Non-traumatic pain is a common chief complaint for most medical patients. The majority of non-traumatic musculoskeletal pain is related to the activity and overuse and does not point to or mask a life-threatening condition. General muscle soreness that is not related to overuse, is typically caused by an infection. Note that non-traumatic, non-tender chest pain may indicate a serious heart or lung problem and abdominal pain, while often benign, can also be quite serious. To determine the potential cause of their pain, follow the standard SAMPLE history format. Remember to ask all menstruating female patients if they are sexually active and, if so, what form of protection they use.
Physical Exam for Medical Problems
While there is no need to physically examine a medical patient head-to-toe as there is with trauma patients, you should explore all painful areas using gentle, firm pressure. Remember that pain and tenderness refer to different events; pain is a sign, tenderness is a symptom. When you ask a patient What hurts? and they tell you or point to a place on their body that hurts, that is “pain.” When you touch them somewhere on their body and they say. “Ouch,” that’s tenderness. While pain and tenderness frequently occur together with musculoskeletal injuries, it’s not unusual for a patient with a medical problem to report an area as painful, yet find that the area does not hurt when it is palpated.
Abdominal pain is a common complaint, that is often difficult to diagnose. There are three basic types of abdominal pain: visceral, somatic, and referred; each is serviced by a set of different sensory nerves. Visceral nerves originate from different levels on both sides of the spinal cord and are unmyelinated. Their nerve endings terminate in the walls of hollow organs and in the capsules of solid organs. They are stimulated by stretching, distension, and excessive contraction and produce a generalized dull pain or ache, which is usually described as crampy. In contrast, each somatic nerve originates at a specific level of the cord, is myelinated, and services a portion of the parietal peritoneum. Stimulation gives rise to a more specific, sharp, and intense type of pain that is seen as abdominal tenderness, guarding, or rebound pain. Finally, referred pain occurs when nerve pathways overlap, causing the pain to appear at a site away from its actual cause. Abdominal pain often begins as diffuse visceral pain, as an organ swells from inflammation, and then spreads to somatic pain, as the peritoneum becomes irritated. Patients suffering from severe abdominal pain typically present on their back or side with their legs drawn up and knees bent.
Vital Signs for Medical Problems
As with any patient, record multiple sets of vital signs; DO NOT skip any. A fever usually indicates an infection. Expect the patient’s pulse and respirations to increase slightly in the presence of a fever.
Evaluating Medical Problems
A three-step process for evaluating patients suspected of having a medical illness is discussed below. If possible, consult with a physician. When in doubt, take them out.
- Identify any urgent Red Flags and, if found, begin a level 1 or 2 evacuation (Refer to the tables below).
- Identify any conditions, such as heart attack, asthma attack, diabetic reactions, or anaphylaxis, that require emergency medications and, if possible, administer them.
- If NO urgent Red Flags exist, treat the patient’s signs and symptoms and begin a level 3 evacuation. Alternately, attempt to diagnose and treat the problem directly.
Consider carrying our waterproof field handbook, the Wilderness Medicine Handbook and our weatherproof Patient SOAP notes to help guide your thought process. Both are available for preview and purchase at our online store.