Triaging
1. Probability Diagnosis - Dr's perspective |
2. Serious Disorders should not to missed - high index of suspicion, red flags and considered until proven otherwise |
3. Pitfalls (Conditions that are often missed - usually non-life threatening) |
Further questions should be considered |
1. Symptoms due to visceral/serious/potentially life threatening disease? |
2. Tissue responsible? |
3. What is happening for the tissue to generate pain? |
Back Pain General S&S
Mechanical |
Not Associated with Marked Swelling/warmth |
| |
Limited to one joint |
| |
Lessened by rest and aggravated by Activity (opposite to inflammatory back pain) |
| |
Systemic Inflammatory |
Boggy swelling, warmth and redness of a joint - symmetric |
| |
Pain relieved with activity, aggravated by rest & inactivity |
| |
Morning stiffness/pain >30 mins |
| |
Systemic disease |
| |
Synovitis |
| |
Subcutaneous nodules on extensor Surfaces |
| |
Joint & Valgus Deformities common |
| |
Extensor tendon ruptures |
| |
Night pain |
| |
Local Inflammatory |
No systemic signs |
| |
Localised morning pain/stiffness >30 minutes |
| |
Localised boggy swelling, warmth & redness of a joint |
| |
Night pain |
| |
Degenerative |
Bony Swelling, symmetrical/asymmetrical |
| |
Morning stiffness/pain <30 minutes |
| |
Aggravated by activity, relieved by rest |
| |
Weakness and tightness of muscles crossing involved joints |
| |
Varus deformity |
| |
Crystal deposition joint disease |
Very painful, red ,hot, swollen joint |
| |
Loss of ROM |
| |
No systemic signs/symptoms |
| |
Severe joint destruction |
| |
Nerve Compression |
Pain, Weakness, SMR findings, paraesthesias in derma/myotomal areas |
| |
Stretching of Nerve increases Pain |
| |
+ve Tinel's sign |
| |
Neoplasm |
No comfortable position |
| |
No relief from pain |
| |
Often wakes up patient from sleep |
| |
Fever, weight loss, fatigue |
| |
Septic Arthritis |
Red, Hot , Swollen joint |
| |
Very Painful |
| |
Fever and Fatigue |
| |
Decreased Joint ROM |
Visceral Referral patterns
Additional referral Patterns
Bladder: Lower abdomen and upper thighs
Oesophagus: Sternum + Left upper Thorax
Heart: Base of neck, left jaw, left shoulder + arm
Liver: Right Shoulder
Pancreas: Lower left quadrant, umbilicus
Spleen: Left Shoulder + Upper third of arm
Patient Consultation
Three phases: |
Rapport |
Diagnostic phase (Hx, physical exam, investigations) |
Management (education, reassurance, explanation, manual, functional, motivation interviewing, OTC medications, follow up, further investigations, referral) |
Types of Rapport Building
Neurolinguistic Programming (NLP): |
Establish rapport by, mimicking body language, speech, posture, pace - improves patient's attitudes |
| |
Mirroring |
Coping patient's gestures and position - uncomfortable/unusual gestures should not be mirrored- matched by doing something else in the same rhythm - cross pacing |
Pacing |
Matching a person's pace/rhythm - breathing, talking, movements of the head, hands/feet |
| |
Then go on to try and change their pace by changing yours - leading |
Vocal Copying |
Copying intonation, pitch, volume, pace, rhythm, breathing and length of the sentence |
|
