Acute emergencies Flashcards
Acute abdomen - what is it and what to do in primary care:
severe acute abdominal pain
if very severe they need immediate hospital admission for iv fluids - don’t take detailed history examination
History and abdominal examination to identify cause - few differentials to know which department pt needs to be referred to
History
SQITARS - associated symptom important e.g. vom, systemic signs, stool/urine changes, lumps in area
PMH - DH and surgical
Obs & Gynae -
occupation, recent travel, recent abdominal trauma
abdo examination
- pulse, temp, BP
RR - if peritonitis pt would take shallow rapid breaths
GCS - if altered consciousness
urine test - for women of childberaing age first line to rule out ectopics - inspection
- anaemia/jaundice
- Cullen’s sign - bruising around umbilicus - if pancreatitis/ectopic
- Grey Turner’s sign (bruising of flanks) - if retroperitoneal haematoma
- dehydrated - Auscultation
- 4 quadrants
- Bruits –> AAA
- absent –> paralytic ileus/intestinal obstruction/peritonitis - Percussion
- for swelling/distention
- tenderness –> red flag and likely have peritonitis
- shifting dullness and fluid thrill
- size of an abdominal mass - Palpation
- rebound tenderness
- gently–> deeply
- scrotum
- hernial orifices
acute appendicitis presentation
pain from periumbilical region to right iliac fossa
colicky abdominal pain ?
biliary tract obstruction
colicky pain - is intermittent pain secs-mins
sudden onset pain ?
radiation to back?
vascular accident - dissection/bleeding/infarction
from pancreas/AAA
anaemia or cachexia ?
suggests acute on chronic conditions
red flags and possible system organised differentials
go to notes
ABCDE in acutely unwell children
A - head tilt chin lift
B - pre-terminal (late) signs: high RR, gasping, exhaustion, silent chest, bradycardia
C - “ - hypotension
D - disability/neuro assessment - AVPU/GCS. stiff posturing, check pupil size/blood sugar/ICP
E - exposure - assess head –> toe
further assessment - ABCDE again, go to notes
- looking for congenital heart disease - poor feeding
- other common stuff - SVT, status epilepticus, sepsis
child w fever (38 and above) history and examination?
pattern of fever method of temp measurement perinatal complications/PMH recent antipyretics/antibiotics imms history travel parent previous experience w fevers
traffic light system - table in notes
red - lifeT ambulance for A&E
red - nonlifeT - urgent f2f (if telephone) in 2 hrs
amber - arrange f2f
green - home managed : assess for underlying cause e.g. UTI, antipyretics and safety net
SOB common causes
Cardiac
Resp
Others - anaemia, diaphragmatic splinting, psychogenic breathlessness
SOB - management
determine if emergency admission required from BP, HR, RR, temp, PEFR, O2 sats, ECG, consciousness levels
- admit if indicates, arrhythmia, HeartF, sepsis, pulmonary embolus, pneumothorax, S/LT asthma, pneumonia CRB65
- other features - Stridor, altered consciousness/ acute confusion, significant respiratory effort (esp if exhausted), Elevated RR, O2 sats < 92%, Cyanosis, Tachycardia, Hypotension, PEFR < 50% of predicted, Immunosuppression / other significant comorbidity, Pregnancy or postnatal period, elderly or very frail, unable to cope at home, poor/deteriorating general condition
if need to admit: give oxygen if o2 sats 94% or < and constantly monitor sats
if not: identify cause, manage, investigations to confirm diagnosis
Stroke/TIA management
arrange immediate admission to acute stroke facility (if suspected symptoms of stroke/TIA or resolved symptoms w bleeding disorder) despite -ve FAST can still have symptoms
- ambulance team understand urgency and pt will have access to thrombolysis for stroke
- inform hospital - w history details
- ABC while waiting
identifying symptoms of stroke/TIA
exclude hypoglycaemia - check blood glucose (<3.3.)
ECG - exclude arrhythmias
history:
- time of onset
- progression of symptoms
- current status
- symptoms would’ve resolved if TIA and still present if
stroke
- DH - esp anticoagulants
- FH, PMH and riskF
Examine
- cardiac
- FAST - face arm speech test, positive if weakness in FA or speech impairment
bell’s palsy - management I don’t need to know!)
reassurance - full recovery in 3-4mths
advice - keep affected eye lubricated (sunglasses outdoor, ape when sleeping) , use straw if affected eating
consider prednisolone if present in 72hrs of symptoms refer urgently to 2care if: suspect neuro findings, cancer, UMN cause, systemic signs, trauma
refer to facial nerve specialist (neuro/ENT) if: doubt of diagnosis, no improvement >3wks
bells palsy - assessment
diagnosis - when no other medical conditions is found symptoms - rapid onset - < 72 hrs facial muscle weakness ear/postauricular pain mouth - dry, chewing/speech problems, drooling eyes - incomplete closure numbness/tingling - cheek/mouth
anaphylaxis - assessment
A - pharyngeal/laryngeal oedema (throat/tongue swelling), hoarse voice, stridor
B - SOB, wheeze, tiredness, cyanosis, peripheral cap O2 sats <92%
C - shock signs (pale, clammy), tachycardia, hypotension, consciousness altered, cardiac arrest, ECG changes
D - ABC alter this
E - erythema, urticaria, angio-oedema
diagnosis criteria - sudden/rapid progression:
- feeling of “impending doom” , anxious
- unwell - feel & look
- over several minutes - onset depends on type of trigger e.g. rapid if IV (stings)
- exposure to known allergen can help diagnosis
- be aware that biphasic anaphylaxis can occur - recurrence of anaphylaxis despite no re-exposure to allergen
- skin and GI symptoms can also be present
