Chapter 9. Taking a medical history
In medical illness, the history affords 70% of the information on which most diagnoses are made.
The history is thus much more important than the physical examination in establishing a diagnosis.
Assessment and correction of any problems in airway, breathing and circulation will take priority.
The aims of history-taking are to establish:
• What has happened (the history)
• What the patient feels to be wrong (the symptoms)
• The background to the current events (the past medical history)
• What medication the patient is taking
• A list of possible diagnoses (the differential diagnosis)
• Priorities for treatment
• Information that will not be available later (e.g. from the scene).
Structure of the history
However detailed or simple a medical history is being taken, a structured approach is essential. While at the scene a detailed history is not usually appropriate, a brief outline history is ample – and ‘AMPLE’ is a useful mnemonic to remember what constitutes an adequate history at the scene:
A – Allergies
In all emergencies other than cardiac arrest, it is important to try to establish any known allergies before drugs are administered.
M – Medicines
The presence of medications in the bloodstream may influence the response to injury or illness or to any other drugs which may be given. Knowledge of what medication the patient has been taking may indicate the severity and duration of any pre-existing illness.
P – Past medical history
The past medical history has a major bearing on responses to treatment and possible outcomes from illness or injury. It also offers vital clues as to what the current problem may be. Particular note should be made of any known cardiac disease, respiratory disease or such chronic conditions as diabetes or epilepsy.
L – Last food and drink
A full stomach is a major risk factor for regurgitation and consequent airway compromise. It is also helpful to obtain information about the patient’s nutritional status and general level of self-care.
E – Events leading up to the current problem
This is the core of the history. The other elements are important but this is the key to understanding what is happening to the patient now.
Not all of the information needs to be acquired at the scene; some can be acquired en route to the hospital.
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