Question

1. explain the difference between a sign and a symptom. 10. you are caring for a 24 - year - old male with a pertinent sexual history. what questions should he be asked as part of your history taking? ambulance calls the following case scenarios provide an opportunity to explore the concerns associated with patient management and to enhance critical - thinking skills. read each scenario and answer each question to the best of your ability. 1. you are dispatched to a motor vehicle collision where you find a 32 - year - old man with extensive trauma to the face and gurgling in his airway. he is responsive only to pain. you also note that the windshield is spider - webbed and that there is deformity to the steering wheel. he is not wearing a seat belt. how would you best manage this patient? what clues tell you the transport status? 2. you are dispatched to a local residence for “difficulty breathing.” you find a man standing in his kitchen, leaning against a counter in a tripod position, and holding a metered - dose inhaler. as you question him, you see that he is working very hard to breathe, hear wheezing, and note that he can answer you with only one - or two - word responses. what is the transport status of this patient? 3. you are dispatched to “man fallen” at a private home. you arrive to find an older man who appears to have fallen down a flight of wooden stairs onto a cement basement floor. he is responsive to painful stimuli, has bruising, and has a small laceration above his left eye. how would you best manage this patient?

Explanation:

1. A sign is an objective indication of a disease or condition that can be observed by others (e.g., a rash, abnormal vital - signs). A symptom is a subjective experience reported by the patient (e.g., pain, nausea).
2. Questions could include: number of sexual partners, use of protection, history of sexually - transmitted infections (STIs), last STI test, any current STI symptoms, history of genital herpes or other recurrent STIs, and if in a monogamous relationship, partner's sexual history.
3. First, ensure airway patency by suctioning to clear the gurgling in the airway. Immobilize the spine due to the high - energy mechanism of injury (motor vehicle collision, non - seatbelt use, deformed steering wheel). Transport as a high - priority patient due to extensive facial trauma and altered mental status (responsive only to pain). Clues for transport status: extensive trauma, airway compromise, and altered mental status.
4. The patient is in significant respiratory distress (tripod position, hard work of breathing, wheezing, limited verbal responses). He should be transported as a high - priority patient to receive more advanced respiratory care.
5. First, assess and manage the airway, breathing, and circulation (ABCs). Immobilize the spine as a fall from stairs can cause spinal injury. Control bleeding from the laceration. Transport the patient for further evaluation and treatment, especially to check for possible head and spinal injuries given the fall and the patient's age.

Answer:

1. A sign is objective; a symptom is subjective.
2. Number of sexual partners, use of protection, history of STIs, last STI test, current STI symptoms, history of recurrent STIs, partner's sexual history.
3. Manage airway, immobilize spine, transport as high - priority. Clues: extensive trauma, airway compromise, altered mental status.
4. Transport as high - priority.
5. Assess ABCs, immobilize spine, control bleeding, transport for further evaluation.