Introduction: History and Physical exam

The history and physical is arguably the most important aspect of diagnosis in medicine today, and takes on unique importance in a grid-down scenario, as you will have no other diagnostic tools at your disposal.  With this you tell the story of the patient’s illness. Importantly, it allows you to narrow down, from all the possible causes of your patient’s problem, a workable list.

For example: your patient presents with “chest pain”.

Well, crap.  The list of things that cause chest pain would require at least 3 full pages, single spaced in small font.  You don’t have time to wade through all that.  So you say: “Tell me about it.” (This is the History part)

–“Well, doc, you see, I fight in underground MMA tournaments, and while I was in the middle of an epic beatdown on some fool that thought he could hang with me in the octagon, he landed a lucky punch on my chest that really hurts.”**

in contrast to:

–“Well, doc, you see, I watch underground MMA tournaments, and was enjoying watching my favorite fighter put an epic beatdown on some young fool, I had this crushing, left sided chest pain, right under my breastbone, that extended out my left arm and felt just like my last 3 heart attacks.”**

Now that you have heard the history, you have narrowed down what you think might be wrong with the patient.  You then perform a Physical, which is the examination of the patient, and is obviously driven by what you heard in the history.

For the first patient, you would look closely for a bruise on the chest, feel for broken or dislocated ribs, and check for muscle tears.

The second person’s exam would note the morbid obesity, heavy smell of cigarette smoke, the scar on the chest from prior cardiac bypass surgery, and perhaps the cold and clammy skin, just before you called for an EKG and troponins.

These two H&Ps, as they are typically called, lead you down two very different paths.  They narrow down your list of All The Things In the Universe That Can Cause Chest Pain” (known as a differential diagnosis) into something workable, and direct what kinds of lab or imaging tests you would order (if you are working with modern, Western medicine) in order to confirm the diagnosis. Out in the wilderness, your test options are much more limited, and we will discuss as we go along what items you might bring along that would dramatically increase your ability to diagnose, without breaking the bank.

As a reference text, we will use Bates’ Pocket Guide to Physical Examination and History Taking, available here at archive.org, and will springboard to discussions about individual diagnoses as we meander through the various medical problems.

**Neither of these patients were invented.  I found it quite amusing to take care of both spectator and fighter on the same night.

One response to “Introduction: History and Physical exam

  1. Pingback: The rapid trauma assessment – part I | Hogwarts School of Grid-Down Medicine and Wizardry·

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