OHC Medical Officer - Clinical Management Guide

General OHC Approach (Applies to All Conditions)

• Chief complaint, onset, duration, severity (0-10 scale)
• Occupation/work activity - any relation to work?
• Previous episodes, past medical history, medications, allergies
• Last meal, fluid intake, recent travel
• Referral flag: Is this work-related? Document accordingly.

1. HEADACHE

History

• Site (frontal, occipital, temporal, diffuse), onset (sudden vs gradual), character (throbbing, pressing, band-like), radiation
• Severity (VAS scale), associated symptoms: nausea/vomiting, photophobia, phonophobia, aura, neck stiffness
• Triggers: stress, screen time, noise, fumes, dehydration, missed meals, eye strain
• Work-related: VDU use, loud noise, chemical exposure, shift work, fasting due to work
• Medications taken, effect; previous headache history, family history of migraine
• Red flags to rule out: sudden severe "thunderclap," first/worst headache, progressive, with fever + neck stiffness, visual changes, neurological symptoms

Examination

• Vitals: BP, PR, Temperature, SpO2
• General: appearance, distress level
• Eyes: pupils (equal, round, reactive), visual acuity (if complaint)
• Neck: meningism (stiffness, Kernig's, Brudzinski's) - if fever present
• Neurological: orientation, focal deficits (if any red flags)
• Sinus tenderness (frontal, maxillary), temporal artery tenderness

Management (OHC)

• Tension headache: Paracetamol 500-1000 mg; NSAIDs (Ibuprofen 400 mg with food); rest in quiet room, hydration
• Migraine: Sumatriptan if available + NSAID; dark quiet room; anti-emetic (Domperidone/Metoclopramide) if nausea
• Dehydration/hunger related: ORS/fluids, glucose biscuits, rest
• Work-related (VDU strain): Advise 20-20-20 rule, ergonomic review, temporary duty modification
• Refer if: red flag headache, new-onset severe, neurological signs, hypertensive headache (DBP >120), post-head injury
• Document if occupationally linked

2. FEVER / VIRAL ILLNESS

History

• Onset, duration, pattern (continuous, remittent, intermittent), peak temperature
• Associated: chills/rigors, sweating, myalgia, arthralgia, rash, sore throat, cough, running nose, loose stools
• Sick contacts at workplace or home; recent travel; vaccination history
• Oral intake, urine output (hydration status)
• OHC concern: multiple cases in workplace? (outbreak flag)

Examination

• Temperature (oral/axillary/tympanic), PR, RR, BP, SpO2
• General: toxic vs non-toxic appearance, hydration
• ENT: throat (erythema, exudate, tonsillar enlargement), nasal mucosa, ears
• Chest: breath sounds (wheeze, crepts)
• Abdomen: tenderness, organomegaly
• Skin: rash (maculopapular, petechiae)
• Lymph nodes: cervical, axillary

Management (OHC)

• Paracetamol 500-1000 mg every 6-8 hours (antipyretic + analgesic)
• Oral hydration - fluids, ORS if borderline dehydrated
• Tepid sponging if temp >39°C
• Supportive: rest, light diet
• Antibiotics ONLY if bacterial source confirmed (e.g., strep throat with exudate, ear pus); avoid empirical antibiotic use
• Isolate from coworkers if potentially infectious (influenza-like illness)
• Fitness to work: advise rest/sick leave if temp >38.5°C
• Refer if: temp >40°C, rigors, altered sensorium, rash with fever, SpO2 <94%, >5 days fever, suspected dengue/malaria/leptospirosis (endemic areas)
• Outbreak protocol: Report cluster to OHC Head/plant management if ≥3 cases in one department within 48 hours

3. URTI (Upper Respiratory Tract Infection)

History

• Nasal symptoms: congestion, rhinorrhoea (clear/purulent), sneezing
• Throat: soreness, dysphagia, voice change
• Ear: pain, fullness, hearing change
• Cough: dry or productive, duration
• Fever, myalgia, malaise
• Duration (>10-14 days suggests secondary bacterial infection)
• Occupational exposure: dust, fumes, chemicals, cold environment, air-conditioning

Examination

• Vitals, SpO2
• Throat: erythema, follicular tonsillitis, exudates, uvula deviation
• Nasal: turbinate hypertrophy, discharge colour (clear = viral; yellow/green = possibly bacterial)
• Ears: TM appearance (if earache)
• Neck: lymphadenopathy
• Chest: auscultation to rule out lower respiratory involvement

