Scribe Series: HPI Practice Case 3

Hey all,

I’m back with some more HPI practice! This will be text practice; I’m not technologically fancy enough to do a voiceover. These cases are long, so I will do 1 per post. Let me know if you find this helpful in the comments below!

Also, here is a drive worksheet you can use. Feel free to make a copy of it or print it out so you can work through this on your own. I will not be giving edit access out simply to allow others to come across a blank worksheet. Worksheet here.

Diarrhea

Here are the list of complaints given to you in no particular order.

  • 27 y/o M
  • Diarrhea, having several episodes a day
  • Watery, not much mucus. No blood.
  • Stomach hurts all over. 
  • Some nausea and vomiting. Vomited 2 times.
  • Symptoms started 3 days ago. 
  • Having abdominal cramps that seem to get better after going to the bathroom. Cramps and pain are a 6/10. 
  • He’s been taking pepto bismol with slight relief of cramps and diarrhea. He hasn’t been eating much as he just gets sick when he does. 
  • He doesn’t have a thermometer at home to take his temperature. 
  • He was travelling recently before he got sick.

Task 1: Can you pick out the elements of this HPI?

Age/Sex
Chief Complaint
Onset
Location
Duration
Characteristic
Alleviating factors
Aggravating factors
Associated Symptoms
Radiation
Timing
Severity
(anything else you can add at the bottom of your paragraph).

Answer:

Age/Sex: 27 y/o M
CC: Diarrhea
Onset: 3 days ago
Location: Abdomen
Duration: episodic. Having several episodes a day.
Characteristic: watery, no mucous or blood.
Alleviating factors: going to the bathroom to relieve himself. pepto bismol. Not eating.
Aggravating factors: eating
Associated symptoms: abdominal pain and cramping. Nausea and vomiting x2.
Radiation: None.
Severity: 6/10
Everything else: He recently travelled prior to symptoms seeming to start.

Task 2: Write an HPI!

Write an HPI so that your order, flow and story makes sense. Use medical terminology as if you were writing this in a chart. The blessing is this is text, and you aren’t converting it from what you are hearing down into text form.

My version of this HPI:

Patient is a 27 y/o M presenting with 3 days of diarrhea. It is watery, but no mucous or blood noted. He is experiencing several episodes a day with associated cramps and generalized abdominal pain rated a 6/10. This improves briefly with bowel movements. Patient is also experiencing nausea and has had vomiting x2 since onset. He has been taking pepto bismol and not eating as much with some improvement in symptoms. Of note, he was recently traveling before symptoms started.

Bonus!

On exam, he appears uncomfortable. HR is 103, RR is 18, Temp is 99.7’F, BP is 115/87. Conjunctiva are pink. Mucous membranes are slightly dry. Heart is slightly tachycardia, but regular rhythm. No murmurs, rubs, or gallops. Pulses equal and bilateral to upper and lower extremities. Abdomen: Generalized tenderness without rebound or guarding. Hyperactive bowel sounds noted. in all four quadrants. Negative Murphy’s and McBurney’s sign. The remainder of exam is non-contributory.

Labs show a slightly elevated white count. But normal hemoglobin. Slightly elevated hematocrit. BMP shows a slightly elevated BUN and creatinine, but still within normal range. Negative liver panel. Stool studies were sent off and are pending.

Task 3: Can you guess what happened?

Now this is just for funsies as I certainly didn’t give you all of the clues or everything that I would order for this patient. You also wouldn’t be asked to do this as a scribe! But just for fun, what do you think this patient has?

Answer:

I was going for a viral gastroenteritis here. There are lots of different presentations for this and it could be viral or bacterial. This is a very common thing to get in the winter (viral) and popular in the summer at cookouts (bacterial). You see this frequently in both outpatient clinics, urgent cares, and ER’s. Since this one is likely viral from his recent travel, he will probably get some fluids and some anti-emetics and left to ride it out. The biggest concern with diarrhea is dehydration. Depending on someones baseline of hydration will depend on how much diarrhea will cause dehydration to that patient.

So our diagnoses (or Assessment!) is as follows:

  1. Diarrhea, likely viral.
  2. Gastroenteritis, likely viral.
  3. Mild dehydration.

Hopefully you enjoyed this practice HPI post! Let me know if this helped in the comments below.

Cheers!

Kenya Series! Medical Mission Trips & How To Get Started

Jambo! (Hello in Swahili).

