Approach To Patient

APPR OAC H TO ORTH OPA EDI C PATI ENT

Dr. Ashish Gohiya Assistant Professor Department of Orthopaedics & Traumatology

• The Doctor or hospital is not doing a favor by seeing the patient, the patient is doing a favor in the making of a doctor or towards the growth of the hospital www.esnips.com/web/gohiya

Fir st vi sit wit h the patie nt • Acceptance by the patient & relatives • Our approach

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Bio dat a of patie nt • Name • Age • Sex • Address • Religion • Occupation www.esnips.com/web/gohiya

Hist ory

•HIS – STORY •His Own language

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Pr ese ntin g Complain ts • Chief complaints • Chronological order 1. 2. 3. 4. 5. 6.

Pain Swelling Deformity Difficulty in movement Wound / sinus Constitutional symptoms

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H/O Pre se nt Illn ess • Patient was apparently alright -------- back. • Elaborate incidence of trauma in detail • Elaborate all presenting complaint in chronological order • Don’t add new complaint. www.esnips.com/web/gohiya

Pain 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Site Duration Onset Progression Character Severity Diurnal variation Radiation Relieving factor Aggravating factor Associated symptoms

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Swellin g 1. 2. 3. 4. 5. 6.

Site Onset Progression Painful / Painless Similar swelling elsewhere Associated symptoms www.esnips.com/web/gohiya

Defo rm it y 1. 2. 3. 4. 5.

Site Onset Progressing / static / regressing Attempts for correction Disability due to deformity

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Difficult y in mov eme nt 1. Onset 2. Progression In detail

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Si nu s 1. 2. 3. 4. 5. 6.

No. Site Relation with deeper structure Relation with skin Margin Discharge • • •

•

Color Nature Odour

Bony spicules www.esnips.com/web/gohiya

Pa st Histo ry • Earlier injury • Earlier infection • Tuberculosis • Syphilis • Leprosy

• No significant past history

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Tr eat me nt Hist or y • All sorts of treatment

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Pe rso nal Histo ry • Occupation • Addiction • Allergy • Marital status • Children

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Fam ily Hist ory • Similar illness in the family • H/O tuberculosis • H/O arthritis

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•Summarize History Examination

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Exami natio n • General Examination • Systemic Examination • Local / Regional examination

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Ge neral Ex amin at io n 1. 2. 3. 4. 5. 6.

Built Nutrition Pallor Cyanosis Edema Lymph nodes www.esnips.com/web/gohiya

Sy ste mi c E xam in ati on • CNS – Pt conscious, cooperative, oriented to time, place & person. • R/S – chest expansion normal, B/L vesicular breathing, no added sounds. • CVS – S1, S2 heard no murmur • A/S – soft, non tender, no organomegaly www.esnips.com/web/gohiya

Local Exam in ati on • Look • Feel • Move • Measure • Special test • Distal neurovascular status • Adjacent joint status www.esnips.com/web/gohiya

Look • Gait / Attitude • Look from different sides • Look for – Bones – Soft tissue – Skin • • • •

Color Scar mark Discharging sinus Dilated veins

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Feel • Temperature • Tenderness (Bone, joint, soft tissue) – Touch – Pressure – Thrust

• Palpate all tissues for any abnormality www.esnips.com/web/gohiya

Mo ve ment • Zero position , axis of movement • Active movement • Passive movement • Restriction of movement • Range of movement • Fixed flexion deformity • Fixed in flexion www.esnips.com/web/gohiya

Me asure me nt • Circumferential • Linear • Apparent • True • Segmental measurement

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Sp ecial test • Depending on the site and pathology

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Ex am in at io n in co mple te

•Distal neurovascular status •Status of adjacent joints www.esnips.com/web/gohiya

Et io lo gi cal c la ssifi cati on 1. 2. 3. 4. 5. 6. 7. 8.

Congenital Developmental Traumatic Infective / Inflammatory Neoplastic Metabolic Degenerative Idiopathic www.esnips.com/web/gohiya

Pr ob ab le D iag nosis • Causative pathology • Anatomical site • Duration • Stage arthritis • Complication flexion

-Tuberculosis - Rt Hip - 6 months - stage of - fixed deformity

300 • Treatment - untreated www.esnips.com/web/gohiya

Inve stig at io n • Routine investigation • X - Ray of the part

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De fin it ive Diag nosis Treatment

Rehabilitation

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THAN K YOU

• When life in danger – u r God

• When danger passes off – u r equal to God • When pain goes off

– u r normal huma

being • When bill is given – u r Devil www.esnips.com/web/gohiya