f. Block TD-15-1 (block number 1 of algorithm number 15 of the TD section.)
asks if the patient can touch his chin to his chest. Tell the patient to try to touch his chin
to his chest.
If he cannot perform this maneuver, proceed to block TD-15-2.
If he can perform this maneuver, proceed to block TD-15-3 instead.
g. Assume the patient can touch his chin to his neck. Upon reading block
TD-15-3, you see that you are to check the patient's throat for swollen tonsils and pus
on the tonsils. Check his throat.
(1) If his tonsils are swollen or if you observe pus or if his oral temperature
is 101 F or higher, take a throat culture and have the patient see the PA today (Level
(2) If his tonsils are not swollen and no pus is observed on his tonsils and
his oral temperature is below 101F, proceed to block TD-15-4.
h. Assume the patient's tonsils appear normal (or have been removed) and his
oral temperature is 99.8F. You would then proceed to block TD-15-4. Block TD-15-4
requires you to determine if the patient can clear both ears. Ask the patient to clear his
(1) If the patient cannot clear one or both ears when he swallows, the
eustachian tubes (channels leading from middle ears to the nasopharynx which serve to
adjust the air pressure in the middle ear to the external air pressure) may be inflamed.
Refer the patient to the PA today (Level III).
(2) If the patient clears both ears when he swallows, proceed to self-care
protocol TD-14. Tell the patient to take the appropriate self care measures. Provide
aspirin and gargles or lozenges as needed. Instruct the patient to return if there is no
improvement in three days or if his oral temperature rises above 101oF).
i. Upgrade the Level IV evaluation to Level III if the patient rejects the protocol
or if you believe that Level III is more appropriate (for example, the patient had
temperature of 100.8F and significant pain upon swallowing).
Although most of the work in a clinic can be described as routine, emergencies
do occur. You should be prepared for emergencies and know the appropriate
procedures to follow.