Management (OHC)

• Most URTI = viral, self-limiting (5-7 days)
• Symptomatic: Paracetamol, nasal decongestant (Xylometazoline drops/spray for ≤3 days), antihistamine (Cetirizine/Chlorpheniramine for rhinorrhoea/sneezing)
• Throat: warm saline gargle, antiseptic lozenges
• Cough: if dry - Dextromethorphan; if productive - no suppressant; steam inhalation
• Antibiotics (Amoxicillin/Azithromycin) ONLY if bacterial signs (exudative tonsillitis, purulent sinusitis >10 days, Rapid Strep Test positive)
• Fitness: may work if mild; sick leave if febrile or very symptomatic
• Refer if: Stridor, respiratory distress, peritonsillar abscess features (uvula deviated, hot-potato voice), epiglottitis suspicion

4. GASTRITIS / ACIDITY

History

• Location: epigastric, retrosternal, right hypochondrium
• Character: burning, gnawing, bloating
• Relation to food: better or worse after meals, on empty stomach
• Heartburn, regurgitation, water brash
• Nausea, belching, bloating
• Aggravating: NSAIDs, alcohol, smoking, spicy/oily food, irregular meals, stress
• OHC context: shift workers, irregular meal timings, excessive tea/coffee, work stress
• Alarm features: dysphagia, weight loss, haematemesis, melaena, anorexia

Examination

• Vitals, general appearance
• Abdomen: epigastric tenderness (mild in gastritis), guarding/rigidity (rule out peptic perforation), Murphy's sign, organomegaly
• Check for pallor (if chronic bleeding)

Management (OHC)

• Antacids (Aluminium/Magnesium hydroxide): immediate relief
• PPI: Omeprazole 20 mg or Pantoprazole 40 mg OD before breakfast (14-28 day course)
• H2 blocker: Ranitidine/Famotidine if mild
• Anti-flatulent: Simethicone for bloating
• Lifestyle advice: regular meal timings, avoid NSAIDs on empty stomach, reduce tea/coffee/spicy food, elevate head end if GERD
• OHC-specific: review work schedule for irregular meal patterns, canteen diet quality
• Refer if: alarm symptoms, haematemesis, melaena, severe pain, no response to 2 weeks treatment, suspected ulcer/malignancy

5. VOMITING / DIARRHEA

History

• Onset, frequency, quantity, colour, blood in vomit or stool
• Stool: consistency, colour, blood/mucus, frequency
• Fever, abdominal cramps, tenesmus
• Food history: last meal, canteen/outside food, others with similar complaints (food poisoning cluster)
• Hydration: last urine output, oral intake, thirst
• Medications: recent antibiotics (C. diff risk), NSAIDs
• Travel history, sick contacts
• OHC concern: canteen cluster = food safety incident; report to management

Examination

• Vitals: look for tachycardia, hypotension (dehydration), fever
• Dehydration assessment: dry mucous membranes, skin turgor, sunken eyes, capillary refill
• Abdomen: tenderness (diffuse vs localised), bowel sounds (hyperactive), guarding
• Check for features of appendicitis (RIF tenderness, rebound), cholecystitis

Management (OHC)

• Dehydration correction (primary goal):
  • Mild: ORS 200 ml after each loose stool; encourage fluids (coconut water, rice water, clear soup)
  • Moderate: IV fluids if oral not tolerated (Ringer's Lactate / NS)
• Antiemetic: Domperidone 10 mg or Ondansetron 4 mg (if severe vomiting)
• Antidiarrheal: Loperamide 2 mg (only for non-bloody, non-febrile diarrhea); avoid in dysentery
• Probiotics: Lactobacillus
• Diet: BRAT diet (Banana, Rice, Applesauce, Toast) - bland, easily digestible
• Antibiotics (Ciprofloxacin/Azithromycin) ONLY if dysentery (blood/mucus in stool + fever), travellers' diarrhea, or Cholera suspicion
• OHC protocol if food poisoning cluster: collect food samples, notify hygiene officer, report to management
• Refer if: signs of severe dehydration/shock, blood in stool, uncontrolled vomiting, >48 hours no improvement, suspected surgical abdomen