At KCU, we have a couple of options to partake in a medical mission trip. You can be a part of the global health track (which you have to apply for and be chosen to for), you can fill out the applications that are sent out, OR you can find one on your own.

I recommend researching any mission fairly in depth. Including the ones that are offered at KCU or at your school. You should know some basic things such as:

  • How much does it cost?
  • How long will I be traveling?
  • What sort of experience do I want out of this?
  • Are there scholarships available?
  • What guidance is available to me?
  • What to I need to obtain before traveling out of the country?

For this particularly mission, I had emailed the head professor in charge of the global health track. I was curious if KCU would take students outside of the track at the time, and wanted to know some more information on the Kenya trip. A few months later, an email was sent out to all students for applying. The summer Kenya Mission took 9 students this year (more students were taken this year than in previous years). It was a total of 18 days, but our total clinic days weren’t set in stone. We personally had a great mix of clinic and additional touristy things to do. Looking back, I wanted slightly more clinic time, but the weather and other factors this past year just didn’t allow for it.

Applying

You need to make sure you have researched all potential places before applying. I emailed a lot of companies/sites before deciding to actually apply. Please be mindful with travel companies, they may try to spin a few things or sell pretty hard because they want you to pay to go with them instead of to another country with another company.

You will also need a valid passport. Depending on the time of year, it could take several months to get a passport if you’ve never gotten one before. Renewing a passport takes less time, but still takes time. If you are thinking of doing a trip, I suggest you try to tackle this way ahead of time. You can’t leave the country without a valid passport. End of story. You also likely won’t get picked for a school trip if you don’t have one either.

The KCU trip, like I stated, was an email sent out to every student with the information for how much it would cost and the application. For all other applications through specific companies, they usually have their application on their website. Most will ask you why you are interested in going and if you have any previous experience. That way if you do have some medial experience they will be more open to allowing you to use your skills.

Obviously, KCU knows how much experience you have because they have access to your profile. For KCU, you need to be in good academic standing. If you need to repeat a course that summer or you have lower than a 2.5 GPA (required GPA for any clubs or leadership positions), then you likely won’t get it.

Other than that, I don’t think KCU had too many requirements. If you do the MBA program in medical school, you won’t be able to do the summer mission trip. At least the year that I went the schedules collided. I’m not sure if the bioethics one overlaps as well with this trip. But be cognizant that you can’t do everything. And some of your previous scholastic engagements may overlap when you are wanting to do a summer trip.

After acceptance:

Filling out the application was easy. Especially if your passport is ready. It is all the additional things you need to get done to go that take up time, effort, and obviously cost $$$. Most of the vaccinations you need will be done or had to have been updated in order to be enrolled at KCU. Some will not. Here are the things that were expected of us to complete, and we were given some additional information on:

  • vaccinations
  • visa
  • specific cost breakdown
  • packing list
  • some information about your travel/specifics of what you will be doing

Majority of your vaccines should be up to date as you needed them for medical school. Unfortunately for me I needed a bunch of boosters because I hit that sweet spot of still young but my original immunity was waning. Le sigh….

So I did have to get boosters plus the additional traveling vaccinations as Kenya is endemic to many diseases that are eradicated in the United States.

-make sure you are paying adequately for the amount of time you will be gone… and if there are any additional services/experiences included. Some places are extremely unreasonable with the amount of money asked…

Vaccinations
  • Typhoid Capsules (the oral vaccination lasts 5 years and is recommended over the injection which lasts 1-2 years).
  • Malaria prophylaxis (not really a vaccine, but you do need this).
  • Yellow Fever Vaccine
  • Meningitis
  • Polio (Kenya has an endemic. You must get this prior to going. If you are going to be there longer than 28 days, you need to have it boosted right before leaving).
  • Tdap
  • Hepatitis A & B

Fun fact: if you were born before 1995 the Hepatitis A vaccine was not created yet. So even though it is now part of the mandatory vaccination routine for children, I never got it. And that shit hurts.

Yellow Fever vaccine is EXTREMELY hard to get. It is very costly, and there are limited clinics which are now able to give this out. Apparently, there were 2 factories who made this vaccine; one in France and one in the US. Well the US one shut down and has not reopened (yet). Thus, France is the only supplier for the entire world of this vaccine. Hence the hefty price tag and difficulty obtaining it. There is one clinic in KC Overland Park that has it, but call ahead of time. St. Louis, Nebraska, etc tend to have month(s) long waiting periods. As soon as you know you are going on this trip, call ahead and book an appointment with one of these places. It will be less stressful for you if you have it on the books, and will be awful if you have to cancel your trip because you couldn’t get it.

