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Everyday EMS
by Greg Friese

Associated Signs or Pertinent Negatives

By Greg Friese

Category: Clinical Practice

Our patient had fallen from his roof. He was supine on his driveway with C-spine stabilization, held by an emergency medical responder. The patient was awake, oriented and had normal vitals. In addition to asking OPQRST questions about pain, I wanted to learn if he had any associated symptoms of a spinal cord injury.

The patient denied:

  • Loss of consciousness
  • Neck pain
  • Spinal column pain
  • Sensory deficit
  • Motor function deficit

We expected to find associated signs in the presence of a specific traumatic injury or medical illness. If a spinal cord injury had occurred, I would have expected spinal column pain, sensory deficit, and/or motor deficit. He had none. Instead I had a list of pertinent negatives, which are findings I checked for, but were not present.

Consider these possible associated signs or pertinent negatives for a patient with an abdominal pain complaint:

  • Fever
  • Blood in stool or urine
  • Persistent diarrhea
  • Persistent vomiting
  • Inability to empty bladder or bowels
  • Specific pain location
  • Radiating pain

Remember use OPQRST to start a conversation about pain. Ask additional questions to seek out pertinent negatives or associated symptoms.


About the author

Greg Friese is the Director of Education for CentreLearn Solutions, LLC. He is also an e-learning designer, writer, podcaster, presenter, paramedic, and marathon runner. Read more from him at the EverydayEMSTips.com blog. Ask questions or submit tip ideas to Greg by e-mailing him at greg.friese@ems1.com.
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