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GP week 1Back pain history • Pain = Socrates • Need to nail down the time frame – get dates • Ask about any falls or strains, do they work out or have they tried a new work out recently • What do they do for work • Morning stiffness • Any other pain in other joints • Use of intravenous drugs • Weakness, loss of sensation, change in balance • Incontinence • Weight loss, fever night sweatsRed Flags • New onset incontinence • Saddle anesthesia • Muscle weakness in legs • History of cancer • Weight loss • Non-mechanical • Night time pain • Age > 20 • Thoracic back pain • Intravenous drug useYellow flags • Negative attitude that their backpain is serverly disabling • Belief that activity is harmful to recover • Belief that passive treatment will be beneficial • Depression and social withdrawal • Financial difficultiesCauses to consider • Mechanical – no red flags, pain worse on movement, previous episodes, minor trauma • symptomslapse – sudden onset while straining back, sciatica, neuro • Cauda equina – urinary and fecal incontinence, saddle anesthesia • Malignancy – prev history of cancer, b symptoms, gradual onset • Osteoporotic fracture – osteoporosis (or risk factors), sudden pain after minimal trauma • Discitis – fever, IVDU • Ank Spond – under 30, early morning pain and stiffness which improves with exercise • AAA – tearing backpain of sudden onset, man>55Back pain station 1 Please see 55-year-old Jane who has come to the GP surgery to see you regarding some back pain she’s been having. Take a history and advise her on the next steps in her management.Back pain station 2 Please see 55-year-old Jane who has come to the GP surgery to see you regarding some back pain she’s been having. Take a history and advise her on the next steps in her management.Palliative prescribing • Pain – opioids normally starting with oral morphine • Secretions - hyoscine hydrobromide or hyoscine butylbromide • Agitation and confusion – midazolam • Nausea and vomiting – haloperidol • interCrainial – cyclizine • Decreased gastric Motility – metoclopramideConversionsSyringe Drivers Indications for use of a syringe driver in patients nearing the end of life include: • a 24 hour period more doses of any one of the anticipatory medications in • release opiates, anti-epileptic medications)eed replacing (e.g. modified • Continuous infusion provides a constant level of medication to the patient, which helps to achieve better symptom control. • Only medications that a patient has required are put into a syringe driver. Therefore, regular reviews are important as they may still require further ‘as required’ doses of medication on top of those in the syringe driver. the other anticipatory medications.hey are already receiving or one ofAlcohol History Current use • How much are you drinking – exact numbers are needed • What are you drinking (big difference between 1 bottle of wine and 1 bottle of vodka) • When are you drinking - get a timeline • Where – home, pub, alone? • Why – social, emotional ect… Repeat for previous use, if there has been a change why? Also include any previous attempts to quit and what happenedAlcohol history Social • Effect on work and relationships • Do they drive • Do they have children • Trouble with police • Do they use any other substancesAlcohol history Physical symptoms • Tolerance • Withdrawal symptoms – tremor, sweating, nausea ect… Psych • Compulsion • Effect on mood • MUST RISK ASSESSAlcohol History Everything else • Past psych history • Past medical history • Drug history • Family history – anyone else struggled with addictionAlcohol station Rebecca has come into the GP today to speak to you regarding her drinking. Please take a history and assess her motivation for change.