Writing an HPI

• Mr. Smith is a 48 year old man who presents with chest pain.

• The pain began 3 weeks ago and has been slowly getting worse. It lasts for 5-10 minutes at a time and comes on several times throughout each day. It is located in the middle of his chest and does not radiate. At its worst it is a 5/10 in severity. Resting seems to make the pain get better. He can not describe the quality further; he says “it just hurts”.

• Mr. Smith is a 48 year old man who presents with chest pain.

• The pain began 3 weeks ago and has been slowly getting worse. It lasts for 5-10 minutes at a time and comes on several times throughout each day. It is located in the middle of his chest and does not radiate. At its worst it is a 5/10 in severity. Resting seems to make the pain get better. He can not describe the quality further; he says “it just hurts”.

3. Characterization

• Mr. Smith is a 48 year old man who presents with chest pain.

• The pain began 3 weeks ago and has been slowly getting worse. It lasts for 5-10 minutes at a time and comes on several times throughout each day. It is located in the middle of his chest and does not radiate. At its worst it is a 5/10 in severity. Resting seems to make the pain get better. He can not describe the quality further; he says “it just hurts”.

3. CharacterizationOPPQRST

Pertinent positives

• Mr. Smith is a 48 year old man who presents with chest pain.

• The pain began 3 weeks ago and has been slowly getting worse. It lasts for 5-10 minutes at a time and comes on several times throughout each day. It is located in the middle of his chest and does not radiate. At its worst it is a 5/10 in severity. Resting seems to make the pain get better. He can not describe the quality further; he says “it just hurts”.

4. Pertinent negatives

• Mr. Smith is a 48 year old man who presents with chest pain.

• The pain began 3 weeks ago and has been slowly getting worse. It lasts for 5-10 minutes at a time and comes on several times throughout each day. It is located in the middle of his chest and does not radiate. At its worst it is a 5/10 in severity. Resting seems to make the pain get better. He can not describe the quality further; he says “it just hurts”.

4. Pertinent negatives

3. CharacterizationOPPQRST

Pertinent positives

• Mr. Smith is a 48 year old man who presents with chest pain.

• The pain began 3 weeks ago… 3. Characterization

• He denies any… 4. Pertinent negs

• Mr. Smith is a 48 year old man with DM, HTN and tobacco abuse who presents with chest pain.

• The pain began 3 weeks ago… 3. Characterization

• He denies any… 4. Pertinent negs

• Mr. Smith is a 48 year old man with DM, HTN and tobacco abuse who presents with chest pain.

• The pain began 3 weeks ago… 3. Characterization

• He denies any… 4. Pertinent negs

1. Opening sentence

• Mr. Smith is a 48 year old man with DM, HTN and tobacco abuse who presents with chest pain.

• The pain began 3 weeks ago… • He denies any…

• Mr. Smith is a 48 year old man s/p appendectomy who presents with chest pain.

• The pain began 3 weeks ago…• He denies any…

• Mr. Smith is a 48 year old man with DM, HTN and tobacco abuse who presents with chest pain.

• The pain began 3 weeks ago… • He denies any…

• Mr. Smith is a 48 year old man with HIV who presents with chest pain.

• The pain began 3 weeks ago…• He denies any…

• Mr. Smith is a 48 year old man with HIV with recent CD4 count of 22 who presents with chest pain.

• The pain began 3 weeks ago…• He denies any…

• Mr. Smith is a 48 year old man with DM, HTN and tobacco abuse who presents with chest pain.

• The pain began 3 weeks ago…• He denies any…

• Mr. Smith is a 48 year old man with known CAD who presents with chest pain.

• The pain began 3 weeks ago…• He denies any…

• Mr. Smith is a 48 year old man with known CAD who presents with chest pain.

• The pain began 3 weeks ago…• He denies any…

2. Context

• Mr. Smith is a 48 year old man with known CAD who presents with chest pain.

• He first presented with chest pain 4 years ago. Cath demonstrated 90% LAD lesion and he received a bare metal stent. He has been asymptomatic since then.

• 3 weeks ago…

2. Context

• Mr. Smith is a 48 year old man with known CAD who presents with chest pain.

• He first presented with chest pain 4 years ago. Cath demonstrated 90% LAD lesion and he received a bare metal stent. He has been asymptomatic since then. Baseline

• 3 weeks ago…

2. Context

• Mr. Smith is a 48 year old man with known CAD who presents with chest pain.

• He first presented with chest pain 4 years ago. Cath demonstrated 90% LAD lesion and he received a bare metal stent. He has been asymptomatic since then. Baseline

• 3 weeks ago… Is pain the same as before?

2. Context

• Mr. Smith is a 48 year old man who presents with chest pain.

• The pain began 3 weeks ago and has been slowly getting worse. It lasts for 5-10 minutes at a time and comes on several times throughout each day. It is located in the middle of his chest and does not radiate. At its worst it is a 5/10 in severity. Resting seems to make the pain get better. He can not describe the quality further; he says “it just hurts”.

• Mr. Smith is a 48 year old man with known CAD who presents with chest pain.

• He first presented with chest pain 3 years ago. Cath demonstrated 90% LAD lesion and he received a bare metal stent. He has been asymptomatic since then.

• 3 weeks ago…

• He denied any…

2. Context / baseline

3. Characterization

4. Pertinent negatives

1. Opening

• Mr. Smith is a 48 year old man with known CAD who presents with chest pain.

• He first presented with chest pain 3 years ago. Cath demonstrated 90% LAD lesion and he received a bare metal stent. He has been asymptomatic since then.

• 3 weeks ago…

• He denied any…

• In the ED… 5. Other tests (not diagnoses) if will change management

2. Context / baseline

3. Characterization

4. Pertinent negatives

1. Opening

• Mr. Smith is a 48 year old man with known CAD who presents with chest pain.

• He first presented with chest pain 3 years ago. Cath demonstrated 90% LAD lesion and he received a bare metal stent. He has been asymptomatic since then.

• 3 weeks ago…

• He denied any…

• In the ED… 5. Other tests (not diagnoses) if will change management

2. Context / baseline

3. Characterization

4. Pertinent negatives

1. Opening