Acute abdomen, ABCDE and AALS Flashcards
What is meant by an acute abdomen?
Recent, rapid onset of urgent abdominal or pelvic pathology
Presents with abdominal pain
List 2 differentials for generalised abdominal pain
- Peritonitis
- Ruptured AAA
- Intestinal obstruction
- Ischaemic colitis
List 2 differentials for RUQ pain
- Biliary colic
- Acute cholecystitis
- Acute cholangitis
List 2 differentials for Epigastric pain
- Acute gastritis
- Peptic ulcer disease
- Pancreatitis
- Ruptured AAA
List 2 differentials for central abdominal pain
- Ruptured AAA
- Intestinal obstruction
- Ischaemic colitis
- Early stages of appendicitis
List 2 differentials for right iliac fossa pain
- Acute appendicitis
- Ectopic pregnancy
- Ruptured ovarian cyst
- Ovarian torsion
- Meckel’s diverticulitis
List 2 differentials for left iliac fossa pain
- Diverticulitis
- Ectopic pregnancy
- Ruptured ovarian cyst
- Ovarian torsion
List 2 differentials for suprapubic pain
- Lower UTI
- Acute urinary retention
- PID
- Prostatitis
List 2 differentials for loin to groin pain
- Renal colic (kidney stones)
- Ruptured abdominal aortic aneurysm
- Pyelonephritis
List 2 differentials for testicular pain
- Testicular torsion
- Epididymo-orchitis
List 4 signs of peritonitis
- Guarding
- Rigidity
- Rebound tenderness
- Coughing test
- Percussion tenderness
What is localised peritonitis?
List 2 causes
Underlying organ inflammation ie.
- Appendicitis
- Cholecystitis
What is generalised peritonitis?
List 2 causes
Perforation of an abdominal organ releasing contents into peritoneal cavity → inflammation ie.
- Perforated duodenal ulcer
- Ruptured appendix
SBP is associated with what/who?
Treatment?
Spontaneous infection of ascites in patients with liver disease
Treated with broad-spectrum antibiotics (poor prognosis)
What is assessed in A of the ABCDE assessment?
Airway
Ensure patient’s airway is patent and secure
What is assessed in B of the ABCDE assessment?
Breathing
- Assess breathing
- RR
- O2 sats
- auscultate lungs
- provide O2 if required
What is assessed in C of the ABCDE assessment?
Circulation
- BP
- HR
- Ausculate heart
- CRT
- Gain IV access → take bloods and provide fluid if required
What is assessed in D of the ABCDE assessment?
Disability
- Assess consciousness level using AVPU or GCS
- Check blood glucose
What is assessed in E of the ABCDE assessment?
Exposure
Finish full assessment, incl examination of the abdomen
How is the Adult advanced life support management divided?
- ‘shockable’ rhythms: VF, pulseless VT
- ‘non-shockable’ rhythms: asystole, PEA
What is the standard ratio of chest compressions to ventilation in ALS?
30:2
Chest compressions are continued while a defibrillator is charged
Protocol for non-shockable rhythms in ALS?
Adrenaline 1 mg as soon as possible
Continue CPR until the cause of arrest is identified and treated
Further adrenaline 1 mg IV should be given every 3-5 min during alternate 2 min loops of CPR
Protocol for shockable rhythms if the arrest is unwitnessed?
Single shock followed by 2 minutes of CPR
After 3 cycles administer 1mg adrenaline and 300mg amiodarone while CPR is restarted
- Further 150mg amiodarone after 5 shocks if patient is still in VF/pVT
- Adrenaline should be repeated every 3-5 minutes whilst CPR continues
Protocol for shockable rhythms if it is witnessed (connected to a monitor)
Upto 3 quick successive (stacked) shocks
1mg adrenaline and 300mg amiodarone while CPR is started
- Further 150mg amiodarone after 5 shocks if patient is still in VF/pVT
- Adrenaline should be repeated every 3-5 minutes whilst CPR continues
Check this
What is recommended for drug delivery in ALS?
First line: IV access should be attempted
If IV access cannot be achieved then drugs should be given via the intraosseous route (IO)
Medication and protocol for a VF/VT cardiac arrest?
Adrenaline 1 mg is given once chest compressions have restarted after the third shock
Repeat adrenaline 1mg every 3-5 minutes whilst ALS continues
Causes of reversible cardiac arrest
(H’s and T’s)
- Hypoxia
- Hypovolaemia
- Hyper/hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia
- Hypothermia
- Thrombosis (cardiac or pulmonary)
- Tension pneumothorax
- Tamponade
- Toxins
