2 - Acute Emergencies and Pre-Hospital Care Flashcards
What is the ABCDE approach to emergency presentations?
- LOOK LISTEN FEEL ensuring personal safety
- Check patients drug chart for disability for any changes in consciousness
- Respect patients dignity when exposing and prevent uneccessary heat loss
What are some major causes of acute abdominal pain that may present to primary care?
- Shingles
- Hernia
- UTI/Pyelonephritis
If a patient described abdominal pain in each of the regions shown, what may be some differentials?
What are some important questions to ask a female presenting with acute abdominal pain?
- History of STIs or PID
- Contraceptive method e.g IUD
- LMP
- History of ectopic pregnancies
- Any vaginal bleeding
What pathologies can cause back pain as well as abdominal pain?
- Pancreas
- Abdominal aorta
- Bowel obstruction/ perforation
- Cirrhosis
- Appendicitis
- Gall stones
- Kidneys
How do you examine a patient that you have assessed/taken a history for with abdominal pain?
Inspection: look for anaemia or jaundice, Grey-Turners and Cullens, ab distension, visible peristalsis, assess hydration
Auscultation: listen for absent bowel sound, bruit
Percussion: shifting dullness, fluid thrill, organomegaly
Palpitation: start away from pain and move towards it, rebound tenderness, look for hernia in groin, examine scrotum, look at groin and supraclavicular lymph nodes
Extra: urine, pregnancy test, lower limb pulse, rectal or pelvic exam
How do you investigate a patient with acute abdominal pain?
Investigations to consider, depending on differential diagnosis, may include:
urine analysis (+/- culture +/- pregnancy test if indicated)
electrolytes +/- LFTs
lipase for pancreatitis
venous blood gas
blood sugar for DKA
LFTs, lipase and UEC in abdominal injury
imaging
How should you help a child who has respiratory difficulty or is choking?
- Resp difficulty: High flow oxygen (15L/min) or bag valve mask if poort effort
- Choking: Encourage coughing, if not 5 back blows then 5 chest thrusts
What are some red flags with abdominal pain?
- Hypotension
- Confusion
- Dehydration
- Patient lying still or writhing
- Rebound tenderness
- Guarding
- Rigid abdomen
- Tenderness to percussion
- History of haematemesis or melaena
- Testicular pathology
What is the diagnosis and management for the following clinical findings in a child?
What is the traffic light system used for identifying a child’s risk of serious illness?
- Any red features that are a life threatening cause of febrile illness (e.g sepsis) need emergency ambulance to A+E
- Any red non-life threatening need face to face assessment within two hours
- Any amber face to face assessment on clinical judgment
- Any green can be managed at home with support e.g hydrate and ibuprofen, and safety net
What are some major causes of acute chest pain?
- PE
- Pneumothorax
- Pericarditis
- Cardiac Tamponade
- Pneumonia
- Pleural effusion
What symptoms would make you think a patient’s acute chest pain is due to ACS?
What management should a patient with pre-existing angina be given when undergoing an angina attack?
How can chest pain be classified?
- Cause: cardiac/non cardiac
- Type: localised/poorly localised and pleuritic or non-pleuritic
How should you investigate and manage a patient with acute chest pain?
- Full CVS exam
- ECG 12 lead
- Cardiac enzymes/troponin
- Call 999 if urgent admission needed
If a patient presents with chest pain and does not require an immediate admission, where should they be referred to?
REFER TO CHEST PAIN CLINIC
- Urgent same day assessment: if suspected ACS but pain-free with chest pain in the past 12 hours and a normal ECG or chest-pain in past 12-72 hours with no complications
- 2 Weeks: suspected ACS with pain in past 72 hours, suspected malignancy, suspected pleural effusion, suspected lobar/lung collapse
- Routinely if stable angina or unknown chest pain