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GP - mx > Acute and serious illness > Flashcards

Acute and serious illness Flashcards

1
Q

Appendicitis - ix/mx

A

Ix
1. Not needed, clinical dx

Mx

  1. Send to nearest hospital
  2. +/- contact private surgeon
  3. Write letter detailing medical situation
  4. Advise not to eat or drink
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2
Q

Bowel obstruction - ix/mx

A

Ix

  1. Plain AXR - reveals dilated gas filled loops of bowel
  2. Baseline UEC, FBE to ax hydration and electrolytes

Mx

  1. Send to nearest hospital
  2. +/- contact private surgeon
  3. Write letter detailing medical situation
  4. Advise not to eat or drink
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3
Q

Pancreatitis - ix/mx

A

Ix

  1. Serum amylase + lipase
  2. Upper abdominal U/S and/or CT scan
  3. Electrolytes
  4. BGL
  5. Calcium
  6. FBE
  7. Blood gases if SaO2 low

Mx

  1. Send to nearest hospital
  2. +/- contact private surgeon
  3. Write letter detailing medical situation
  4. Advise not to eat or drink
  5. Could insert IV line
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4
Q

Gastroenteritis - ix/mx

A

Ix
None needed

Mx

  1. Provide written instructions about when to return.
    a. Increasing abdominal pain especially if pt can’t push on abdomen
    b. Blood in vomit or motion or black motion
    c. Evidence of dehydration (no urine production for 12h or HR increases by 25% above normal)
    d. Symptoms persisting over next 24-48h. May institute ix
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5
Q

Cholecystitis - ix/mx

A

Ix
1. Upper abdominal U/S - thickened edematous gall bladder wall
Others?

Mx

  1. Send to nearest hospital
  2. +/- contact private surgeon
  3. Write letter detailing medical situation
  4. Advise not to eat or drink
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6
Q

IBS - ix/mx

A

Ix

  1. FBE
  2. ESR
  3. TFTs
  4. Celiac serology
  5. Colonoscopy
  6. H2 (hydrogen) breath test (lactose/fructose intolerance)
    * Dx of exclusion of organic disease

Mx

  1. Reassurance
  2. Get pt to do food diary to see if there is anything that seems to trigger problems
  3. Reduce fat, alcohol and caffeine
  4. Stress management
  5. +/- antispasmodics
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7
Q

Perforated peptic ulcer - ix/mx

A

Ix
1. Plain supine and erect AXR - gas under diaphragm with fluid levels throughout small intestine
Others?

Mx

  1. Send to nearest hospital
  2. +/- contact private surgeon
  3. Write letter detailing medical situation
  4. Advise not to eat or drink
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8
Q

Myocardial infarction - ix/mx

A

Ix
1. ECG
Others?

Mx

  1. Give aspirin
  2. Give GTN
  3. Attach oxygen
  4. +/- IV line and give morphine for pain
  5. Send to nearest hospital by ambulance immediately
  6. Write letter detailing medical situation
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9
Q

PE - ix/mx

A

Ix
1. ECG
Others?

Mx

  1. Oxygen
  2. Send to nearest hospital for urgent CTPA (CT pulmonary angiography) or ventilation/perfusion scan

Further ix

  1. CXR (pulmonary oligaemia)
  2. FBE (neutrophil leukocytosis sometimes)
  3. ESR (increased)
  4. D-dimer (increased)
  5. LDH (increased)
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10
Q

Esophageal reflux - ix/mx

A

Ix
1. Can do ECG.
Ix not necessary if sure of dx and no alert sx such as loss of weight, dysphagia

Mx

  1. If sure of dx then therapeutic trial of PPI is all that is required
  2. If currently symptomatic, trial some Gaviscon or Mylanta Plus (antacids)
  3. If symptoms persist, need re-evaluation with endoscopy and/or breath test
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11
Q

Anxiety - ix/mx

A

Ix
1. Not required if sure of dx. If any concern then it is better to refer to ED for exclusion of AMI as even an ECG that is normal does not rule out an MI

Mx

  1. If sure of dx, then reassurance with careful explanation and approaches to relaxation
  2. Confidence in dx is more likely if there has been previous episodes
  3. Preferable to tx pt as a possible AMI if unsure of dx
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12
Q

Herpes zoster - ix/mx

A

Ix
1. Not needed. With classical sx most likely cause is herpes zoster and pt can be advised tht a rash will appear in 2d time. If no rash appears, the pt needs to be investigated for other causes of neuropathic pain

Mx

  1. Review immediately if rash presents for antiviral treatment, or in 3-4d if no rash appears
  2. Use famciclovir or valaciclovir
  3. In the meantime, provide adequate analgesia. Use corticosteroids (oral prednisolone) if not contraindicated as better for neuropathic pain than paracetamol
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13
Q

Costochondritis - ix/mx

A

Ix
1. If 100% confident then may decide not to investigate

Mx

  1. Reassurance
  2. Analgesia
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14
Q

Head injury - ix/mx (add)

