Read the SAMP instructions & do the practice exam (get to know the interface)
Four Principles of Family Medicine
- The family physician is a skilled clinician.
- Family medicine is a community-based discipline.
- The family physician is a resource to a defined practice population.
- The patient-physician relationship is central to the role of the family physician.
Canadian CT head Rule – Minor Head injury pt
- Not for <16yo, GCS <13, non-trauma, coumadin / bleeding disorder, or obvious open skull #
- High risk – neurological intervention
- GCS <15 2hours after injury
- Suspected open or depressed skull #
- Sign of basal skull fracture
- Hemotympanum, racoon eyes, Battle’s sign
- CSF otorrhea/rhinorrhea
- Vomiting >=2
- Age >=65
- Medium risk – CT
- Retrograde Amnesia >=30min
- Dangerous Mechanism
- Pedestrian struck by vehicle
- Occupant ejected from vehicle
- Fall >=3 ft or 5 stairs
The Ottawa SAH (Subarachnoid hemorrhage) Rule
- For alert patients older than 15 y with new severe nontraumatic headache reaching maximum intensity within 1 h
- Not for patients with new neurologic deficits, previous aneurysms, SAH, brain tumors, or history of recurrent headaches (≥3 episodes over the course of ≥6 mo)
- Investigate if ≥1 high-risk variables present:
- Age ≥40 y
- Neck pain or stiffness
- Witnessed loss of consciousness
- Onset during exertion
- Thunderclap headache (instantly peaking pain)
- Limited neck flexion on examination
Canadian C-Spine rules (see neck pain post)
- Stable, Age >16, non-pregnant, GCS15, non-penetrating injury <48hr, no vertebral dz
- X-ray if
- Age >65
- Dangerous mechanism: Fall >3ft / 5 stairs, axial load, MCV >100km/h, motorized recreation vehicle / bicycle struck
- Paresthesia in extremities
- Low risk factors for assessment of ROM
- sitting position in ER
- ambulatory at any time
- Simple rearend MVA: except pushed into traffic, hit by bus, rollover, hit by high speed vehicle
- Delayed onset of pain
- No Midline C-spine tenderness
- Rotate Neck 45 degree L and R
- X-ray if Can’t rotate neck 45 degree
Ottawa Knee rules – X-ray if
- Age >55
- Isolated patellar tenderness
- Tenderness of head of fibula
- Inability to flex 90 degree
- Inability to wt bear (4 steps) immediately AND in ER
Ottawa Ankle Rules – Not for pt <18yo
- Ankle X-ray if Pain in malleolar zone &
- Bone tenderness on posterior 6cm of lateral or medial malleolus
- Inability to wt bear (4 steps) both immediately and in ER
- Foot X-ray if Pain in midfoot zone &
- Bone tenderness at base of 5th metatarsal
- Bone tenderness at navicular bone
- Inability to wt bear both immediately and in ER
Statistics:
- Sensitivity = True positive / condition positive
- Specificity = True negative / condition negative
- Positive Predictive value = True positive / (true positive + False positive)
- Negative Predictive value = True Negative / (true negative + False negative)
- Positive likelihood ratio = sensitivity / (1-specificity)
- Negative likelihood ratio = (1-sensitivity) / specificity
| Events | Non-events | |
| Experimental group (exposed) | A | B |
| Control Group (not exposed) | C | D |
- Control event rate (CER) = C / (C+D)
- Experimental event rate (EER) = A / (A+B)
- Relative Risk = EER / CER
- Absolute risk Reduction (ARR) = CER – EER
- Relative Risk Reduction (RRR) = (CER – EER) / CER
- Number need to treat (NNT) 1 / ARR
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