Good call on fleshing out the history!
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Originally Posted by x SF med
I noticed that the Hx kind of bypassed the time frame for this attack (onset, severity increase over time, and loss of mobility over time, what helps what aggravates),
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As noted, there was no clear precipitating incident, and the onset was gradual over a few days. The pain has continued to increase, and this morning it was the worst its been. The patient is clearly in discomfort, exacerbated by movement, especially flexion.
Quote:
Originally Posted by x SF med
and the timing/severity of other similar attacks for the Pt... Are the attacks consistent, when was the first remarkable attack he can remember, excluding 'normal' training pain.
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The patient has had sporadic lower back pain in the past, typically associated with heavy leg days. However, this feels "different." As noted, he first noticed this pain a few days ago. You are one week in country.
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Originally Posted by x SF med
Have there been any remarkable changes in activity, medication, hydration. Has the Pt been at depth or altitude for long periods in the recent past? Do altitude or depth change the symptomology? We know the big green tick or armor will change things / aggravate symptomology, but.... to what degree has this changed, and does it scale the pain or refer it to other areas. What are the postural locations that aggravate or relieve symptomology, in any degree.
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The patient had been in "normal" SF pre-mission training (lets say various vendor schools and other team training). Now, the team is out at ranges all day every day training the LNs. No significant depth or altitude exposures (team flew commercial FWIW). PT admits he hasn't been drinking enough water. Medications as noted.
Wearing body armor or carrying gear is particularly unpleasant. No ruck training, but he has been wearing body armor for much of the range training. He prefers sitting with a fairly straight posture. As noted, all movement exacerbates the pain, but flexion most of all.
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Originally Posted by x SF med
Ok, those are my add ons to the Pt Hx questionnaire and where I'd go with the phys exam...
(Is this going to be a Rocky Farr question... with an answer like "He's been eating a 1/4 lb of black licorice a day for the last week?"... huh Ender? If it is, I know where to find you... and this time it won't be pleasant...  ) |
I promise this won't be a complete Zebra.
