HPI Triage Assessments

How would you describe otitis externa?

• Inflammation of the skin lining the external auditory canal 

• Acute onset

• S/S: itching, occasional hearing loss, clear discharge

• Due to: 

  • Q-tips, pencils, swimming 

Recommend: stop the offending thing causing otitis externa

How would you describe Otitis media?

• Risk factors: Hx of AOM, respiratory tract infections, daycare, 2^nd hand smoke 

• Sharp steady pain, comes with runny nose, not itchy, possible exudate

• creates fluid buildup behind the eardrum, causing pain, fever, and hearing difficulties

• Refer to PCP

How would you describe allergic conjunctivitis?

• Allergic: red eyes, itching, vision usually not impaired 

  • Recommend:

    • artificial tears

    • antihistamines

    • Avoid allergen exposure 

    • Cold compress 3-4x/day

    • Keep doors/windows closes

    • Hypoallergenic bedding

    • wash clothes frequently

    • shower just before bed

• Refer to PCP is not resolved in 72 hours

How would you describe bacterial conjunctivitis?

• Bacterial: crusty discharge, itchy, red, symptoms last throughout the day; daycare

  • Refer to PCP

How would you describe viral conjunctivitis?

• Viral: crusty discharge, itching, redness, starts in morning and resides as day progresses 

• Often linked to common colds, it may involve swollen eyelids, sore throat, fever, and tender lymph nodes.

  • Refer to PCP

How would you describe a dry eye?

• Sandy, gritty feeling 

• Recommend: Artificial tears

• Refer to PCP if:

  • symptoms do not subside after >72 hours – refer to PCP

  • Contact wearer

  • eye pain

  • light sensitivity

  • etc

Recommendation for a chemical burn in the eyes?

• Flush and Refer – ER 

• Ask about Occupation?

Recommendation for constipation

• New diet? 

• Medications? 

• OTC Recommendation: bulk forming laxatives, fibers, fluids – miralax, colace 

• Refer to PCP: 

  • Significant pain/cramping, unexplained flatulence, fever, N/V, daily laxative use, change in bowel habits, bloody or dark stool, tarry stool, if symptoms persist >2 weeks, IBD, anorexia, age <2 

How would you describe Appendicitis?

• Pain located at the lower right quadrant of the abdomen 

• Vague pain followed by anorexia, NAUSEA, vomiting 

• May begin as epigastric pain, but over 4-48 hours severe pain migrates to RLQ

• Refer to ER 

Recommendation for Diarrhea

• New diet? 

• Medications? 

• Recommend: rehydration, loperamide 

• Refer to PCP when 

  • <6 months old 

  • Pregnant 

  • Diarrhea >48 hours

  • Blood in stool or vomitus

  • High fever in combination with other symptoms

  • Moderate abdominal pain

  • Unexplained weight loss

  • Refer to treatment algorithms in the OTC book for additional exclusions to self treatment

• Refer to ER when 

  • Severe abdominal pain

  • Severe dehydration (severe weakness, confusion)

  • Severe vomiting

  • Large amount of blood in the stool or vomitus

  • See additional exclusions to self treatment in treatment algorithms in the OTC book.

How would you describe PUD?

• Duodenal – mid-epigastric pain, relieved by food or antacids 

• Gastric – mid-epigastric pain, aggravated by food (1-2 hours after meals) or alcohol, relieved my antacids 

• S/S: gnawing or burning pain

• Consider NSAID use and H. pylori (duodenal) 

• Refer to PCP 

How would you describe GERD?

• Epigastric pain 

• Variable severity 

• Typical symptoms – Heartburn, dysphagia, acid regurgitation 

• Alarm – bleeding, anemia, weight loss, recurrent vomiting (endoscopy) 

• Symptoms worse when laying down 

• May try OTC products first, prior to referral (H2RA or PPI) 

• Refer to PCP if 

  • Heartburn for +3 months, continues after 2 weeks of treatment, severe or nocturnal, pain swallowing, black/tarry vomit, unexplained weight loss, signs of MI, adults >45 with new onset 

• PCP – atypical 

• ER – alarm

How would you describe IBD?

