# HPI? Really?



## NCCoder (Jun 14, 2010)

I have a dr who has given me this HPI and I'm having a hard time finding enough elements. Can someone please help???

HPI: The pt is a 91 yr old woman admitted yesterday by Dr. Blah for urosepsis and atrial fibrillation with a rapid ventricular rate response. She has elevated troponins. The pt is hard of hearing. THe pt has some degree of dementia. Most of the history is based on Dr. Blah note. However, the pt denied having chest pain or other anginal-like symptoms, CHF signs or symptoms, palpitations, syncope, or near syncope. The pt has no known history of any significant cardiovascular disease. Her cardiovascular risk factors include her age, postmenopausal, hypertension. 

Maybe I'm overlooking something and another look for different eyes could help. 

Thanks.


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## sbicknell (Jun 14, 2010)

Why was he asked to see this patient?  What's the CC?  The HPI is supposed to be based on the CC. Seems most of what he has given is ROS. Let's say as a Cardio specialty, he was called in for the Afib

HPI: The pt is a 91 yr old woman admitted yesterday by Dr. Blah for urosepsis and atrial (location) fibrillation (CC) with a rapid ventricular rate response (timing or quality). 

She has elevated troponins (Assoc S&S). 

The pt is hard of hearing (Neuro or ENT ROS). 

The pt has some degree of dementia (Neuro ROS). 

Most of the history is based on Dr. Blah note. (Irrelevant- he must perform ROS to get credit for ROS)

However, the pt denied having chest pain or other anginal-like symptoms, CHF signs or symptoms, palpitations, syncope, or near syncope. (all CV ROS)

The pt has no known history of any significant cardiovascular disease. Her cardiovascular risk factors include her age, postmenopausal, hypertension. (all Past History)

You have 3 HPI, 3 ROS, and 1 history so he gets an EPF History.  
If you give him credit for duration (admitted yesterday) then he has 4 HPI, 3 ROS and 1 history and he gets a Detailed History. I would not as "admitted yesterday" does not identify when the Afib started. Before admit?  After admit? Chronic?

See what other responses you get. These HPI questions always leads to good discussion of what statements meet what bullets


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## NCCoder (Jun 14, 2010)

*Hpi?*

Thanks for your response. When pt was being worked up for urosepsis there was an incidential finding of afib and that why dr was consulted. I didn't think about rapid ventricular rate response as being timing/quality... 
Thanks again


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## sbicknell (Jun 14, 2010)

_"....I didn't think about rapid ventricular rate response as being timing/quality... "_

Are you saying you would not count it as an HPI element at all or just count it differently?


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## ewinnacott (Jun 14, 2010)

I agree with sbicknell but the chief complaint should be more apparent, it's pretty vague. When I first looked at it, it seemed like there was no CC.


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## NCCoder (Jun 14, 2010)

*Hpi?*

To ewinnacott, Afib was the CC but they are having a hard time listing CC as a separate listing and adding this in the HPI.

To sbicknell, I would count that as an element but I didn't even take that into consideration at first until after I read your post.

Thanks for the postings!!!


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