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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 Editor-in-Chief of He is an educator, author, paramedic, and marathon runner. Ask questions or submit tip ideas to Greg by e-mailing him at
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