Visa

In general, the company or school you are booking your trip through should walk you through how to fill out that country’s visa. But it never hurts to make sure you have guidance if you need it. I could easily visit Kenya’s government website and had to pay $50 for my visa to be processed.

Cost Breakdown

KCU’s total cost was $4300 for the trip. This included most things: flights, lodging, transportation, food, safari, and groceries. If you wanted extra money to spend or needed more groceries/water then the allotted allowance, you would need to bring more money.

KCU also recommended you bring about $300 extra in case you wanted trinkets or if we ran across any additional touristy things. We ended up going out a few times as well; sometimes we had to pay and other times our tab was covered for us. I did not end up spending all of this money. In fact, I barely spent any of this extra money I brought. But it was good to have on hand just in case I needed it in Kenya to do something extra or in case I needed it when I got back to the States.

The last thing you need to know is you may have to spend a bit more prior to your trip on things such as your vaccinations, visa, and extra stuff when packing.

Sure, you could probably figure out how to get to your country and back for much cheaper. But if you are traveling with your school, they have to ensure all of you are on the same flights and usually are seated near one another. Because of this, flights can be a bit more.

In general your flight should be the most expensive part. But look at flights, lodging, if food is paid for or provided (and if not, how much are you expected to find for yourself), transportation, and touristy attractions. You will also need to know if the company you are with can help you exchange your money or where you can go to do that. You will want to bring extra money in case: tourist attractions that may pop up, getting trinkets and gifts to take back, tipping, etc.

Make sure that when you are looking at these costs there is a good ratio for you. If you want to only be in clinic, pick a company that only goes to clinics. If you want more touristy events and less clinic, find a company that does that.

If you feel you are being gypped, do your research on other companies to see if it is a fair price.

During my school trip we were given about 1000 Kenyan Shillings a week each. My roommate and I pooled our expenses together since we were buying water and snacks together anyways. This money was part of what we had already paid for in our trip as well. And if we needed more, we had access to exchanging American dollars for Kenyan Shillings.

Emergency Contacts

This goes without saying, but make sure you have phone numbers or a way to get a hold of the company if an emergency happens. Send your visa to the nearest embassy and have copies of your passports/visas stowed away from your originals as a just in case. If you are going with your school, they likely will have already done this for you. Make sure your school/company has contact information for your emergency contacts in case something happens to you and they have to phone home. And as always, ask about if they carry medicine on them or have a reliable hospital to take you to if need be.

Global Health Trips

Here were a few places that students have gone or where I looked into:

IVHQ. They have have many locations and have volunteer needs for much more than just medical. I had two classmates go with this company this past summer and they thoroughly enjoyed it.

Power of a Nickel. Another two of my classmates also went on this. I looked into this one, but the one place I wanted to go was a bit more expensive than I preferred and not as long as I would have liked. However, my classmates seemed to have had a blast.

DOCARE International. Here you can apply to a range of international trips. However with this, if it is through a specific school they may advertise it on the website but most spots will go with to their own student population. But it is a good place to look and see what is available and try!

Health Corps Haiti. It looks like trips last about 1 week and they take both pre-med/pre-dental and medical/dental students. They also seem to have multiple trips throughout the year. This was suggested by a upper classmate but I’m not sure how many students have previously gone with this one.

Rad-Aid. Does something with medical imaging. I’m not sure what is with this one, but it was suggested by an upper classmate.

Plan my Gap Year. This was the company I was going to go through if I didn’t get into KCU’s global health program. I found many reliable prior volunteer accounts. The only downside seemed to have been that if you didn’t know any skills they weren’t willing to teach you… makes sense. But overall there were many different places you could go at reasonable prices.

Your school! If your school has a global health tract OR has professors that are involved in global health trips, you can get in with them and tag along or apply.

Lastly…

I’m not sure how many times I have written this in this post, BUT DO YOUR RESEARCH. There were a few companies that I was completely sold on, but until I did a deep dive realized they were money scamming or were not great experiences per other travelers/students. Do your research. Reach out to other students or previous volunteers. Ask all those questions. And make sure you go with a place where you feel you will get the most out of your experience!

I hope this helps. Cheers!