6. MUSCULOSKELETAL PAIN

History

• Location, onset (acute vs chronic), character (aching, sharp, cramping)
• Aggravating/relieving factors: rest, movement, heat, cold
• Work relation: repetitive movement, heavy lifting, awkward posture, vibration, long standing
• Swelling, redness, warmth at joint
• Morning stiffness duration (>30 min = inflammatory)
• Numbness/tingling (nerve involvement)
• Past history: prior injury, arthritis, gout, rheumatic disease

Examination

• Inspection: swelling, redness, deformity, muscle wasting, posture
• Palpation: tenderness (joint line, muscle belly, tendon), warmth, crepitus
• ROM: active and passive range of motion
• Special tests: relevant to area (e.g., Finkelstein for De Quervain's, Phalen's/Tinel's for CTS)
• Neurovascular: distal sensation, power, pulses

Management (OHC)

• RICE (Rest, Ice, Compression, Elevation) for acute injury
• Analgesics: Paracetamol; NSAIDs (Ibuprofen 400 mg TID / Diclofenac 50 mg BD) with food; Topical NSAID gel
• Muscle relaxant if spasm: Cyclobenzaprine/Methocarbamol/Diazepam (short course)
• Physiotherapy referral for chronic cases
• OHC-specific: Ergonomic assessment, job task analysis, duty modification (light duty, restricted lifting)
• Document as occupational if work-related (repetitive strain, vibration, force)
• Refer if: fracture suspected, locked joint, severe restriction, signs of inflammatory arthritis, neurovascular compromise

7. BACK / NECK PAIN

History

• Location: cervical, thoracic, lumbar, sacral; unilateral or bilateral
• Onset: acute (sudden movement, lift) vs chronic; character: dull, sharp, shooting
• Radiation: to arm (cervical) or leg (lumbar - sciatic distribution)
• Paraesthesia, weakness in limbs, bladder/bowel changes (cauda equina red flag)
• Posture at work: prolonged sitting, desk work, heavy manual handling, vibration (forklift, machinery)
• Previous similar episodes, investigations done
• Red flags: bilateral leg weakness, saddle anaesthesia, loss of bladder/bowel control, progressive neurological deficit, fever + back pain (spinal infection), weight loss (malignancy)

Examination

• Posture and gait
• Spine: alignment, paraspinal muscle tenderness/spasm, range of motion (flexion, extension, lateral flexion, rotation)
• Neurological:
  • Lower limb: power (L3-S1), sensation dermatomal, reflexes (knee L4, ankle S1)
  • Upper limb: power, sensation, reflexes (biceps C5, triceps C7)
• Special tests: SLR (Straight Leg Raise) - for lumbar disc; Spurling's test - for cervical radiculopathy
• Abdominal palpation (rule out referred pain from aortic aneurysm/renal cause)

Management (OHC)

• Reassure: most acute back pain resolves in 4-6 weeks
• Analgesics: Paracetamol + NSAID combination; topical NSAID/counter-irritant
• Muscle relaxant: short course (3-5 days)
• Encourage early mobilisation - bed rest not recommended beyond 1-2 days
• Hot fomentation for subacute/chronic
• Posture advice, back care education, core strengthening exercises (handout)
• OHC-specific: Workstation ergonomic review; manual handling training; temporary duty modification (no heavy lifting, avoid prolonged sitting/standing with microbreaks)
• Physiotherapy referral for chronic, recurrent cases
• Refer (urgent) if: cauda equina signs, progressive neurological deficit, fever + back pain, post-trauma, suspected malignancy/infection

8. MINOR WOUNDS

History

• Mechanism: cut, laceration, abrasion, puncture, bite (animal/human), crush
• Time since injury, site, depth, contamination (soil, rust, chemical)
• Bleeding: controlled or ongoing
• Tetanus immunisation status (critical)
• Diabetes, immunosuppression (affects healing)
• OHC context: Work-related injury - Incident report mandatory

Examination

• Location, size (length x depth), edges (clean vs ragged), depth (skin only vs subcutaneous vs deeper structures)
• Contamination level
• Neurovascular status distal to wound: sensation, movement, pulses (especially for hand/forearm wounds)
• Tendon integrity (ask to move fingers/toes against resistance if near tendon)
• Signs of infection (if delayed presentation): erythema, warmth, pus, lymphangitis

