A+E Essentials Flashcards
Where should a life-threatening emergency be directed to?
999
Where should a traumatic but non-life threatening emergency be directed to?
A+E
In how many hours should a patient be seen by a physician in A+E?
Dependent on urgency (standard, urgent or very urgent) but within 4 hours
State 5 factors which contribute to a decision of hospital admission in A+E.
- Age
- Social
- Comorbidities
- Access to hospital
- Resources: available beds and time
- Condition requiring admission – severity/urgency
- FU care
- Time of presentation
What should be done to allow a safe discharge from the emergency department?
- Inform and educate patient: event, process (Hx, CEX, Ix, Ddx, Tx)
- Post-ED discharge care (management plan – medications, wound care, suture removal, use of crutches)
- Safety net (Red flags and who to contact)
- Liaise with other care providers (referral; communicate with GPs; community care)
State a handover framework
- SBAR
- AT MIST
- METHANE
Outline an SBAR
Situation
Background
Assessment
Recommendation
Outline an ATMIST
Age Time Mechanism of injury Injuries Signs Treatment
What is the primary survey?
A systematic method of managing life-threatening conditions. The principles are conducted in order of urgency. Any intervention or change in status requires reassessment starting from A.
State the primary survey.
Danger – environment, people, surroundings Response – of patient Airway Breathing Circulation Disability Exposure
What is the relevance of the c-spine in the primary survey?
First 7 vertebrae of vertebral column. Increased risk of injury during high mobility flexion, extension and rotation.
How may you assess the c-spine?
NEXUS Criteria
Mechanism of Injury
Outline the NEXUS criteria.
- Neuro deficit
- Spinal midline tenderness in C-spine
- Alertness
- Intoxication
- Distracting injury
How may you manage a C-spine?
MILS
Collar
Block
Tape
Triple immobilisation: hard collar + head block + tape
How may you assess the airway?
- Talk to patient
- Look for chest and abdominal wall movements
- Listen for breathing and abnormal sounds
- Feel for expired air and chest movements
State 3 potential signs of airway obstruction.
- Absent breath sounds (complete obstruction)
- Stridor
- Crowing
- Gurgling
- Snoring
- Paradoxical chest movements
- Use of accessory muscles
- Reduced consciousness
How may you manage the airway
- Positioning – ensure you or the patient is in a comfortable position. You may be in that position for a substantial period of time.
- Consider C-spine: hands splayed alongside patient’s head
- Consider need to suction airway – clears debris from the airway
- Manoeuvre the airway: head-tilt (C-spine unsuspected) or jaw-thrust (C-spine suspected)
- Airway ladder
Outline the airway ladder.
Position (head-tilt chin lift/ jaw thrust) - OPA/NPA - SGA - ETT - Surgical airway
How may you clear an airway that is obstructed with blood or vomit or sputum?
Position (recovery)
Suction
Magill’s forceps
State the indication for suction.
- Audible secretion
- Noisy crackles of secretions
- Ineffective cough and physical deterioration
State the contraindications for an oropharyngeal or nasopharyngeal airway.
- Mandible fracture
- Oral trauma
- Trismus
How would you insert a Guedel (OPA) Airway in an adult?
Measure from front teeth to angle of mandible
Insert pointing up and rotate 180º
How do you insert a Guedel (OPA) Airway in an adult?
Measure from front teeth to angle of mandible
Insert facing downwards
How do you size up a NPA?
Done according to height
M = 7
F = 6
Child = 5
How do you insert a NPA?
Bevel faces towards the septum
What is the use for a SGA and why may it be useful?
I-gel is an SGA with a soft non-inflatable cuff made of gel-like substance to give a tight seal around laryngeal inlet. Gel design means no inflation is necessary which speeds up process of insertion and causes reduced compression and trauma in the airway
How are SGAs sized up?
- Size by weight: 3 small adult, 4 female, 5 male
State 3 indications for definitive airway management.
- Apnea
- Airway protection from aspiration
- Unconsciousness GCS < 8
- Faciomaxillary fractures
- Risk of obstruction
- Impending airway compromise e.g. upper airway
State 5 common causes of airway obstruction.
- Consciousness
- Foreign body
- Infection
- Trauma
- Malignancy
- Allergy
- Anatomical
- Acute on Chronic
