I See I Had ... Chief Complaint

 

Study Notes:

  1. 1.We need to be able to answer the question ‘What’s wrong’?

  2. 2.Be sure to “rule in/rule out” the big three: Altered Mental Status (AMS), Chest Pain (CP) and Shortness of Breath (SOB).

  3. 3.Ask about these with every patient.

  4. 4.The big three chief complaints focus on four critical organs.  AMS = brain (and pancreas), CP = heart, and SOB = lungs (and heart and blood).

Chief Complaint

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The next major question we need to answer is “What’s wrong”?  We often refer to this as the patient’s ‘chief complaint’ (which we abbreviate in charts as ‘CC’), even though it’s not always something that they are ‘complaining’ of.

There is some confusion between a persons ‘chief complaint’ and their ‘presenting condition’, and sometimes we use the two terms interchangeably. 

For example, if we respond to an elderly, chronically hypertensive patient who is complaining of a sudden onset of confusion, slurred speech and unilateral weakness it’s not uncommon for us to say that their ‘chief complaint’ is a stroke - even if the patient never actually ‘complained’ or having a stroke, or even ever used the word ‘stroke’.  In fact, the patient might not know what a ‘stroke’ is, but you’ll still hear medical professionals describing the patient as having a chief complaint of ‘stroke’. In reality, that stroke is the patients ‘presenting condition’, but you’ll still often hear medical folks describe it as a ‘chief complaint’.  Just be aware that that sometimes happens.

There are three chief complaints that we should inquire about with every patient, they are: altered mental status (AMS), ischemic-type/anginal chest pain (meaning the classic description of cardiac chest pain ... severe, crushing, mid-sternal chest pressure, radiating to the left arm or jaw, that worsens with exertion and may improve with rest) (CP) and shortness of breath (SOB).

Ask about these three in every patient.  No matter what the problem.  Even if it doesn’t seem likely - for example someone who burned their hand in hot water - ask anyway.  You need to know if any of these issues were a factor in the incident (maybe they burned their hand because they were about to pass out because they were confused or dizzy).  So ask every time.

The reason these three complaints are so important is that they help you to discover any conditions that might be life threatening.  People should not normally have altered mental status, anginal chest pain or shortness of breath.  If they do, it means something is wrong, and you need to find out about it. 

The three big chief complaints each are related to major, life-critical organs.  AMS often indicates a problem with the brain (such as a brain injury, stroke, or lack of blood) or a problem with the pancreas (such as diabetics with low blood sugar). Anginal chest pain obviously suggests some sort of problem with the heart, and shortness of breath can indicate a problem with the lungs, or the blood (an inability to carry enough oxygen to the organs, for some reason) or even possibly the heart again (such as, it’s not pumping enough oxygenated blood to the organs).

So, be sure to ask about these with every patient.  Did I say that already?

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