Management (OHC)

• Wound irrigation: copious saline/clean water irrigation (most important step)
• Haemostasis: direct pressure, elevation
• Wound cleaning: antiseptic (Povidone-iodine or Chlorhexidine)
• Closure:
  • Small clean cuts: Steri-strips / steristrips / wound closure strips
  • Larger lacerations: suturing (if trained) or refer
  • Puncture wounds/bites: do NOT close primarily (risk of infection/abscess)
  • Abrasions: non-adherent dressing
• Tetanus prophylaxis:
  • Immunised (within 5 years): no action needed
  • Immunised (5-10 years): TT booster if heavily contaminated wound
  • Unknown/unimmunised: TT + TIG (Tetanus Immunoglobulin)
• Antibiotics (Amoxicillin-Clavulanate): animal/human bites, heavily contaminated wounds, diabetic/immunocompromised patient, puncture wounds
• Dressing: check after 48 hours
• Occupational injury documentation: First Aid Register, Accident Report
• Refer if: deep/complex wound, tendon/nerve/vessel involvement, heavily contaminated, facial wounds, wound > 6-8 hours old with contamination

9. MINOR BURNS

History

• Mechanism: thermal (flame, hot liquid, steam, contact), chemical, electrical, radiation
• Time of injury, first aid given (cool water applied?)
• Surface area estimate (Rule of Nines or Palmar method)
• Face, hands, genitalia, circumferential involvement (priority areas)
• Chemical burns: agent, concentration, duration of exposure
• Electrical burns: voltage, entry/exit points
• OHC context: work-related incident - mandatory reporting

Examination

• Degree classification:
  • 1st degree (superficial): erythema only, no blisters, painful
  • 2nd degree superficial: blisters, moist, very painful, blanches
  • 2nd degree deep: blisters, less pain, may not blanch well
  • 3rd degree (full thickness): dry/leathery/waxy, painless, does not blanch
• BSA (Body Surface Area): Rule of Nines (head 9%, each arm 9%, chest 9%, abdomen 9%, each thigh 9%, each leg 9%, perineum 1%)
• Airway: soot around nose/mouth, singed eyebrows/nasal hair, hoarse voice, stridor (inhalation injury - emergency)
• Circumferential burns (limb/chest): compartment syndrome risk

Management (OHC)

• Immediate: Remove from source; cool with running cool water 10-20 min (not ice); remove clothing/jewellery
• 1st degree: moisturiser/aloe vera, analgesic (Paracetamol/NSAID), no dressing required
• 2nd degree superficial: clean with saline, intact blisters - leave; burst blisters - debride gently; non-adherent dressing (Mepitel/paraffin gauze); change every 48-72 hours; analgesic
• Chemical burns: continuous water irrigation ≥20-30 min; specific antidote if available
• Tetanus prophylaxis (same protocol as wounds)
• Analgesics: Paracetamol, NSAID; Tramadol for more severe pain
• Refer (urgent) if:

  • 5-10% BSA in adults (any 2nd/3rd degree)

  • Burns to face, hands, feet, genitalia, joints
  • Full thickness (3rd degree) any size
  • Circumferential burns
  • Inhalation injury (emergency - airway at risk)
  • Electrical burns (ECG monitoring, urine output monitoring needed)
  • Chemical burns to eyes
• Incident report: all work-related burns

10. EYE IRRITATION / FOREIGN BODY SENSATION

History

• Onset, unilateral or bilateral
• Character: burning, itching, grittiness, foreign body sensation, watering, discharge (clear/purulent), photophobia, blurred vision
• Chemical splash (type of chemical, first aid given)
• Occupation: welder (UV - arc eye), grinder (metallic FB), chemical handling, dust exposure
• Contact lens use
• History of trauma, prior eye surgery
• Red flags: sudden loss of vision, severe pain, chemical splash, hyphaema, penetrating injury

Examination

• Visual acuity (Snellen chart or hand-count): bilateral, record in notes
• Inspection: lid swelling, conjunctival injection (diffuse = viral/allergic; circumcorneal = corneal/anterior chamber pathology), discharge
• Eyelid eversion: look for subtarsal foreign body
• Cornea: clarity (slit lamp if available), fluorescein staining (ulcer/abrasion) with cobalt blue light
• Pupil: size, shape, reactivity (irregular pupil = intraocular injury)
• Seidel test (if penetrating injury suspected): fluorescein - look for aqueous leak

