Oral Presentations in Emergency Medicine This guide is

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ex endocarditis,pathophysiology of the DISEASE which causes. the chief compliant and a minor complaint,chief compliant minor complaint minor compliant. ex chest pain ex fingertip pain ex fever,Chronological Order of the Chief Complaint. Patient at the,time of the,What changed to make,the patient come in to. the ED on this,particular day,Illness progression,hospitalizations.
First episode of,or ED visits,Chief Complaint,related to CC. Order of HPI in the Oral Presentation,1st 2nd 3rd 4th 5th 6th 7th. The overall feel for oral presentations in the emergency department is to give concise. sentences in a bullet point like fashion taking this mentality will hopefully rid you of extra. words and phrases Most importantly is using a format that makes sense which will increase. fluidity and confidence of oral presentations,What does pertinent really mean. Before discussing the individual sections of the oral presentation the vague term of. pertinent must be clearly defined Often students are interrupted during their oral presentation. by the listener who says only give me the pertinent information or tell me what I need to. know to treat this patient These interruptions are likely due to the listener s frustration with. the medical student s regurgitation of too many facts Therefore it is critical for medical. students to become more proficient dividing all the facts into 2 categories pertinent and non. pertinent information The skill of labeling information as pertinent or non pertinent requires a. significant level of clinical knowledge therefore students will naturally have limited abilities. When students receive non helpful phrases such as only give me info that is related to the chief. complaint you should respectively ask the educator for specific explanations as to why a given. piece of data is or is not pertinent, Of note students should generally not duplicate presentations of senior residents or. attending because these instructors have mastered the oral presentation and might not use the. same format as required by medical students, Table 1 Illustrates one way how pertinent patient information is determined.
Complaint Possible etiologies of Pertinent Example phrases to be. complaint questions stated in the HPI,Have you ever had this Patient had similar chest. Chest Pain type of chest pain before pain a year ago. Does the chest pain Chest pain increases with,Coronary ambulation but decreases. increase with walk,Syndrome with rest,Is the chest pain sharp Chest pain is dull and. dull or burning in nature substernal with radiation. down left arm,Do you feel short of Patient does not have. breath shortness of breath, Pulmonary Does the chest pain change Chest pain is non pleuritic.
Embolism when you breathe,Have you ever had blood Patient has never had a. clots before deep venous thrombosis, The responses to the pertinent question column are pertinent by association and thus should be stated in. the HPI section not the ROS section of the oral presentation. Another way to determine pertinent information is as follows depicted in Figure A if you. believe a symptom complaint could be caused explained by the same pathophysiology that could. be causing the CC then by definition that information is pertinent Let s say the patient has. chest pain for a chief complaint During the review of system questioning the patient also. complains of fingertip pain Is the fingertip pain important enough to mention in the. presentation If you believe the fingertip pain is related to the chief complaint therefore. pertinent information then it is stated in the HPI On the other hand if you believe the fingertip. pain is NOT related to the chief complaint therefore non pertinent information then it is. mentioned in the ROS Since you have limited clinical knowledge for now all complaints. should be mentioned because experienced clinicians might be able to connect the pieces together. that students can not do yet, Let s say the previously mentioned finger pain resulted during a basketball game Since the. mechanism causing the fingertip pain trauma during a basketball game could not also cause the. patient s chest pain the fingertip pain is NOT pertinent to the chief complaint Therefore. fingertip pain should be mentioned in the ROS However if the medical student believes there is. a way the finger trauma could cause the chief complaint of chest pain then the fingertip pain is. pertinent information and should be mentioned in the HPI Of note any information mentioned. in the HPI should NOT be repeated in the ROS, Now let s say the patient is febrile and an intravenous drug user Now you believe the. patient has endocarditis which is causing the chest and the fingertip pain Since endocarditis can. cause the chief complaint see Figure C of chest pain and cause fingertip pain Osler s nodes. fingertip pain is pertinent information and should be mentioned in the HPI and not in the ROS. In other words if you believe any minor complaints which the patient usually mentions during. ROS questioning are being caused by the underlying process that could also cause the CC then. mention the minor pertinent complaints in the HPI If the minor complaints are not caused. by the underlying process that s causing the CC then the minor non pertinent complaints. should be mentioned in the ROS In summary students should mention all patient complaints in. the oral presentation However the difficulty is in what section should state the complaints in. the HPI or in the ROS,Chief Complaint, Quickly stating the CC prior to stating the one liner of the oral presentation orientates the.
listener If not mentioned the listener becomes frustrated due to not having a reference point and. thus stops paying attention It s like going to lecture and not being told what the lecture is about. Example The chief complaint is abdominal pain,History of Presenting Illness HPI. The HPI can be one of the most difficult sections for students due to the great variability of. styles Therefore Figure B and C were created to illustrate the difference between the patient s. chronological story Figure B and the oral presentation story Figure C There are 3 general. ways to present the HPI in the oral presentation,1 In order of importance. 2 Chronologically,3 No organization, For most attendings and complaints method 1 is the best way to deliver the HPI because. there are 2 unwritten but important rules in oral presentations. i listeners have limited memory space,ii listeners have short attention spans. Method 1 takes in account both of the above rules by having the most important information. and located at the beginning of the oral presentation illustrated by Figure C. The second most common and entirely acceptable method is method 2 The reason for. method 2 s less popularity is that 2 does not address the previously mentioned unwritten rules. of oral presentations When presenting in chronological order by the time the speaker gets to. describing the CC the listeners with their short attention spans and limited memory. space will not remember as many important facts On the other hand in some situations. method 2 will work better than method 1 but unfortunately only experience will help the. medical student decide when to use method 2, Method 3 is how many medical students give oral presentations All the information is in.
