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Cheatography

Triaging Cheat Sheet (DRAFT) by

How to triage conditions

This is a draft cheat sheet. It is a work in progress and is not finished yet.

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