Your OLDCARTS coverage
Tick your questions, then press Take the history.
OLDCARTS. Onset · Location · Duration · Characteristics · Aggravating and associated factors · Relieving factors and radiation · Timing and treatment · Severity. PQRSTU covers the same ground: Provocative and palliative, Quality, Region and radiation, Severity, Timing, and Understanding — the patient’s own interpretation and the impact on daily life. Use whichever your programme teaches, and use it every time, including at three in the morning, because completeness is what makes the pattern visible.
Documented pertinent negatives are evidence of clinical reasoning. “Denies fever, cough, haemoptysis, leg swelling or recent travel” in a patient with chest pain proves you thought about pneumonia and pulmonary embolism. Absent findings, deliberately asked about and recorded, are what separates a student history from a professional one.
Reported, observed, and the one that is both
Sort the findings, then press Check my sort.
Nausea is subjective; emesis of 200 mL of coffee-ground fluid is objective. Subjective data is charted as reported — “Pt reports…”, “Pt states…”, “Pt denies…” — or in direct quotation. Objective data is what you observe, measure or elicit: vital signs, a wound’s dimensions, lung sounds, a laboratory value, an observed limp.
Pain is uniquely both, and you never override a reported score with your own impression. The score is charted as the patient states it. Guarding, grimacing, tachycardia and diaphoresis are objective corroboration charted alongside it. If the two disagree, name the discrepancy out loud — that is gentle confrontation, not a licence to change the number.
The sequence, and the one exception
Choose a region and order the techniques.
Everywhere except the abdomen: inspection → palpation → percussion → auscultation. Inspect first because touching changes what you will see and because looking costs nothing. Palpate second, light before deep, warm hands, painful areas last. Percuss third for density and organ borders. Auscultate fourth. Work head to toe, compare side to side for symmetry, and expose only the region being examined.
The abdomen: inspect → auscultate → percuss → palpate. Auscultation moves ahead of percussion and palpation because manipulating the abdominal wall alters bowel motility and therefore falsifies the bowel sounds you are about to grade — you would be scoring an artefact you created. Listen in all four quadrants before touching anything, examine any painful area last, and stop deep palpation entirely if there is rigidity, rebound, or a known or suspected abdominal aortic aneurysm.
Choose an age group and press InterpretThe same number means different things at different ages, and no number outranks how the patient looks.
Pulse oximeters can overestimate true arterial saturation in patients with darker skin pigmentation, producing occult hypoxaemia — a normal-looking reading in a patient who is genuinely hypoxic. Never let the number override the patient: work of breathing, respiratory rate, mental status and the patient’s own report of breathlessness come first. A reading that does not match the patient warrants a repeat on a different site and escalation. Assess cyanosis at the oral mucosa, tongue, conjunctivae, palms, soles and nail beds, where an ashen or grey dullness is readable on every skin tone.
Temperature. Adult oral runs 36.5–37.5 °C (97.7–99.5 °F); rectal averages about 0.5 °C higher and axillary about 0.5 °C lower. Fever in an adult is 38.0 °C (100.4 °F) or above. Older adults run a lower baseline, often 35.8–36.6 °C, and may mount no fever at all with serious infection.