Management (OHC)

• Chemical splash (emergency - act FIRST, examine LATER):
  • Immediate copious water irrigation - minimum 20-30 min; evert lids; normal saline preferred
  • Alkali burns (lime, cement, ammonia): more severe than acid; irrigate longer
  • Refer to ophthalmology urgently after irrigation
• Foreign body (conjunctival/superficial): topical anaesthetic (Proparacaine/Tetracaine 1 drop); evert lid; remove with moist cotton swab or irrigation; antibiotic eye drops (Chloramphenicol/Moxifloxacin); patch not required
• Corneal abrasion: topical antibiotic ointment; cycloplegic (Homatropine) for pain if available; no patching for contact lens wearers
• Arc eye (UV keratitis - welder's flash): onset 6-12 hrs post exposure; topical anaesthetic for exam only (do not prescribe); cycloplegic; systemic NSAID/analgesic; dark room rest; usually resolves in 24-48 hrs
• Allergic conjunctivitis: topical antihistamine (Olopatadine); oral antihistamine (Cetirizine); cold compresses; avoid allergen
• Viral conjunctivitis: lubricating drops; cold compresses; hygiene advice (highly contagious); no antibiotics
• Bacterial conjunctivitis: Chloramphenicol/Moxifloxacin eye drops 4-6x daily x 5-7 days
• Refer urgently if: chemical burn, corneal FB (metallic - rust ring), significant corneal opacity, irregular pupil, suspected penetrating injury, vision loss, no improvement in 48 hrs

11. EARACHE

History

• Unilateral or bilateral, onset, severity
• Associated: ear discharge (colour, consistency, smell), hearing loss, tinnitus, vertigo, facial weakness
• Recent URTI (Eustachian tube dysfunction/AOM)
• Water exposure: swimming, bathing (Otitis externa)
• FB in ear (especially paediatric - if seeing contractors' children)
• Jaw pain, teeth pain, TMJ pain (referred otalgia)
• Immunosuppression, diabetes (risk of malignant/necrotising otitis externa)

Examination

• External ear: pinna tenderness (tragus/pinna pull - Otitis externa), swelling, discharge from canal
• Otoscopy:
  • EAC: oedema, discharge, FB, furuncle
  • TM: colour (red/orange = AOM), landmarks (cone of light), bulging (AOM with effusion), perforation (CSOM), retracted TM (Eustachian tube dysfunction)
• Mastoid: tenderness (mastoiditis)
• Facial nerve: asymmetry
• Lymph nodes: pre/post-auricular

Management (OHC)

• Otitis Media (AOM): Analgesic (Paracetamol/Ibuprofen); Amoxicillin 500 mg TID x 5-7 days; Decongestant nasal drops; Review in 48-72 hours
• Otitis Externa: Keep ear dry; Topical antibiotic+steroid drops (Ciprofloxacin-Hydrocortisone or Gentamicin-Betamethasone); Analgesic; Wick insertion if canal very oedematous (refer if not trained); avoid water/cotton buds
• Eustachian tube dysfunction: nasal decongestant (Xylometazoline), auto-insufflation (Valsalva), steam inhalation, treat URTI
• Referred otalgia (dental/TMJ): treat primary cause, analgesic
• Wax (ceruminosis): if causing symptoms - olive oil drops x 5 days then warm water syringing (only if intact TM) or refer for suction clearance
• Refer if: suspected TM perforation (avoid drops), mastoid tenderness/swelling, facial palsy, suspected cholesteatoma, hearing loss, vertigo, FB (if unable to remove safely)

12. ALLERGIC REACTIONS

History

• Trigger: food (nuts, shellfish, dairy), drug (NSAID, antibiotic, contrast), insect sting, latex, chemical/industrial exposure
• Onset and time since exposure
• Symptoms: skin (urticaria, angioedema), respiratory (wheeze, stridor, throat tightness, dyspnoea), GI (nausea, cramps), cardiovascular (palpitation, dizziness, hypotension)
• Prior similar episodes; previous anaphylaxis; known allergy
• Severity classification:
  • Mild: localised urticaria, rhinitis only
  • Moderate: urticaria + angioedema or mild respiratory/GI
  • Severe/Anaphylaxis: throat tightness, stridor, wheeze, hypotension, syncope, altered sensorium

