Ch. 2:Choosing the Best Initial Intervention

Question 1

SOAPE

Answer 1

Subjective
Objective
Assessment
Planning
Evaluation

Question 2

“Subjective” information

Answer 2

Patient’s symptoms

Historical/demographic information

Question 3

“Objective” information

Answer 3

Performing a physical examination or other tests

Best to start out “low-tech”: physical exam or a low-tech maneuver

(i.e.: Peripheral vascular disease (PVD): check pulse, and B/P first on the lower and upper extremities before ordering an expensive test such as an U/S doppler flow study)

Question 4

S: Look for Subjective Evidence (S)

Answer 4

1) Interview the pt and/or family member about the HPI
2) Ask about the presentation of illness (timing, signs and symptoms, etc.)
3) Ask if the patient is on any medication, the past medical history, diet, etc)
4) Be alert for the historical findings because they provide important clues that help point to the correct diagnosis (or differential diagnosis)

Question 5

O: Look for Objective Evidence

Answer 5

1) Perform a physical exam (general or targeted to the present complaints)
2) If applicable, perform a physical maneuver (Tinels, Kernigs, Drawer, etc)
3) Order laboratory/other tests to “rule in” (or “rule out”) the differential diagnosis
4) If the laboratory test result is abnormal, you may be asked about the next step (such as a follow-up lab test that is more sensitive of specific)

Question 6

A: Diagnosis or Assessment (A)

Answer 6

1) What is the most likely diagnosis based of the history, disease presentation, and physical exam findings?
2) If applicable, figure out if the lab or other testing results point to a more specific diagnosis (or rule out a diagnosis).
3) Decide if the condition is emergent or not (if applicable)

Question 7

P: Treatment Plan (P)

Answer 7

1) Initiate or prescribe medications and symptomatic treatment (if applicable)
2) Patient education
3) Follow-up visit to assess response to treatment, etc.

Question 8

E: Evaluate Response to the Treatment/Intervention or Evaluate the Situation (E)

Answer 8

1) Poor or no response to treatment (or worsens). An exception is a strep pharyngitis patient who is not responding to amoxicillin after 3 days. Switch to second-line such as Augmentin or second-to-third generation cephalosporin
2) If emergent, refer to ED/call 911