When a patient comes with a problem:
STEP 1: Assess
-See/inspect.
-Ask (what went wrong, what made him/her to seek medical support)
-History (brief, precise, to the point. No leading question. Take help from the attendant if the patient is minor, dumb, unconscious or psychologically unstable.)
-detect the major symptoms (from the clinical features. This helps to check & elicit the important signs)
-check the vitals: pulse, BP, respiratory rate, temperature.
STEP 2: Examine
>> Local.
>> Systemic.
>> Lab (blood, urine, stool, collections, pus, secretions etc) {consider the financial condition of patient.}
>> Imaging (x-ray, USG, scan, ECG etc) {consider the financial condition of patient.}
STEP 3: Manage
>>GENERAL:
-rest
-remove the factor that caused the disease.
-assurance
>>MEDICAL
-Analgesic (pain, acute inflammation etc)
-Antibiotic (systemic, local and topical: on the basis of lab finding.)
-Antihistamine (allergy, urticaria, mild hypersensitivity, hyper secretion.)
-Steroid (auto-immune, hypersensitivity, chronic inflammation, atrophy etc.)
-Fluid & electrolyte
-others.
Use of drugs is a bit complicated. Such as, there may be circulatory overload or insufficiency. What you going to do? In case of overload you can find edema, lung crepitations etc. You make the heart to beat slowly, use diuretic (if kidney & liver act normal) and monitor vitals, specially input and output. In case of insufficiency infuse fluid and electrolyte orally or I/V and monitor vitals, input, output. There is so much to write about this. But above mentioned are common.
STEP 4: Surgical Intervention
Only if the pathology is non-responsive to medical treatment or it is not treatable medically.
STEP 5: Follow Up & Re-assess
routine follow-up, re-assessment and re-evaluation is good for both, the patient & the doctor. It helps in better prognosis and necessary early intervention to the things that are going other than the normal track.
Md. Mukit Osman Chawdhury
Sunday, 11 July 2010
Chittagong
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