• Fever, weight loss, Diarrhea, abdominal pain, rectal bleeding, malaise 

• Refer to PCP

Recommendation for acne

• OTC Recommend: benzoyl peroxide 

• PCP: moderate-severe, possible rosacea

Recommendation for Allergic rxn (including SJS)

• New medication? 

• OTC Recommendation - Just allergies → Benadryl

• ER - if SJS

How would you describe chicken pox/shingles?

• Have you had chicken pox before? 

• History of vaccines? 

• Is the rash painful? 

• Is the rash itchy? 

• Refer to PCP

How would you describe contact dermatitis?

• Crusty, itching, inflamed, red 

• Recommend: hydrocortisone 

• Refer to PCP: 

  • <1 year old 

  • On large area of the body 

  • Moderate-severe 

  • On face

  • No improvement after 2-3 days of treatment

What would you recommend for a fungal infection (tinea pedis)?

• Refer to PCP: cause unclear, unsuccessful treatment or worsening of condition, nails, scalp, face, mucous membrane, genitals, excessive exudates, DM, immunodeficiency, fever, malaise 

• Recommend: Lotrim ultra

What would you recommend for Impetigo?

• Intense itching, not painful, cornflakes 

• Daycare?

• Refer to PCP

What would you recommend for Lice?

• Recommend: pyrethrin (dry hair) or permethrin (damp hair) 

• Refer to PCP 

  • Allergic to ingredients 

  • <2 years old for pyrethrin 

  • <2 months for permethrin 

  • On eyebrow or eyelids 

  • Pregnant or breastfeeding 

  • Active tumor

How would you describe scabies?

• Inflammation, maculopapular rash, intense itching, may not appear for 4-6 weeks 

• a highly contagious skin infestation caused by the Sarcoptes scabiei mite, which burrows into the skin to lay eggs, causing intense, nocturnal itching and a pimple-like rash. It spreads through direct, prolonged skin-to-skin contact, with symptoms often taking 3–6 weeks to appear in first-time cases.

• Need Rx, Refer to PCP

How would you describe DVT?

• Unilateral presentation 

• Sudden onset of pain 

• Intense sharp deep muscle pain 

• Warm to the touch 

• Discoloration 

• Things to ask 

  • Recent travel, swelling, recent trauma, ulcers, sores, pain when walking 

• Refer to ER 

How would you describe PE?

• Sudden onset, SOB, chest pain, bloody sputum 

• Risk factors: smoking, obesity, oral contraceptive use

• Refer to ER 

How would you describe Diabetic neuropathy?

• Do they have DM? lol 

• Does the pain radiate anywhere? 

• Tingling/burning sensation 

• Inability to detect temperature 

• Numbness 

Refer to PCP

ER if necrotic

How would you describe peripheral neruopathy disease (PVD)?

• ADRs to medications 

  • Oral contraceptives 

  • Estrogens 

  • Statins 

  • Diuretics 

• S/S 

  • Pain/aching

  • Leg Cramping

  • Tightness

  • Weakness/fatigue 

• Refer to PCP / ER 

How would you describe MI?

• Symptoms 

  • Sudden onset, SOB, chest pressure, N/V, sweating, palpitations 

  • Moderate to severe angina 

• Refer to ER

How would you describe CHF?