Examination

• Vitals: BP, PR, RR, SpO2, temperature
• Skin: urticaria (wheals), angioedema (lips, tongue, periorbital), flushing
• Airway: stridor, hoarse voice, tongue/uvula swelling
• Chest: wheeze (bilateral), air entry
• Cardiovascular: BP, pulse character, capillary refill
• Abdomen: tenderness

Management (OHC)

1. Call for help / activate emergency response
2. Position: supine with legs elevated (if hypotensive); sitting up if respiratory distress
3. Adrenaline (Epinephrine) 0.3-0.5 mg (0.3-0.5 ml of 1:1000) IM - lateral thigh - FIRST LINE; repeat in 5-10 min if no improvement
4. O2: high-flow 10-15 L/min via non-rebreather mask
5. IV access: rapid IV fluids (NS 1-2 L for hypotension)
6. Antihistamine: Chlorpheniramine 10 mg slow IV or IM (adjunct - NOT first line)
7. Hydrocortisone 200 mg IV (adjunct - NOT first line; delays 4-6 hrs for effect)
8. Bronchospasm: Salbutamol nebulization
9. Transfer to hospital IMMEDIATELY

• Remove/avoid trigger
• Antihistamine: Cetirizine 10 mg PO or Chlorpheniramine 4 mg PO
• Topical antihistamine/calamine for localised urticaria
• If angioedema without airway compromise: Prednisolone 20-40 mg PO x 3-5 days
• Monitor 1-2 hours for progression
• Educate: avoid trigger, carry antihistamine, refer for allergy testing

13. DIZZINESS

History

• Character: true vertigo (room spinning) vs lightheadedness/presyncope vs imbalance/disequilibrium
• Onset: sudden vs gradual; continuous vs episodic (seconds = BPPV; minutes = TIA; hours = Meniere's)
• Positional? (worse on head turning/lying down = BPPV)
• Associated: tinnitus, hearing loss, nausea, vomiting, headache, diplopia, dysphagia, limb weakness (posterior circulation stroke)
• Palpitations (cardiac arrhythmia), standing up quickly (postural hypotension)
• Medications: antihypertensives, diuretics, sedatives, aminoglycosides
• Work-related: heat exhaustion, dehydration, working at heights, vibration exposure

Examination

• Vitals: BP lying and standing (postural drop >20 mmHg systolic = orthostatic hypotension), PR, SpO2
• Nystagmus: direction, horizontal vs vertical, fatigable (peripheral) vs non-fatigable (central)
• Dix-Hallpike test: for BPPV (posterior canal) - geotropic rotatory nystagmus with latency
• Neurological: cerebellar signs (finger-nose, heel-shin, Romberg), gait, cranial nerves
• Cardiovascular: heart sounds (arrhythmia), peripheral pulses
• Ears: otoscopy (look for acute labyrinthitis, Ramsay Hunt - vesicles)

Management (OHC)

• BPPV: Epley manoeuvre (document technique); Betahistine 16 mg BD for symptom relief; refer to ENT if not resolving
• Vestibular neuritis/labyrinthitis: Prochlorperazine 5 mg TDS or Betahistine; rest; hydration; usually resolves in 1-2 weeks
• Postural hypotension: sit/lie down; oral fluids; review medications; advise rise slowly; compression stockings; refer to physician if drug-related
• Dehydration/heat-related: ORS/IV fluids, rest, cool environment
• Work restriction: no working at heights, operating machinery, driving until resolved - document fitness restriction
• Refer urgently if: sudden severe vertigo + headache + neurological signs (posterior stroke), vertical nystagmus, non-fatigable nystagmus, new-onset in elderly with vascular risk factors, syncope

14. WEAKNESS

History

• Onset: sudden (stroke, cardiac, hypoglycaemia) vs gradual (anaemia, hypothyroidism, malignancy)
• Distribution: generalised vs focal (one limb, one side); proximal vs distal
• Associated: fever, weight loss, fatigue, dyspnoea, palpitation, chest pain, fainting
• Work-related: excessive physical work, heat/dehydration, fasting, night shift, chemicals (heavy metals, organophosphates)
• Medications: statins (myopathy), antihypertensives (hypotension)
• Past history: diabetes (hypoglycaemia), cardiac disease, neurological disease
• Red flags: sudden onset with facial droop/speech slurring/unilateral weakness (stroke), chest pain (ACS), severe headache, loss of consciousness

