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

Basic General Examination - Every OHC Patient (Universal Screening Protocol)

1. First Look - General Survey (before touching the patient)

• Build and nutrition: well-built, thin, obese, wasted
• Posture and gait: limping, guarding a body part, stooped, unsteady
• Distress level: comfortable, in pain, anxious, breathless, diaphoretic
• Consciousness/mentation: alert, oriented, confused, drowsy
• Colour: pallor, cyanosis, jaundice, flushing, cold sweats
• Obvious findings: visible deformity, swelling, bleeding, rash, tremor

2. Vital Signs (mandatory on every single patient, no exceptions)

3. Head-to-Toe Quick Screen

• Eyes: pallor of conjunctiva (anaemia), icterus/jaundice (sclera), pupils equal and reactive
• Mouth/throat: dehydration (dry mucosa), pallor, cyanosis (lips/tongue), oral hygiene
• Neck: thyroid swelling, lymph nodes, jugular venous distension, neck stiffness (if fever/headache)
• Hands/nails: clubbing, cyanosis, pallor, capillary refill, tremors, temperature of extremities
• Skin: rash, bruising, wounds, turgor (hydration), sweating
• Lymph nodes: cervical, axillary, inguinal if relevant to complaint
• Oedema: ankles/pedal (screening for cardiac/renal issues)

4. Focused Systemic Examination (guided by chief complaint, but keep a baseline habit)

• Cardiovascular: pulse character, auscultate heart sounds (rate, rhythm, murmurs) if BP/pulse abnormal or chest symptoms
• Respiratory: inspect chest movement, auscultate breath sounds (crepitations, wheeze, reduced air entry) if any respiratory/fever complaint
• Abdomen: inspection, palpation for tenderness/guarding/organomegaly, bowel sounds if GI complaint
• Neurological (brief): orientation, pupils, gross power/sensation, gait - especially for headache, dizziness, weakness, trauma, or any altered sensorium
• Musculoskeletal/local: inspect, palpate, range of motion, neurovascular status distal to any injury

5. Documentation Discipline (applies to every consult)

1. Presenting complaint + brief history
2. All vitals (even if "normal" - document the number, not just "stable")
3. General survey findings
4. Relevant system examination findings (positive AND pertinent negatives, e.g. "no neck stiffness," "no focal deficit")
5. Working diagnosis
6. Treatment given
7. Fitness status: Fit for duty / Fit with restriction / Unfit (with review date)
8. Work-relatedness (Yes/No) - trigger Incident Report if Yes
9. Follow-up / return precautions given to patient

Quick "Never Skip" Checklist for Every OHC Consult

• Temperature, Pulse, BP, RR, SpO2
• GRBS (if diabetic, weak, dizzy, sweating, altered sensorium, or unwell-looking)
• General appearance (distress, pallor, cyanosis, jaundice, hydration)
• Focused system exam relevant to complaint
• Red-flag screen (chest pain, breathlessness, altered sensorium, focal weakness, severe pain, uncontrolled bleeding)
• Fitness-for-duty decision documented
• Work-relatedness assessed and documented