Specific Presentations history taking

Question 1

Seizures

Answer 1

Hx epilepsy, seizure medications (compliance)
Description - generalised, absent, partial, tonic, clonic, myoclonic
Duration, frequency
Usual seizure and post ictal presentation - compared with current.
Assess for injury.
Assess for cause(ie. drug/alcohol, epilepsy, trauma, NTBI, hypoxia)associated symptoms ie. post ictal (drowsy, altered conscious), incontinence, nystagmus

Question 2

Asthma

Answer 2

Hx asthma
Asthma mx plan - have they followed it, last medication admin
Are they on medication for their asthma - reliever, preventer, ICS
Do they know what triggers it?
Risk factors:
- thunderstorm
- 2 hospital admins for asthma in past year
- previous icu admission for asthma
- past hx of severe asthma
- previous intubations for asthma

Question 3

COPD

Answer 3

HX COPD? (suspected in >40 w/ hx smoking, dyspnea, cough).
Medications for COPD? Relievers, preventers, ICS
Currently on antibiotics?
Home 02? Litres?
Normal spo2?
Risk factors?:
- smoking
- end stage copd
- current respiratory infection (fever, myalgia, lethargy, headache, cough, sore throat, pleuritic chest pain)
- previous hospital admits/icu/intubations for copd

Question 4

Pneumonia

Answer 4

Prodromal symptoms - unwell for a few days with infective symptoms ie (fevers, chills, myalgia, lethargy, headache, cough, sob)
Hx respiratory conditions ie. COPD, asthma, cancer
Currently on ABs?
Risk factors:
- elderly
- chronic medical conditions ie COPD
- Immunocompromised - chemo, organ transplant
- infants
- indigenous

Question 5

PE

Answer 5

History is the biggest indicator of PE for prehospital
Sudden onset Pleuritic Chest pain w/SOB and clear chest
Risk factors:
- hx of PE
- Suspected or known DVT (pain, redness and swelling in legs)
- recent period of immobility (ie sedentary lifestyle, long haul flight)
- pregnancy
- long bone fractures
- oral contraceptive

Question 6

ACS

Answer 6

Hx angina, AMI and when (stents, cabgs)
Hx cardiac investigations ie; stress test, tilt test, angiogram - findings?
Other cardiac hx - cardiomyopathies, valvular disease
Hx heart book?
Risk factors:
- HT, HC, diabetes, Age, Smoker, Family hx, Obesity

Question 7

Aortic aneurisms

Answer 7

Hx of known aneurisms (size, last scan)
Hx of Ht or other CVD risk factors

Signs and symptoms
Tearing CCP or abdo pain radiating into back
pulsating mass
Syncope
Hypotension, tachycardia, Pallor, diaphoresis
Motor/sensory deficit in lower limbs

Question 8

APO

Answer 8

Hx heart failure, AMI, Cardiomyopathies
Hx fluid on lungs
Fluid tablets (amount per day, compliance)
Fluid restrictions
Current ACS presentation
Worse laying down
Exertional dyspnea

Signs:
Peripheral oedema, hypertension, fine crackles, hypoxia.
Consider cardiac wheeze

Question 9

Mental Health

Answer 9

I understand you have been having a tough time lately, do you mind if i ask you a few questions about whats being going on?

What has happenned today/ why have you called?
what is your biggest concern at the moment.

Hx mental ilness - how have they been coping, access to support, triggers
Medications - compliance, changes
Suicidal thoughts/homicical - plan, intent, means, have they done it, previous attempts
auditary/visual hallucinations - what are they, is this normal, anything new
drug/ etoh use - what, when, how much
thoughts of harming others, weapons

care plan?

Question 10

Stroke

Answer 10

Symptom onset time
Independent with ADLS? (washing, toileting, changing, feeding,, mobilising, transferring)
CVD risk factors of thromboembolic stroke

Question 11

Croup

Answer 11

History of severity