Examination

• Vitals: BP, PR, temperature, SpO2, GRBS (Blood Glucose - mandatory)
• General: pallor (anaemia), jaundice, hydration, nutritional status
• Neurological: power (grade 0-5 MRC), tone, reflexes, sensation, facial symmetry, speech, coordination - bilateral vs unilateral deficit
• Cardiovascular: heart sounds, BP both arms (if aortic dissection concern)
• Abdomen: hepatosplenomegaly

Management (OHC)

• Hypoglycaemia (GRBS <70 mg/dl): 15g glucose (3 tsp sugar in water / glucose tablets / juice); recheck in 15 min; IV Dextrose 25% 50ml if unconscious
• Dehydration/exhaustion: ORS/IV fluids, rest, cool environment
• Heat exhaustion: cool environment, fans, cool fluids, monitor temp; if heat stroke (core temp >40°C + altered sensorium) = emergency, cool rapidly, refer
• Anaemia (suspected): CBC referral; iron supplementation if dietary deficiency likely; refer to physician
• Post-viral weakness: reassurance, nutrition, graded return to work
• Work restriction: no heavy work, machinery, heights pending cause identified
• Refer urgently if: focal neurological deficit (stroke protocol - call emergency), chest pain, GRBS not responding, severe dehydration/shock, suspected toxic exposure (organophosphate - SLUDGE signs)

15. MINOR TRAUMA

History

• Mechanism: fall, struck by/against object, caught-in/between, motor vehicle, sports
• Force/energy of impact, site of injury
• Immediate pain, swelling, deformity, inability to weight-bear/use limb
• Head involvement: LOC, amnesia, vomiting, headache (MTBI assessment)
• Neck pain post-trauma: cervical spine precautions
• OHC context: Workplace accident - mandatory incident documentation

Examination

• Vitals (especially if high-energy mechanism)
• ATLS principles (primary survey) if significant trauma:
  • A: Airway with c-spine control
  • B: Breathing, SpO2
  • C: Circulation, bleeding, BP
  • D: Disability - GCS, pupils, GRBS
  • E: Exposure - full examination
• Injured area:
  • Inspect: swelling, bruising, deformity, wounds
  • Palpate: bony tenderness, soft tissue tenderness
  • ROM: active then passive
  • NV status: distal sensation, power, pulses, capillary refill
• Specific tests: Ottawa Ankle Rules (to decide X-ray for ankle), Ottawa Knee Rules

Management (OHC)

• RICE: Rest, Ice (15-20 min, protect skin), Compression bandage, Elevation
• Analgesics: Paracetamol, NSAID; Topical NSAID gel
• Wound management if laceration: as per Minor Wounds section
• Splinting/buddy taping for suspected minor fractures pending X-ray
• Head injury (minor): GCS 15, no LOC or LOC <30 sec, no amnesia = Minor; Paracetamol (avoid NSAIDs - bleeding risk); Head injury observation card; return precautions (worsening headache, vomiting, confusion, unequal pupils = go to emergency)
• Cervical spine precautions: if neck pain post-trauma - hard collar application, immobilise, refer
• Mandatory documentation: Accident Report, First Aid Register, Near Miss Register; notify Safety Officer
• Refer if:
  • Suspected fracture (deformity, point tenderness, inability to bear weight) - X-ray
  • Head injury with any red flag (GCS <15, LOC >30 sec, focal deficit, seizure, suspected skull fracture)
  • Suspected spinal injury
  • Vascular compromise
  • Large haematoma/degloving injury
  • High-energy mechanism

OHC Emergency Equipment & Drugs - Quick Reference

OHC Documentation Checklist

1. Date/time, employee ID, department
2. Chief complaint, brief history
3. Vitals + examination findings
4. Diagnosis (working/confirmed)
5. Treatment given (drug, dose, route)
6. Fitness assessment: Fit / Fit with restrictions / Unfit (with duration)
7. Referral if done (where, urgency, reason)
8. Work-related? (Yes/No) - if Yes: Incident Report number
9. Follow-up instructions + return-to-work plan
10. Doctor signature + designation