EYE
- Eye pain (e.g. sharp pain)
- Sensitive to light
- Vision lost
- Trauma or injury to the eye
- Spread to one eye (unilateral/bilateral)
* Sx affect one eye rather than both - Yellow discharge, crusting
- Blurry vision that does not clear on blinking
- Foreign body sensation
- Any eye surgery
- Sx significant and pt wears contact lens
- History of ocular disease
- Intense redness in eyes
HEADACHE
- Trauma to the head
- Stroke (FAST)
- Infection
- Psychiatric disorders - mood or behavioral changes
- Cluster headache - red watery eye, runny nose
- Progressive headache (worsening)
- Eye pain
- Seizure, loss of consciousness
SNNOOP10
pain
- Infection - fever, night sweating, chills, unintended weight loss
- Neurological cause - numbness, muscle weakness, loss of bladder control
- Cancer - FH/PMH
- Mechanical - Loss of range of motion
gerd
- MI (radiating chest pains)
- Pneumonia
- Asthma
- ALARM:
* GI bleed (coughing of coffee-ground like substance, black tarry sticky stools)
* Pain or difficulty swallowing
* Unintentional weight loss
* Anemia, jaundice - Possible medication related
- Extra-esophageal (cough, sore throat, wheeze, SOB, enamel erosion)
- Mod-severe GERD ≥3wx/ wk with significant impact on QOL
constipation/ diarrhea
- Blood in stool
- Severe abdominal pain
- GI bleed (coughing of coffee-ground like substance, black tarry sticky stools)
- Anaemia, abdominal masses, rectal masses, unintentional weight loss, fever
- Mucus stool
skin
- Secondary bacterial infection (pus, fever)
- Suicidal
- ABCDE for skin malignancies
* Asymmetrical lesion
* Border irregular
* Colour, pigmentation
* Diameter >6mm
* Evolving - SJS/TENS, DRESS skin peeling, blistering
- Discolouration of skin & severe pain (necrotising fasciitis)
- Spreading
- Widespread rash
ear
- Trauma
- Fever
- Discharge
- Loss of hearing
- Dizziness/vertigo
- Recent ear surgery in past 6 weeks
- Foreign objects
URTI
- Sore throat: GAS: white patchy exudates in the throat, swollen/tender lymph nodes
- Infection: Fever, night sweats, UWL
Cough: - Asthma, CVD, HF
- Coughing of blood
- croup/ barking cough (child)
- Chronic cough with sputum >3mnths
- a/w GERD
- a/w drug (ACEi)
- Foreign object aspiration
Nasal-related - Nose bleed
- Loss of smell
- Facial pain/fullness, severe headache, eye pain
- Chest pain, SOB
- Frail pt, advanced age
- Infant <1yr
AR
- Child <12, unless dx by dr for AR alr
- Preg
- Facial pain
- Mucopurulent nasal discharge
- Severe headache, eye pain
- Uncontrolled asthma, shortness of breath
- Nose bleed
- Loss of smell
- Unilateral symptoms
- Severe impair daily activities ≥4days/wk and >4wks/ep
* Disturbed sleep, daily activities, sports, problem at work/ school, disturbing sx - Sx of otitis media, sinusitis, bronchitis, other infections
- Sx of undx asthma, COPD (wheeze, SOB)
eye counsel
Eye: cool compress (itch), warm compress (drain), vit A (AREDS), don’t rub, contact lens hygiene, artificial tears
skin counsel
Skin: don’t pick, scratch, wash face BD, non-comedolytic pdts, moisturise (emollient therapy), occlusive clothing, avoid irritation (temp, humidity, soap)
GIT counsel
GIT: probiotics, hydrate, BRAT (banana, rice, applesauce, toast), yoga, relaxation, gum
GERD counsel
smoking cessation, weight loss, irritant food (spicy, acidic juice, coffee, carbonated), decr LES food (fatty food, alcohol, chocolate). Meds that irritate esophageal mucosa (tetra, bisphos, quinidine, Fe, aspirin, NSAID – or take with a lot of water), sx after eating (take smaller meals, avoid lying down immediately), 6-8inch under head when sleep, avoid tight fitting clothes
constipation counsel
fiber 20-30g (prunes gt sugar), suppl, respond to bowel feedback, hydration, exercise, posture
diarrhea counsel
hydration
electrolytes
avoid raw, uncooked food
ear counsel
Ear: prevent water in ear (dry/ shake out), do not manual/ insert anything into ear, irrigation, clean hearing aids
URTI counsel
prevent spread of infectious disease (hand wash, mask, disinfect), flu vaccination (esp ≥50yrs immunocomp, CVS, pul, metabolic disease, preg – inactivated vaccines), saline nasal wash
Humidifier, hydration, irritant (smoke, dust, pollutant), rest
AR counsel
triggers, animal dander (HEPA), dust mites (wash warm water, dryer hot setting, humidity), cockroach (clean), mould (humidity, water leakage), saline
headache counsel
prevent trigger (stress, activity locked position, alc, caffeine), hydrate, exercise, SLEEP
pain counsel
Prevention (physical exercise – taichi, swim, muscle, flexibility, weight), posture, sitting posture, lifting (bend knees)
RICE
(hot compress for back sprains, sprain after ICE 2day)
Sleep hygiene:
same time, avoid large meals 2hr and fluids before bed, regular exercise, room dark quiet ventilated, avoid using bed for other activity, routine to get ready for bed, relaxation techniques, avoid caffeine, nicotine, alcohol
antidep counsel
improve mood and energy. antidep discontinuation syn (FINISH, taper over few wks.
Less with Fluo. Most with Paroxetine, Venla – short t1/2)
- Suicidal thoughts (call emergency)
o All S: GI, sexual dysfunc.
o Venla: HTN
o Mirt: sedation, weight gain
o Bupropion (no S): not for seizure, psychosis, eating d/o
o TCA: poor tolerability, sedate, Ach, OH, arrhythmia, seizure - Non-pharm: sleep hygiene, psychotherapy, ECT (severe)
o Duloxetine (DM peripheral neuropathy, fibromyalgia, chronic MSK pain)
Antipsychotic: thought organiser counsel
- Drowsy, dizzy, MUSCLE NMS (lead pipe rigidity, CK fever, confuse, tremor, muscle stiff), EPSE, GIT, dry mouth, constipation, sun sensitivity, blur vision, restless, infection (clozapine)
- Non-pharm: dystonia – Ach, low potency QUET/ Akathisia – clonazepam, propranolol, SGA/ tardive dyskinesia – irrever if too late, discont Ach, switch to SGA, tx valbenazine.
o Metabolic SE (dysLDL statins, metformin), SGA
anticholinergic counsel
- Some Antihistamines may cause drowsiness or dizziness
Avoid driving, operating machinery or other activities which require concentration while on this medication - Dry mouth, skin and eyes
Drink more water or suck an ice cube to help with mouth dryness
Use moisturising eye drops to resolve eye dryness - Difficulty in passing urine
Stop taking Antihistamines and consult your healthcare professional for other alternatives - Confusion in the elderly or very young children
Stop taking Antihistamines and consult your healthcare professional for other alternatives
