A useful approach to considering the causes of any disease is the Surgical Sieve
But in acute medicine most processes which kill or maim are limited to the following processes
- Vascular – ischaemia or haemorrhage
- Infection (leading to sepsis)
- Trauma
- Toxic (Poisonings) – due to behaviour or environment
- Metabolic
For MOST patients presenting with acute symptoms it is worthwhile routinely asking about recent precipitants and underlying risks
- Vascular risk factors
- Venous thromboembolic factors (see Wells DVT/PE Scores)
- Disorders of immunity or immunocompromise
- History of acute or chronic, repetitive trauma
- Bleeding disorders – congenital, acquired and drug-induced
- Medication history particularly polypharmacy, recreational drugs and deliberate overdose
- Toxic environmental exposures
The Chronology of the Symptoms also give a clue which process is likely occurring
- Vascular – secs-minutes
- Trauma – immediate (unless chronic repetitive)
- Toxic – minutes to hours (depending on exposure route)
- Metabolic – hours to days
- Infection – hours-days
One last consideration is if the patient has recently become pregnant as the cause of new or unexplained symptoms
The above don’t include some Acute Psychosocial Stressors that may precipitate a person to seek medical attention
During your routine assessment it is useful to complete it with a review of Red Flags suggesting these possibilities