# pertinent negative



## cointosser13

What's a pertinent negative, in the world of ems? could you give me some examples?


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## Clare

A pertinent negative is a negative finding (sign,  symptom or something from the scene or history) that is pertinent (appropriate) to ruling out your diagnosis of exclusion

A pertinent negative must be appropriate, for example of the primary problem is vomiting and dehydration then "no added heart sounds" is not a pertinent negative whereas "no dysuria" might be, likewise if the problem is "fall and broken leg" then "no leukocytosis" is not a pertinent negative whereas "no loss of consciousness" is.

If you want to rule out myocardial ischaemia then no chest pain or history of cardiac disease is a penitent negative whereas if you want to rule out cervical spine injury at a road crash then no neurological signs or symptoms and no significant damage to the vehicle are pertinent negatives.

Hope this helps


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## JPINFV

cointosser13 said:


> What's a pertinent negative, in the world of ems? could you give me some examples?



A pertinent negative would be the patient answering "no" to a question that helps narrow down what's going on. For a patient with chest pain, if the patient answers no to hemoptysis (coughing up blood), it helps to rule out things like pulmonary embolism.


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## patzyboi

is this documented or is the pertinent positive documented?

Or both


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## Shishkabob

Both.  Use it for your justification of how you treated a patient.


Chest pain for 3 days, sharp, non-radiating, pinpoint in nature, reproducible upon palpation, hurts more when breathing, no nausea, no cardiac history, age in the 20s.... probably not an MI, and as such I won't treat it as an MI, documenting all that I just stated here.


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## abckidsmom

patzyboi said:


> is this documented or is the pertinent positive documented?
> 
> Or both



In an imaginary chest pain scenario, the documentation would look like "pt c/o substernal chest "pressure", with difficulty breathing. States the onset was while shoveling snow, denies nausea/vomiting, no LOC, skin is pale warm and dry."


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## abckidsmom

Linuss said:


> Both.  Use it for your justification of how you treated a patient.
> 
> 
> Chest pain for 3 days, sharp, non-radiating, pinpoint in nature, reproducible upon palpation, hurts more when breathing, no nausea, no cardiac history, age in the 20s.... probably not an MI, and as such I won't treat it as an MI, documenting all that I just stated here.



GMTA, only mine wasn't a negative scenario.


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## mycrofft

Th pertinent negative is what your clinical instructor will keep changing her or his mind about when the rest of your history-taking or lab interpretation is spot on. 

Ditto the attorney when you are on the stand.


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## Clare

Yes, pertinent negatives are documented as part of writing up your historical examination and physical findings.


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