and what medication you may want to treat these conditions with,

because we want to make sure we're not accidentally

overdosing our patients, giving our patients

too much.

Is there anything in terms of their treatment of our made it work?

So it might be that they've had

particular

manage easy

example

stomach pain. And they've taken to my both in,

but it's made him nauseous.

Okay,

it might be that normally they have a list of conditions they have,

ah list of treatment options for what they undertake,

especially those perhaps with migraines,

things that might try their initial medication.

And it might not have made that issue better.

Okay.

And then our final thing in terms of ranking severity, which is really,

really important.

Paramedics aren't

who waited. This is is using pain scales

that I'm blanking the severity of of pains of conditions

too, especially in chronic condition.

So we're looking at people on sets of shortness of breath.

Perhaps when they've got a background of chronic obstructive pulmonary disease,

asthma

ranking the severity of their symptoms can really really help you and working out

what you need to imminently be doing next. I'm aware your

risk stratification as you work through this programme can go.

Kameni will blanket between zero and 10 z well being now Payne or

no symptoms and 10 being completely available on you can't really do anything.

Don't be afraid

to rank people it a 10

on actually. Interesting enough. There's not a lot of evidence here

to support the use of vital signs in pain management.

So your vital signs may not necessarily change if you're in severe penance.

Okay, so just a really important point to make out.

So the other model that commonly we quite used

and this is the one that's mentions in jail cow

believe it's mentioned in ambulance care

practise

is the Socrates model

on. We can see the roughly works around the same sort of thing.

So we worked a vessel where exactly are paying Our conditions are

okay

for some of these. Assessment was, it might be that

we don't need to work on the city's.

So let's see if you've got shortness of breath

work fairly confident that might be in your chest.

Okay,

but when we look at,

I'm except we look at onset what was happening when

it came on because that could be a really,

really good indicators to whoever

Asai say whether they were doing something that's exacerbated a condition before

above medical and trauma.

Can we cover the same in terms of characteristics?

Same in radiation. So in that radiation means that the pain move anyone else

but me. Food to the back doesn't move down to the arms. Move

down the legs

anywhere along that sort of thing

alongside associated symptoms.

Okay,

at a time slash Duration of how long we've had this

exacerbating and relieving factors has said about

things about making paying better or worse

on then our initial pain school in terms of severity.

What you're seeing here is all of these

cover a similar sort of

threshold. They asked the same sort of questions,

Okay. And that's really, really important to see

and to work through.

Okay, ability to work through that in terms of your assessment

will give you a good on set as a guiding for your history. Complain.

Okay.

And on Monday

we'll give you an example of a completed Socrates model

as a clinical handle and will light you up a condition and get

you to write out of Socrates and play out this sort of scenario

because it can feel really, really clunky when you first try and take it.

But eventually

for a placement. As you've seen from something, I meant visual.

You're getting to a script in your work your way down

on instinctively. You might

be able to just was through this quite rapidly.

Okay,

so

But to sum up in assessing conditions and assessing presenting complaints,

it's really, really important to have a structure.

Okay, these two models I've showed you

old car

Socrates

are pretty much the standard sort of framework that

we can use initially written up for paying.

But actually, you can use him to get That s Steve.

You're presenting complaint really, really effectively.

And it means when you come to light your patient report form,

come to hand over your mentor or senior clinician

you in that position to give yourself

the best show possible.

So in the next section, we're going to speak about past medical history.

We're going to speak about medications,

and this allows us here to speak about

what we are looking for in terms of

how do we work out? What medical histories? Well,

how do we take a medication history?

Because lots of people nowadays on medications and that's really,

really important

to work out

because you often find out that medications

I

can give you clues that your patient may not necessarily remember will be aware of.

So stand by for the next little bit.

Meantime, if you have any questions, please reach out to me. Give me an e mail

and have a good day.

See in a minute.

Taking a History Week 2 Part 2 CP1 - The History Of The Presenting Complaint

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