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  <head>
    <title>074-02 History, examination, diagnostic strategy, differential diagnosis, and common disease</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Austere diagnosis and differential">
      <outline text="Scene, mechanism, and evacuation">
        <outline text="Hazards, patients, help, weather, transport time"/>
        <outline text="Mechanism predicts hidden injury"/>
        <outline text="Pre-arrival treatment and exposure effects"/>
        <outline text="Stable patient may be unsafe to retain">
          <outline text="Deterioration undetectable, no overnight rescue"/>
        </outline>
        <outline text="Consult retrieval early with a specific question"/>
        <outline text="Telemedicine cannot create treatment capacity"/>
      </outline>
      <outline text="Serial physiology as instrument">
        <outline text="Repeated simple observations beat single tests"/>
        <outline text="Check device values against the patient">
          <outline text="Cold, movement, pigmentation distort oximetry"/>
        </outline>
        <outline text="Shock before hypotension">
          <outline text="Mental change, cool skin, oliguria"/>
          <outline text="Children compensate then collapse"/>
        </outline>
        <outline text="Point-of-care ultrasound depends on operator">
          <outline text="Negative limited scan excludes nothing"/>
        </outline>
      </outline>
      <outline text="Trauma with limited imaging">
        <outline text="Primary survey, prevent hypothermia"/>
        <outline text="Reassess after every move"/>
        <outline text="Head injury without computed tomography">
          <outline text="Declining consciousness strengthens evacuation"/>
          <outline text="Lucid interval does not guarantee safety"/>
        </outline>
        <outline text="Chest injury">
          <outline text="Decompress tension without waiting for imaging"/>
          <outline text="Contusion worsens, early saturation misleads"/>
        </outline>
        <outline text="Abdominal injury may be occult">
          <outline text="Analgesia should not be withheld"/>
        </outline>
        <outline text="Fractures: neurovascular checks around splinting">
          <outline text="Compartment syndrome with pulses present"/>
        </outline>
      </outline>
      <outline text="Environmental illness">
        <outline text="Heat stroke: hyperthermia with brain dysfunction">
          <outline text="Rectal temperature, immediate cooling"/>
          <outline text="Exclude sepsis, stimulants, serotonin syndrome"/>
        </outline>
        <outline text="Hypothermia impairs judgement early">
          <outline text="Gentle handling, prolonged pulse assessment"/>
        </outline>
        <outline text="Altitude illness diagnosed clinically">
          <outline text="Ataxia or confusion: cerebral oedema"/>
          <outline text="Rest dyspnoea, crackles: pulmonary oedema"/>
          <outline text="Do not delay descent for imaging"/>
        </outline>
        <outline text="Envenomation by geography and effects">
          <outline text="Do not capture dangerous animals"/>
        </outline>
      </outline>
      <outline text="Infection with limited laboratories">
        <outline text="Syndromic assessment">
          <outline text="Epidemiology narrows probability"/>
        </outline>
        <outline text="Rapid tests lose accuracy in the field">
          <outline text="Repeat negative malaria test if fitting"/>
        </outline>
        <outline text="Field laboratory quality control">
          <outline text="Only useful when controls work and action changes"/>
        </outline>
        <outline text="Toxic exposure assessment">
          <outline text="Oximetry misses carbon monoxide"/>
          <outline text="Responder symptoms reveal ongoing atmosphere"/>
        </outline>
        <outline text="Outbreaks need denominators and case definitions">
          <outline text="Isolation and sanitation outweigh diagnostics"/>
        </outline>
      </outline>
      <outline text="Obstetric and paediatric risk">
        <outline text="Pregnancy: gestation, bleeding, pressure, pain">
          <outline text="Ectopic, haemorrhage, cord prolapse need transport"/>
        </outline>
        <outline text="Birth before retrieval">
          <outline text="Drying, warmth, stimulation, ventilate if apnoeic"/>
        </outline>
        <outline text="Children dehydrate and cool quickly">
          <outline text="Weight-based drugs and equipment"/>
          <outline text="Lethargy, rash, caregiver concern lower threshold"/>
        </outline>
      </outline>
      <outline text="Mental distress versus physical disease">
        <outline text="Stress and grief often understandable responses"/>
        <outline text="Psychological first aid without forced disclosure"/>
        <outline text="Confusion may be hypoxia, toxin, glucose"/>
        <outline text="Direct suicide and violence assessment"/>
      </outline>
      <outline text="Operational uncertainty">
        <outline text="Document working and dangerous diagnoses">
          <outline text="Record triggers for escalation"/>
        </outline>
        <outline text="Treatment trials only if failure detectable">
          <outline text="Improvement rarely proves cause"/>
        </outline>
        <outline text="Discharge needs supervision and return signs">
          <outline text="Do not assume phone coverage or a car"/>
        </outline>
      </outline>
    </outline>
  </body>
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