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medical
D: What brought you in today? | |
P: Sure, I'm I'm just having a lot of chest pain and and so I thought I should get it checked out. | |
D: OK, before we start, could you remind me of your gender and age? | |
P: Sure 39, I'm a male. | |
D: OK, and so when did this chest pain start? | |
P: It started last night, but it's becoming sharper. | |
D: OK, and where is this pain located? | |
P: It's located on the left side of my chest. | |
D: OK, and, so how long has it been going on for then if it started last night? | |
P: So I guess it would be a couple of hours now, maybe like 8. | |
D: OK. Has it been constant throughout that time, or uh, or changing? | |
P: I would say it's been pretty constant, yeah. | |
D: OK, and how would you describe the pain? People will use words sometimes like sharp, burning, achy. | |
P: I'd say it's pretty sharp, yeah. | |
D: Sharp OK. Uh, anything that you have done tried since last night that's made the pain better? | |
P: Um not laying down helps. | |
D: OK, so do you find laying down makes the pain worse? | |
P: Yes, definitely. | |
D: OK, do you find that the pain is radiating anywhere? | |
P: No. | |
D: OK, and is there anything else that makes the pain worse besides laying down? | |
P: Not that I've noticed, no. | |
D: OK, so not like taking a deep breath or anything like that? | |
P: Maybe taking a deep breath. Yeah. | |
D: OK. And when the pain started, could you tell me uh, could you think of anything that you were doing at the time? | |
P: I mean, I was moving some furniture around, but, that I've done that before. | |
D: OK, so you didn't feel like you hurt yourself when you were doing that? | |
P: No. | |
D: OK, and in regards to how severe the pain is on a scale of 1 to 10, 10 being the worst pain you've ever felt, how severe would you say the pain is? | |
P: I'd say it's like a seven or eight. It's pretty bad. | |
D: OK, and with the pain, do you have any other associated symptoms? | |
P: I feel a little lightheaded and I'm having some trouble breathing. | |
D: OK. Have you had any loss of consciousness? | |
P: No. | |
D: OK. Uh, have you been experiencing any like racing of the heart? | |
P: Um, a little bit, yeah. | |
D: OK. And have you been sweaty at all? | |
P: Just from the from having issues breathing. | |
D: OK, have you been having issues breathing since the pain started? | |
P: Yes. | |
D: OK. Um recently have you had any periods of time where you like have been immobilized or or, you haven't been like able to move around a lot? | |
P: No no. | |
D: OK. And have you been feeling sick at all? Any infectious symptoms? | |
P: No. | |
D: OK, have you had any nausea or vomiting? | |
P: No. | |
D: Any fevers or chills? | |
P: No. | |
D: OK, how about any abdominal pain? | |
P: No. | |
D: Any urinary problems? | |
P: No. | |
D: Or bowel problems? | |
P: No. | |
D: OK, have you had a cough? | |
P: No. | |
D: OK. You haven't brought up any blood? | |
P: No. | |
D: OK, have you had a wheeze with your difficulty breathing? | |
P: No, not that I've heard. | |
D: OK, any changes to the breath sounds at all like any noisy breathing? | |
P: No. Well, I guess if when I'm really having trouble breathing, yeah. | |
D: OK. Has anything like this ever happened to you before? | |
P: No. | |
D: No, OK. And have you had any night sweats? | |
P: No. | |
D: Alright, and then how about any rashes or skin changes? | |
P: No rashes, but I guess like my neck seems to be a little swollen. | |
D: OK, do you have any neck pain? | |
P: No. | |
D: OK, have you had any like accidents like a car accident or anything where you really jerked your neck? | |
P: No. | |
D: OK. Um any any trauma at all to the chest or or back? | |
P: No. | |
D: OK, so just in regards to past medical history, do you have any prior medical conditions? | |
P: No. | |
D: OK, any recent hospitalizations? | |
P: No. | |
D: OK, any prior surgeries? | |
P: No. | |
D: OK, do you take any medications regularly? Are they prescribed or over the counter? | |
P: No. | |
D: Alright, how about any allergies to medications? | |
P: None. | |
D: Alright, any immunizations or are they up to date? | |
P: They are all up to date. | |
D: Excellent. Alright, and could you tell me a little bit about your living situation currently? | |
P: Sure, I live in an apartment by myself. I, uh, yep, that's about it. | |
D: OK, and how do you support yourself financially? | |
P: I'm an accountant. | |
D: OK, sounds like a pretty stressful job or that it can be. Do you smoke cigarettes? | |
P: I do. | |
D: OK, and how much do you smoke? | |
P: I smoke about a pack a day. | |
D: OK, how long have you been smoking for? | |
P: For the past 10 to 15 years. | |
D: OK, and do you smoke cannabis? | |
P: Uh sometimes. | |
D: Uh, how much marijuana would you smoke per per week? | |
P: Per week, maybe about 5 milligrams. Not that much. | |
D: OK, and do you use any other recreational drugs like cocaine, crystal, meth, opioids? | |
P: No. | |
D: OK. Have you used IV drugs before? | |
P: No. | |
D: OK. And do you drink alcohol? | |
P: I do. | |
D: OK. How much alcohol do you drink each week? | |
P: Uhm about I would say I have like one or two drinks a day, so about 10 drinks a week. | |
D: OK, uh, yeah and um alright, and then briefly, could you tell me a little bit about your like diet and exercise? | |
P: Sure, I try to eat healthy for dinner at least, but most of my lunches are, uh I eat out. And then in terms of exercise, I try to exercise every other day, I run for about half an hour. | |
D; OK, well that's great that you've been working on the the activity and the diet as well. So has anything like this happened in your family before? | |
P: No. | |
D: OK, has anybody in the family had a heart attack before? | |
P: Actually, yes, my father had a heart attack when he was 45. | |
D: OK, and anybody in the family have cholesterol problems? | |
P: I think my father did. | |
D: I see OK, and how about anybody in the family have a stroke? | |
P: No strokes. | |
D: OK, and then any cancers in the family? | |
P: No. | |
D: OK, and is there anything else that you wanted to tell me about today that that I on on history? | |
P: No, I don't think so. I think you asked me everything. | |