A+E Essentials

Question 1

Where should a life-threatening emergency be directed to?

Answer 1

999

Question 2

Where should a traumatic but non-life threatening emergency be directed to?

Answer 2

A+E

Question 3

In how many hours should a patient be seen by a physician in A+E?

Answer 3

Dependent on urgency (standard, urgent or very urgent) but within 4 hours

Question 4

State 5 factors which contribute to a decision of hospital admission in A+E.

Answer 4

• Age
• Social
• Comorbidities
• Access to hospital
• Resources: available beds and time
• Condition requiring admission – severity/urgency
• FU care
• Time of presentation

Question 5

What should be done to allow a safe discharge from the emergency department?

Answer 5

• 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)

Question 6

State a handover framework

Answer 6

• SBAR
• AT MIST
• METHANE

Question 7

Outline an SBAR

Answer 7

Situation
Background
Assessment
Recommendation

Question 8

Outline an ATMIST

Answer 8

Age
Time
Mechanism of injury
Injuries
Signs
Treatment

Question 9

What is the primary survey?

Answer 9

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.

Question 10

State the primary survey.

Answer 10

Danger – environment, people, surroundings 
Response – of patient 
Airway
Breathing
Circulation
Disability
Exposure

Question 11

What is the relevance of the c-spine in the primary survey?

Answer 11

First 7 vertebrae of vertebral column. Increased risk of injury during high mobility flexion, extension and rotation.

Question 12

How may you assess the c-spine?

Answer 12

NEXUS Criteria

Mechanism of Injury

Question 13

Outline the NEXUS criteria.

Answer 13

• Neuro deficit
• Spinal midline tenderness in C-spine
• Alertness
• Intoxication
• Distracting injury

Question 14

How may you manage a C-spine?

Answer 14

MILS
Collar
Block
Tape

Triple immobilisation: hard collar + head block + tape

Question 15

How may you assess the airway?

Answer 15

• Talk to patient
• Look for chest and abdominal wall movements
• Listen for breathing and abnormal sounds
• Feel for expired air and chest movements

Question 16

State 3 potential signs of airway obstruction.

Answer 16

• Absent breath sounds (complete obstruction)
• Stridor
• Crowing
• Gurgling
• Snoring
• Paradoxical chest movements
• Use of accessory muscles
• Reduced consciousness

Question 17

How may you manage the airway

Answer 17

• 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

Question 18

Outline the airway ladder.

Answer 18

Position (head-tilt chin lift/ jaw thrust) - OPA/NPA - SGA - ETT - Surgical airway

Question 19

How may you clear an airway that is obstructed with blood or vomit or sputum?

Answer 19

Position (recovery)
Suction
Magill’s forceps

Question 20

State the indication for suction.

Answer 20

• Audible secretion
• Noisy crackles of secretions
• Ineffective cough and physical deterioration

Question 21

State the contraindications for an oropharyngeal or nasopharyngeal airway.

Answer 21

• Mandible fracture
• Oral trauma
• Trismus

Question 22

How would you insert a Guedel (OPA) Airway in an adult?

Answer 22

Measure from front teeth to angle of mandible

Insert pointing up and rotate 180º

Question 23

How do you insert a Guedel (OPA) Airway in an adult?

Answer 23

Measure from front teeth to angle of mandible

Insert facing downwards

Question 24

How do you size up a NPA?

Answer 24

Done according to height

M = 7

F = 6

Child = 5

Question 25

How do you insert a NPA?

Answer 25

Bevel faces towards the septum

Question 26

What is the use for a SGA and why may it be useful?

Answer 26

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

Question 27

How are SGAs sized up?

Answer 27

• Size by weight: 3 small adult, 4 female, 5 male

Question 28

State 3 indications for definitive airway management.

Answer 28

• Apnea
• Airway protection from aspiration
• Unconsciousness GCS < 8
• Faciomaxillary fractures
• Risk of obstruction
• Impending airway compromise e.g. upper airway

Question 29

State 5 common causes of airway obstruction.

Answer 29

• Consciousness
• Foreign body
• Infection
• Trauma
• Malignancy
• Allergy
• Anatomical
• Acute on Chronic