• Symptoms: 

  • SOB, fluid retention, reduced exercise ability 

  • Significant CV history, coarse crackles 

  • Multiple rapid, short popping sounds 

• Shortness of breath

  • DOE associated with CHF (or angina)

  • Onset of symptoms over days or weeks

  • Develop as a result of medication changes or dietary changes (increased sodium)

  • Consider number of pillows at night

    • Orthopnea and PND with CHF 

  • Constant symptoms

• Associated symptoms (chest pain, edema, fatigue, weight gain, n/v, dizziness)

  • Chest pain with angina

  • Edema/weight gain with CHF 

• CHF 🡪 mild-moderate symptom, peripheral edema 🡪 PCP 

• CHF 🡪 symptoms at rest, severe pulmonary edema, cyanosis 🡪 ER

How would you describe stable angina?

• Chest pain or tightness

  • Diffuse, heavy pressure

  • Deep squeezing or crushing pain

  • Aching feeling over sternum

• May be brought on by activity and exercise 

  • Other factors: rest, after eating, emotional stress, anger, sex

• Associated symptoms

  • Sweating, SOB, nausea, vomiting, dizziness, racing heart, irregular heartbeat

• Relieving or precipitating factors

  • Use of nitroglycerin?

• Recent injuries

• Location of pain

  • Radiation to shoulder, jaw, back, or left arm

• Duration of symptoms and frequency

• Stable angina 🡪 Hx of symptoms 🡪 PCP 

• Stable angina 🡪 current symptoms 🡪 ER

How would you describe a migraine?

• Unilateral, with or without aura, photophobia 

• First migraine? Refer to PCP 

• Worst headache they have ever had – Go to ER 

• If diagnosed: recommend NSAIDS, APAP, Excedrin

How would you describe a tension type headache?

• Squeezing, band around the head, unilateral 

• Can treat OTC if needing <2 days/week and <15 times/month (if more frequent, refer)

  • Ibuprofen or APAP (1g) for HA

How would you describe a common cold?

• Chills, productive cough, chest pain, fever 

• Refer to PCP after 7 days of self treatment, 14 days if following up 

• OTC Recommend: oral decongestants

How would you describe Influenza?

• Refer high risk pts, adults 65+, pregnant, obese, nursing home

• Recommend: watchful waiting

How would you describe Pneumonia?

• Course “snoring” sound 

• Multiple rapid, short popping sounds 

• Rapid onset of symptoms, fever, child, chest pain, purulent rust-colored sputum 

• Refer to PCP

How would you describe Sinus Infection?

• Pain behind eyes and forehead  

• Refer to PCP if 

  • Persistent, severe, worsening

• Recommend: intranasal steroid

How would you describe Asthma

• Symptoms: 

  • SOB, nonproductive cough, chest tightness/pressure, anxiety 

  • Wheezing 

• Refer to PCP

How would you describe COPD?

• Symptoms: 

  • Cough (early morning), SOB, frequent respiratory infections – purulent sputum, smoking hx, weight loss 

• Adherence to inhaler regimen? 

• Refer to PCP

How would you describe myalgia?

• Muscle pain, possible swelling, dull constant ache, weakness and fatigue 

• Recommend: heat, rest, analgesics

How would you describe a sprain?

• Stretching or tearing a ligament within a joint 

• Bruising/swelling, tenderness and reduction in joint stability and function 

• Recommend: RICE, wrap, stretch, analgesics

How would you describe Osteoarthritis?

• Happens over time

• Weight-bearing joints, knees, hips, low back, hands 

• Noninflammatory joints, relieved by rest

• Joint stiffness <20-30 minutes 

• Develops over years 

• Recommend: heat, light exercise, analgesics, weight loss

How would you describe Rheumatoid Arthritis?

• Rheumatoid = rapid

• Non-weight bearing joints 

• Joints in hands/fingers 

• Stiffness in the morning 

• Refer to PCP

How would you describe gout?

• painful, inflammatory arthritis

• sudden, severe attacks of pain, swelling, redness, and warmth in joints, most commonly the big toe

• Symptoms often hit at night and are intense

• often causing skin to appear red, shiny, or itchy

• Recommend OTC: NSAIDs

• Severe → Refer to PCP (Allopurinol)