Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Chapter 24: An Approach to Illness

The nonspecific symptoms typical of many illness- es can generate a long list of possible diagnoses. Even in the emergency department it can be diffi- cult to determine exactly what you’re dealing with. In the backcountry it can be impossible. There is little value in working through lists of symptoms and descriptions of diseases just so you can put a name on your patient’s problem. The laboratory and CT scanner aren’t available to confirm your suspicions anyway. Your working diagnosis may remain as generic as “serious,” “not serious,” or “I don’t know.” As you evaluate an illness be sure to consider signs and symptoms in the context of the patient’s behavior. The simple presence of a fever, for exam- ple, will alarmmost people. But, you should worry more about a confused and lethargic person with a normal temperature of 37°C than about an active and oriented patient with a fever of 39°C. How the body and brain are working overall is more important than any specific sign or complaint. Generic Assessment of the Ill Patient A few quick observations and questions can help you make that important generic assessment: Serious or Not Serious? Your generic worry list

for an ill patient is essentially the same as that for trauma: Any pattern that suggests shock, respi- ratory failure, or brain failure needs immediate attention. The rate of progression of the problem can help determine the urgency of treatment or evacuation. A patient who has become gradually worse over the past five days is usually less of an emergency than the one who has become dra- matically worse over the last five hours. A patient who is improving (or at least is not getting any worse) gives you more time to evaluate the illness

1. Is there a critical system problem indicated by persistent respiratory distress, tachycardia, or altered mental status? 2. Is the patient responding appropri- ately to their situation? 3. Is the patient able to eat, drink, pee, and poop normally? 4. Is the patient in significant pain? 5. Are the symptoms getting better or worse?