A

Ix

  1. CT if indicated
  2. Consider cervical spine imaging
  3. Consider VBG and BSL
  4. Consider ECG

Mx - if closed head injury:

  1. Urgent referral for CT scan
  2. Neurological specialist opinion in acute care hospital setting
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15
Q

Paracetamol OD - mx (add)

A

Short-term

  1. Explain that immediate concern is risk of death from OD
  2. Send for monitoring in hospital
  3. Will have gastric lavage and N-acetylcysteine

Long-term

  1. Address underlying mental health issues
  2. Address social issues such as housing and finances
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16
Q

Domestic violence - hx/mx

A

During hx:

  1. Listen, believe and validate the pt
  2. Reassure pt of confidentiality except where children are at risk
  3. Be calm and reassuring
  4. Do not be shocked by the pt’s story. Assure them that they are are not alone
  5. Appear unhurried
  6. Allow the pt to make their own decisions, as making them for them is disempowering

Mx

  1. State the problem
  2. Establish pt’s level of understanding of the issue
  3. Establish pt’s attitude towards the issue
  4. Educate pt about the problem
    i. Very common but often hidden problem in the community
    ii. Explain that this is abuse and that people should not be treated in this way
    iii. Emphasise the seriousness of these events and how the partner is unlikely to change
    iv. Explain the ‘cycle of violence’ - a predictable pattern that has been identified in many marriages. Violence/abuse -> remorse phase -> wooing phase -> honeymoon phase -> tension build-up phase -> explosion
  5. Management plan (after emotional component at least partly defused):
    i. Assist pt to define problems, including level of danger (immediately and short-term)
    ii. Assist in deciding immediate options, and weighing up pros and cons of each
    iii. Assist in devising a safety plan
    iv. Facilitate the pt in reaching their own decision about what to do (which may include doing nothing except to ‘carry on’, and this must be supported by the doctor if it really is the pt’s decision). Doctor must not promote his/her own views or pressure the pt to make a decision straight away (may take several consultations)
    v. If victim reporting to police - notify at once, take witness (if there was one), do not wash or change, do not take alcohol or drugs
    vi. Encourage pt to seek additional support, e.g. through the Domestic Violence Centre
    vii. Provide information about available resources, support shelters, women’s shelters, legal advice, intervention orders
    viii. Give the pt support and encouragement in an attempt to improve their self-esteem and enable them to make decisions
    ix. Discuss show the situation is affecting their children and how they can help them understand the situation. Remember mandatory reporting, if relevant
    x. Ask what, if anything, they would like you to say to their partner. Options range from nothing (all confidential), to sharing with discretion, to telling everything. Make sure you document their wishes
  6. Prevention
    i. Emphasise the importance of safety to them and their children and to have a strategy plan for a crisis.
    ii. Make a safety plan
  7. Reinforce main points, including:
    i. Counselling about any possible self-blame or guilt feelings about being responsible for, or deserving of, their partner’s behaviour
  8. Handout + written copy of safety plan. If possible and with consent, ring crisis service and allow pt to talk to counsellor while they are still at the clinic
  9. Evaluate consultation + give opportunity to ask questions
  10. Arrange F/U
17
Q

Hypoglycaemia - mx

A

a. Mild (pt conscious and cooperative)
1. Give readily available and fast-acting glucose-containing food or drink should be offered. 6-7 jelly beans, 1 tablespoon of honey, 200mL of fruit juice, 150-200mL of soft drink, 20g of glucose tablets
2. If after 10-15 mins the blood glucose measurements remains less than 4mmol/L, the treatment should be repeated
3. Once the BGL returns to normal, a longer-acting carbohydrate (e.g. sandwich, dried fruit, yoghurt) should be given to prevent recurrent hypoglycaemia)
4. Normal diabetes therapy should not be interrupted but might need readjustment depending on the cause of hypoglycaemia

b. Severe hypoglycaemia (confusion/loss of consciousness - pt needs assistance)
1. IV glucose 50% through securely positioned cannula if IV access is available, or
2. Glucagon 1mg IM or SC
3. Unconscious pts usually start to respond within 6 mins following glucagon administration. If failure to respond, IV glucose is second-line tx. If IV glucose not available, give second glucagon dose 20 mins after the first
4. If pt is conscious and able to swallow, give food to prevent recurrence of hypoglycaemia
5. After the episode, monitor the pt’s blood glucose every 1-2hrs for the next 4h, then revert to usual testing regimen
6. Provide dietary and medication review + education about preventing and managing hypoglycaemia

18
Q

Organophosphate poisoning - mx

A
  1. Urgent removal of contaminated clothing
  2. Wash skin
  3. Atropinisation - should explain that this means giving enough atropine to cause mild tachycardia and mydriasis
  4. Urgent admission to hospital for monitoing where pralidoxime may be used
  5. Also check who else is at risk and prevent further exposure, including treating medical team if on clothes, etc.

GP - mx (5 decks)

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