Introduction
WIPER
Presenting Complaint
History of Presenting complain:
Systems review:
Past Medical History
Medications
Family History
The strategy with this history is to rule out emergency conditions to begin with. The most important conditions to rule out through your history include:
I – Introduce yourself and establish patient demographics
P- Permission, taking consent
E – Expose the patient (if needed)
Duration: When did the pain start?
Site and Location:Exact location of the pain (central, left-sided, right-sided, radiating)
Exact location of the pain (central, left-sided, right-sided, radiating)
Onset:How did the pain start? (Sudden or gradual)Any triggering events? (Physical exertion, emotional stress, rest)
How did the pain start? (Sudden or gradual)
Any triggering events? (Physical exertion, emotional stress, rest)
Character of the Pain:What kind of pain? (Tightness, tearing, pressure, squeezing, heaviness, sharp, stabbing, burning)
What kind of pain? (Tightness, tearing, pressure, squeezing, heaviness, sharp, stabbing, burning)
Radiation:Does the pain spread anywhere? (To left arm, neck, jaw, back, shoulders, or other locations)
Does the pain spread anywhere? (To left arm, neck, jaw, back, shoulders, or other locations)
Associated Symptoms:Cardiovascular Symptoms: (as specifically)Shortness of breathSweatingNausea or vomitingPalpitationsDizzinessSyncope
Cardiovascular Symptoms: (as specifically)
Time/duration and Frequency:How long does the pain last? (Seconds, minutes, continuous)Has it occurred before? If yes, how often? Establish the timeline of symptoms.
Time/duration and Frequency:
How long does the pain last? (Seconds, minutes, continuous)
Has it occurred before? If yes, how often? Establish the timeline of symptoms.
Exacerbating Factors: (anything that makes the pain worse?)What causes or worsens the pain? (Physical activity, stress, deep inspiration, movement or eating)Relieving Factors: (anything that makes pain better)What relieves the pain? (rest, medications like nitrates, sitting up, antacids)
Exacerbating Factors: (anything that makes the pain worse?)
What causes or worsens the pain? (Physical activity, stress, deep inspiration, movement or eating)
Relieving Factors: (anything that makes pain better)
What relieves the pain? (rest, medications like nitrates, sitting up, antacids)
Severity of Pain:Pain scale (0–10)Any changes in intensity (Worsening or improving)
Any changes in intensity (Worsening or improving)
Respiratory Symptoms:Cough, haemoptysis (blood in sputum), pleuritic painGastrointestinal Symptoms:Heartburn, regurgitation, indigestionMusculoskeletal Symptoms:Pain with movement or palpationIs there a response to Glyceryl Trinitrate (GTN) (if prescribed). Did it relieve the pain?
Cough, haemoptysis (blood in sputum), pleuritic pain
Gastrointestinal Symptoms:
Heartburn, regurgitation, indigestion
Musculoskeletal Symptoms:
Pain with movement or palpation
Is there a response to Glyceryl Trinitrate (GTN) (if prescribed). Did it relieve the pain?
Unintentional weight loss
Opening bowels and passing urine well
Use this opportunity to elicit Ideas, concerns and expectations
Be sure to summarise the history
Current Medications, paying particular attention to:
Antiplatelets or anticoagulants (e.g., aspirin, clopidogrel, warfarin)
Antihypertensives (e.g., beta-blockers)
Proton pump inhibitors (PPIs)
Recent medication changes
Early cardiovascular disease (heart attack or stroke in first-degree relatives before the age of 60)
Smoking (Pack-years history)
Recreational drug use (Especially cocaine)
Occupation and stress levels (gambling, drive)
Lifestyle (physical activities and diet)
Any recent long distance flights?
Based on history, the pain can be categorised as: