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Respiratory: History and ExplanationWelcome – Session Overview Presentations: o Respiratory History Taking o Explanation and Advice Having a go in break out rooms - Don't panic! This is the perfect opportunity to make mistakes, that's how we learn! Also, we know that everyone may be in different places with revision at this stage, so just let us know what you are comfortable with. Q and A – ask us anything you are worried or unsure about!A Structured History.... WINDEC History of Presenting Complaint Systemic Enquiry ICE Past Medical History Medication History and Allergies Family History Social History Thank the PatientHistory of Presenting Complaint SOCRATES- O: When did the shortness of breath/cough start:- (Try and establish time course and frequency of symptoms in your mind) Did it come on suddenly or gradually? What were you doing at the time? C: Can you describe the cough for me? Can you describe what the shortness of breath feels like? Does the shortness of breath come and go? A: Are you experiencing any other symptoms at the moment? ('when you have these episodes of shortness of breath, do you have any other symptoms?')('are there any other symptoms that seem associated with the cough?')Extra Notes: Cough Character When you are coughing do you bring up any sputum? What colour is it? Very Important: Do you ever cough up blood?§ T: Has the cough/shortness of breath changed over time? § ('is the shortness of breath worse at a particular time of day?') § E: Does anything make it better? Does anything make it worse? § S: How is the … impacting your quality of life right now? How severe on a scale of 1/10? § (If you were walking on a flat level, how far would you predict you would be able to walk?) § (Are you waking up at night?) § --(For shortness of breath you can assess by ability to complete sentences)Systemic Enquiry: Resp Focused RESPIRATORY SYMPTOMS: Cough- if so any blood Shortness of breath Wheeze Chest Pain SYSTEMIC SYMPTOMS: Fever Weight Loss Night Sweats Fatigue ALSO: Orthopnea, PND, Presyncope, SyncopeICE- (Here or at the end) ICE- Very important and very helpful for you. Ideas: Do you have any ideas about what might be causing your symptoms? Concerns: Is there anything you are particularly concerned about? Explanation: Is there anything you were expecting or would like to get out of this discussion/consultation?Past Medical History Do you have any medical conditions? Is there anything that you regularly see your GP for? Have you ever previously undergone any surgery or procedures?Medication History Do you take any regular medications? Any inhalers? Do you take any medications over the counter? Are you allergic to any medications? (If yes) What kind of reaction do you have? Vacination History Family History Do any of your parents or siblings have any lung problems? Do any lung conditions run in your family?Social History Explore general social context:- -type of accommodation -who else lives with them and their social network (are they well at the moment) -pets (-how is their mobility, any carers) Occupation Do you work at all? (If retired ask what they used to work as?) 'Do your symptoms change when you are away from work?'Social History cont. Smoking History:- Looking to establish no. of pack years (I may be tempted to ask this first...) pack-years = [number of years smoked] x [average number of packs smoked per day] one pack is equal to 20 cigarettes Vaping and e-cigarettes Alcohol Recreational Drug Use Exercise DietAny Questions so far?Format of Breakout Rooms You will be put into breakout rooms of 3. One will be the patient, one will be the doctor and one will be the examiner – you will each be given a file with the scenario/marking scheme for your role. You will have 2 minutes to read the scenario, 6 minutes to do the task, and 2 minutes for feedback – whoever is the examiner, keep track of time – feel free to move on when you're ready The tutors will pop in and out of your breakout rooms to observe and give their own feedback. Ask any questions you have! Don’t be scared! We all hate OSCEs and roleplaying but the only way to get good at it is to practice.Respiratory Explain and Advice WINDEC Short history – not as in depth as a full history enough so you can personalise the explanation to the patient Symptoms, presentation, timeline Social history – occupation, smoking, etc. What do they already know? What do they want to know? ICE!! Normal physiology – keep it simple! What is the disease? Mangement – what we can do, what you can do Complications Safety netting Thank the patientAsthma – Example Normal physiology Air comes in through your mouth and down into your lungs. As you get further down, tubes carrying air gets smaller. When air reaches the smallest tubes, oxygen is absorbed into your blood so it can help fuel the rest of your body. What is the disease? What happens in asthma, is these tubes are narrower than usual and that makes it more difficult for the air to get in and for oxygen to be absorbed. This is due to inflammation and increased mucous production. BLN is because you cannot get enough air into your lungs Wheeze is due to air whistling through small tube Cough is due to irritation of narrowed airways Your asthma can be exacerbated by exercise, allergens, viral infection, change in weather, smokingAsthma – Example Management Reliever inhaler - usually blue and usually salbutamol (beta-2-agonist) - bronchodilation (opens airways) Preventer inhaler - usually brown - corticosteroids to reduce inflammation Need to rinse after a steroid inhaler to reduce side effects. Smoking cessation, including second hand smoke; allergen avoidance; weight loss Asthma plan – it tells you and other people what your normal asthma medicines are, what to do if your symptoms are getting worse and what to do in an emergency situation Complications Acute asthma attack – if you are having symptoms that do not improve with 10 puffs of your reliever inhaler, call 999. This is an emergency! Remember, this can be difficult for patients to hear so make sure to be empathetic and ensure they have understood properly.General Tips Demonstrate empathy and show your communication skills! If you are friendly, polite and approachable, you will be off to a great start! Remember to repeat things back to the patient and summarise ‘You mentioned earlier you have been having chest pain, can we talk a bit more about that?’ ‘Just to make sure I haven’t missed anything, you said you have been having 2 weeks of breathlessness and chest tightness, mostly when you exercise or when it’s cold outside. Is that correct?’ Check in with the patient regularly to ensure you are on the same page ‘We have covered a lot today, is there anything you would like to ask me?’ ‘I understand hearing that can be difficult, are you okay?’ History Scenarios You are a 2 ndyear medical student on placement in general practice. You have been asked to take a history from a 14 year old girl regarding recent breathlessness. You may have up to 2 minutes to prepare, and then will have 8 minutes to take a history. You are a 2 ndyear medical student on placement in general practice. You have been asked to take a history from a 68 year old man regarding a recent cough. You may have up to 2 minutes to prepare, and then will have 8 minutes to take a history.Questions?Feedback Please take a minute now before you leave to fill in a quick feedback form: https://app.medall.org/fe edback/feedback- flow?keyword=85dda4bf362 1868dab355ce9&organisatio n=accessibility-in-medicineThank you for coming! If you have any more questions, feel free to email me at s2144801@ed.ac.uk, or email accessibilityinmedicine@gmail.comThank you to our sponsors: