DIRECTED HISTORY AND EXAMINATION

In the setting of the emergency management of a seriously ill patient, traditional history taking must be modified so as to be directed and focused on he patient's immediate illness. For example, an extensive systems review and family history are not initially necessary when managing a patient with acute asthma.

Similarly, a full neurological examination is not appropriate on a patient who has epiglottis. In the seriously ill patient, a history and examination, which are directed save time and will prevent a loss of focus on the patient's most immediate needs.

1. HISTORY

     Ask about :

• EVENT - duration and onset of symptoms
• SYMPTOMS - pain, dyspepsia, cough etc
• PAST HISTORY

2. EXAMINATION

A focused clinical examination is performed.

3. SPECIAL INVESTIGATIONS

4. MONITORING

ECG, pulse, blood pressure etc

COMMENCE SPECIFIC TREATMENT

After the stages of initial stabilization and directed history and examination, most seriously ill patients will require a small number of pivotal interventions or treatments, which are often time critical. For example, the giving of antibiotics to a patient with sepsis or the commencement of dehydration and insulin in diabetic patients.

DISPOSITION

This can be a deceptively difficult and time consuming stage of the emergency management of the seriously ill patient. However, the essential components of this stage are good communication with staff who will be responsible for the ongoing management of the patient, and vigilance concerning repeated assessment of the patient.