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-=-=-=-=-=> [這篇文章最後由JuanFe在 2018/05/11 07:14pm 第 1 次編輯] TELEPHONE ENCOUNTER Doorway information about patient The patient is a 5-year-old boy who has been vomiting for a day , his mother has left a phone message with the clinic . You will talk with the patient’s motor on the phone Approach to the patient To begin a telephone encounter , press the yellow speaker button.Introduce yourself to the patient (or caregiver) and conduct the medical history as yo would in a regular encounter . Physical examination is not possible m but you should obtain enough information to formulate a differential diagnosis and determine the appropriate next steps in patient care. Do not dial any numbers and do not press any other buttons on the phone as these amy disconnect the call . When you are finished , end the call by press ion the yellow speaker button ago an . Once you disconnect the call (intentionally or unintentionally) , you are not permitted to call patient again. Different diagnosis The most common cute of vomiting in children age >1 year is viral gastroenteritis . Suggestive factors includes sudden onset , contact with similar cases , abdominal cramps , and diarrhea . Moderate fever is common . Blood in the emesis or stool warrants additional concern. Other causes of vomiting in children include toxic ingestion , upper respiratory illness (eg, otitis , pharyngitis ) ,obstruction , increased intracranial pressure ,(eg, tumor , hydrocephalus ) . and ,metabolic disorder (eg, diabetic ketoacidosis , adrenal insufficiency). HISTORY History of present illness . How old is your child ? . How long has he been vomiting ? . How many times has he vomited today ? . Has he been vomiting late amounts ? . What dose the vomit contain ? . Did you notice any blood in the vomitus ? . Dose he have any pain in his belly ? . How are his bowel movements ? . Dose he have a fever ? . How is his appetite ? . Did he eat out recently , such as a party or restaurant ? . Dose he have any headaches ? . Is he usually a healthy child , or dose he get sick frequently? . Has he been exposed to any sick contacts? . Has he had all of his recommended vaccinations ? Past medical history . Has he ad similar problems previously ? . Has he had any other medical conditions or surgeries ? . Were there nay problems at brith or during the pregnancy ? Medications/ allergies . Dose he take many medications (prescription and over -the -counter )? Family history . How old are you and dos father ? . Do either of you have any medical conditions ? . Dose he have brothers and sisters ? . Do they have any medical conditions ? Social history . Who dose he live with ? . What grade is he in school ? . Is he OK in school? Closing the encounter Clinical features that may indicate a potentially serious cause of vomiting in children include . Prolonged course (>48 hours in children age > 2 years ) . Lethargy or altered consciousness . Neurotic symptoms (eg, seizure , focal symptoms) . Symptoms of obstruction (eg, dissension , feculent vomiting) . Symptoms of increased intracranial pressure (eg, headache , vomiting without nausea , vomiting triggered by position change) Disposition (eg, admit to hospital ) is not tested as part of USMLE Step CS exam. However , any of the above warning sign warrant additional evaluation , including an in-person clinical assessment . the patient should be advised to have the cild evaluation as soon as possible .If the child is stable , you can counsel the parent to encourage fluid intake with continued observation . Explain that the parent should call again (or you will call the parent) at a specified time. -=-=-=-=-=>
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