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Outline
The OLD CARTS mnemonic helps remember the health assessment steps for a patients current condition:
Onset
Ask the patient questions that can help you learn when exactly they began experiencing the problem. Be very specific with your questioning with items like “Did the pain begin a week ago or today? If the pain began today, what time of day did it start- was it morning or afternoon?” Narrowing the questions down to the specifics helps you establish a clear history.
Location
After identifying when the problem began, the next step is to determine where the pain originates from. Once again, it’s essential to specify your questions and localize the pain. This will help you immensely during the physical exam aspect of the interview.
Ask the patient if they can point to or describe the specific regions the issue is happening. “Is it the abdomen? Is it the left upper quadrant? Or is it the left side of your head?” You can also encourage them to point to the area with one finger.
Duration
The next step is to determine how long they have had the pain. Narrow the duration to specify times such as hours, days, or even weeks. Finding out about the period helps you determine whether the illness is acute or chronic.
Character
Give the pain some character and familiarity. The critical thing is always to be specific and ask them to describe what type of pain they are experiencing. Pain can be categorized in several ways, including:
- Sharp knife-like
- Stabbing
- Cramping
- Aching
- Dull
- Shooting
Alleviating
Ask the patient if they have tried doing things that help alleviate the issue. For example, if they have undertaken any therapeutic measures to help with the problem, follow it up by asking if any of the efforts have helped ease the pain or have made it worse. Such factors might also include the use of medications.
Inquire if they feel anything when consuming certain types of food, such as spicy, acidic, or fatty foods. Don’t forget to inquire about the consumption of alcohol and other caffeinated beverages.
Radiation
Ask them if the pain spreads to other parts such as the neck, arms, or shoulders.
Temporal patterns
Ask the patient whether they have noticed a specific pattern when it comes to the problem’s recurrence. Inquire whether the pain appears every morning or evening? “Does it happen after eating a particular type of food? ”
Symptoms
The final step in the OLD CARTS method is to learn whether there are symptoms associated with the pain. Inquire whether the symptoms occur during or after the pain and if there are other associated issues, such as vomiting or diarrhea. This helps you learn where the pain stems from as it could be coming from various organ systems, so including such questions comes in handy.
Once you’ve used the OLD CARTS mnemonic, you’ll easily be able to uncover the patient’s symptoms which may read as follows:
“The pain started two months ago and mostly occurs whenever the patient indulges in caffeinated drinks. It, however, rapidly disappears when they drink water and rest for a while. When it occurs, they report feeling a burning sensation in their stomach that’s roughly a six on a scale of 1 to 10. Over the last two weeks, they have felt the pain about eight times, while it only happened twice in the first week. The patient has reported ever experiencing this same type of pain, likening it to severe heartburn during pregnancy. They have taken over-the-counter medications before to help ease the pain before finally coming in for a checkup.”
As you can see, this is plenty of information to go with. With additional experience, learning and exposure, you will be able to identify an effective line of questioning to help you achieve an accurate diagnosis.
You can focus your physical exam searching for any physical signs that would support your diagnosis. Always remember that everything comes with time and experience, and so is recognizing symptoms for various illnesses.
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