the HPI but in no particular order No attending wants to hear an unstructured oral presentation. Please avoid method 3 as much as possible, Most importantly by keeping Figure C in your head when you get interrupted with questions. you will not lose your place and you will know what section to mention next. a The One Liner, The point of the one liner is to state important patient specific stats to help clinicians stratify. certain disease risks in the patient The items always included in the one liner are the patient s. age sex pertinent medical history relating to the CC and the CC Do NOT use diagnostic terms. to describe the chief compliant If the patient complains of chest pain the CC chest pain The. CC does angina which is a diagnosis In my experience there are two pathologies that should. be in the one liner almost all of the time Diabetes Mellitus DM and Hypertension HTN. Why Because DM and HTN are very common in the general population and over time they can. affect every organ However DM and HTN can be left out of the one liner in situations where. the CC could not be caused by DM or HTN, Example of the one liner The patient is a age year old sex with a history of pertinent. PMH who presents with CC, The blue sad face represents the patient at the time of the interview The CC should be fully. evaluated location radiation what makes it better or worse Also this is where all the. positive and negative pertinent information goes In other words mention any complaints YOU. think are related to the CC And do not list any complaints if YOU believe they are not related. to the CC they go under the ROS section For example The chest pain is dull substernal with. radiation only to the left arm Chest pain gets worse with ambulation and improves with rest. and sublingual nitrogen The pain began this morning with three out of ten and now is eight out. Examples of common Chief Complaints, PAIN The patient describes the pain as out of ten and is located substernally hip big.
toe The pain is sharp dull pressure throbbing in nature which is exacerbated by. exercises inspiration but is alleviated by exercise rest medications. DIARRHEA The patient complains of diarrhea for the past days with approximately. episodes day The stool is color with no hematochezia melena The diarrhea is not. associated with food The patient does not complain of being ill prior to diarrhea. HEADACHE Pt complains of unilateral bilateral headache which began approximately. days ago The headache is throbbing continuous which is not associated with any. facial symptoms such as tears facial numbness No vision changes during episodes Patient. can not recall any triggers Headache is not preceded by auras or exacerbated by exercise. Why the patient came into the ED is an important piece of information that is often forgotten. by medical students Since the beginning of the patient s illness the patient has not sought. medical assistance but what happened to the patient to compel him her to come to the ED. Patients sometimes volunteer the information right a way I started having chest pain this. morning which I never had before so I decided to come in or I have had a headache off and. on for the past five years but last night the headache was totally different and woke me up It is. apparent in the previous two examples what changed to make the patient seek medical advice. new chest pain and different headache respectively But what about the following example I. been having diarrhea for the past three days It might be easy to stop here and say she came in. because she s having diarrhea for 3 days is tired and wants treatment But if no one asked. specifically why she came into the ED today and not yesterday or 2 days ago the medical. student would not find out that the patient noticed some blood in her stool this morning but has. not had one since and therefore did not mention it until specifically asked Then the patient gets. really emotional and states that colon cancer runs in her family and her father died around her. age due to undiagnosed colon cancer Yes you might get this info later on in the interview such. as FmHx BUT you might not, Example Patient came to the ED today because of pain became more severe pt. could not take it any longer family persuaded pt to come in medication stopped working. Every listener wants to know how long the patient has had the chief complaint The CC. duration is important because the ranking of the differential diagnosis will change depending if. the CC has been going on for 2 days versus 2 years Keep it short and sweet. Example The chief compliant started approximately time ago. The progression of the chief compliant is useful to relay how rapidly the CC is changing. Keep it big picture do not give too much detail The listener what s to know if the CC is getting. worse better or unchanging If the CC is getting worse tell how it s getting worse it the pain. lasting longer becoming more frequent does not respond to meds now Like wise if the CC. is getter better quickly explain how, Example Since the first episode the CC has been getting worsening improving unchanged. due to reason why CC is worse improved, Briefly mention previous hospitalizations or emergency department visits IF the prior. encounter is pertinent to the present CC What should be included is Prior CC related to. today s CC date of hospitalization ED visit pertinent test results CT MRI stress test. pertinent lab results cbc lipase LFTs Alc and discharge treatment. Example The patient was previously hospitalized for a similar chief complaint of chest pain 2. months ago Patient had ST elevation and elevated troponins Discharge diagnosis was Acute. Myocardial Infarction with medical management, The patient had a previous emergency department visit for a similar complaint of. right upper quadrant abdominal pain 2 days ago Right upper quadrant ultrasound then was. normal Patient sent home with the diagnosis of Abdominal Pain of Unknown Etiology with. Oral Presentations in Emergency Medicine This guide is designed to help medical students establish and refine their presentation skills with a focus on the emergency medicine presentation Please note that there are two key elements to giving presentations good feedback and flexibility of presenting style You should make sure to use this guide in concert with feedback you get from your

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