Resp

ID

cc: Chest pain/cough/wheeze

HPI

• Chest pain / discomfort

  • onset

  • duration

  • precipitants

  • aggravating & alleviating factors

  • quality (squeezing, crushing, pressure)

  • location (central chest or epigastrium)

  • radiation (jaw, arms, neck, abdo, back)

  • severity

    • Canadian Cardiovascular Society (CCS) Angina Grading Scale

      • I: Angina only during strenuous or prolonged physical activity (e.g. shoveling snow)

      • II: Slight limitation, with angina only during vigorous physical physical activity (e.g. > 2 flights of stairs)

      • III: Symptoms with everyday living activities; moderate limitation (e.g. walking to washroom, 1-2 flights of stairs)

      • IV: Inability to perform any activity without angina or angina at rest; severe limitation

  • frequency

• Dypnea

  • amount of activity (distance walking or flights of stairs before dyspnea)

  • NYHA Functional Classification

    • I: No symptoms and no limitation in ordinary physical activity (e.g. SOB when walking, climbing stairs, etc.)

    • II: Mild symptoms (mild SOB and/or angina) and slight limitation during ordinary activity

    • III: Marked limitation in activity due to symptoms, even during less than ordinary activity (e.g. walking short distances (20-100m). Comfortable only at rest

    • IV: Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients

• Wheezing (continuous,, course whistling sound)

  • circumstance (exercise, allergen, etc).

• Cough

  • Sputum

    • volume

    • colour

    • odour

    • consistency

  • blood

    • volume

    • colour (bright vs dard red or brown)

Associated symptoms

• Orthopnea

  • Ddyspnea when supine

  • Ask how many pillows used for sleep

• Paroxysmal nocturnal dyspnea

  • Sudden, severe SOB that wakes from sleep (associated with decompensated heart failure)

Risk factors

• Smoking

  • How much

  • How long - pack years

  • Previous

  • Quit attempts

  • Second hand exposure

Medications

• puffers

Allergies

• environmental allergies

Past Medical History

• Asthma

• COPD

• lung cancer

Social history

• Occupation

  • Job description, duties involved

  • Work place exposures

    • Biologic agents

    • Chemicals

    • Dust or fibres

    • Fumes

  • Personal protective equipment

    • Available?

    • Using appropriately

  • Symptoms in co-workers?

  • Satisfaction with work

• Community Exposures

  • Hobbies

  • Pets

FIFE