Acute emergencies and pre hospital care Flashcards
(36 cards)
What is the approach used in an emergency when assessing a patient?
A-E approach
what is the A-E approach
A - airway B - breathing C - circulation D - disability E - exposure
what needs to take place during the airway assessment of an acutely ill patient?
- look for obstruction
- listen to chest
- jaw thrust/head tilt/chin lift
- give O2?
what needs to take place during the breathing assessment of an acutely ill patient?
- check chest expansion
- listen to lungs
- non rebreathe mask 15L/min O2
- monitor O2 sats and resp rate
what needs to take place during the circulation assessment of an acutely ill patient?
- do the C on arm then listen to heart sounds
- venous access and send bloods
- get VBG and ABG if under 95%
- give fluids
what needs to take place during the disability assessment of an acutely ill patient?
- check AVPU
- check glucose
- check pupils
what needs to take place during the exposure assessment of an acutely ill patient?
- feel temperature (warm if hypothermic)
- expose and check everywhere (head to toe)
what should be the initial assessment of a patient with an acute abdomen?
- note whether patient looks ill, septic or shocked
- note whehter lying still (peritonitis) or rolling in agony
- assess A-E
- arrangemnts for rapid transfer to hosp
- take Hx and complete examinations needed
what is the pre-hosp/emergency dept. care of a patient with suspected acute abdo?
- nil by mouth
- O2
- IV fluids
- NG tube consider
- analgesia
- antiemetic
- ABX
- arrange investigations
what important investigations need to take place in a patient with an acute abdo
- bloods: FBC, U+E, LFTs, amylase, glucose, clotting, calcium, ABG
- group and save
- blood cultures
- preg test
- urinalysis
- AXR, CXR, CT, US
- ECG and cardiac enzymes consider
- laparoscopy maybe
name some important red flag signs in a patient who has an acute abdo?
- hypotension
- confusion/impaired consiousness
- signs of shock
- systemically unwell
- signs of dehydration
- rigid abdo
- patient lying still/writhing
- absent/altered bowel sounds
- associated tesicular pathology
- guarding/rebound tenderness
- heamatemesis, malean
what symptoms may indicate a patient is having an ACS?
- pain in the chest (/radiating to arms, back jaw) lasting longer than 15 mins
- chest pain with N+V, sweating and/or breathlesness
- new onset chest pain or abrupt deterioration in stable angina, last longer than 15 min
what should patients experiencing an angina attack take
GTN spray or tablets - and second dose after 5 mins if pain not eased
what is the typical presentation of a pt. with chest pain due to cardiac ischameia\?
- retrosternal or epigastric
- tight adn crushing
- may radiatie to arm, sshoulders, neck or jaw
what is pleuritic chest pain a sign of?
pericarditis or pulmonary pain (worse on inspiration)
what examinations are important in a pt. with chest pain?
CVS exam pulse rate and rhythm BP Heart sounds Lungs tenderness of chest wall epigastric tenderness ? due to peptic ulcer focal lung signs?
name the main differential diagnoses of chest pain?
- angina, ACS
- acute pericarditis
- pneumonia, PE, pneumothroax
- GORD, oesophageal spasm
- peptic ulcer
- gallstones, cholecystitis
- acute pancreatitis
- chest wall pain
- aortic dissection
- anxiety, depression
what investigations need to be done in a pt. with chest pain?
CXR (pneumonia)
abdo US (gallstones)
serum amylase (pancreatitis)
bloods (cardiac enzymes, lipids, glucose, FBC)
ECG
maybe echo, pulmonary angiography, CT aortography ,endoscopy
what is the management in primary care of a pt. who is has chest pain and suspected acute coronary syndrome?
- GTN spray 2.5mg to 5mg over 5 mins
- apsirin 300mg
- take resting 12 lead ECG
what is the management in primary care of a pt. with chest pain and suspected acute pulmonary oedema?
give an IV duiretic
give IV opioid
give IV antiemetic
give nitrate e.g. GTN spray
what is the management in primary care of a pt. with chest pain and suspected tension pneumothorax?
consider inserting large bore cannula through second intercostal space in mid clavicular line on side of pneumothorax
what is the traffic light system when assessing an acute unwell child
traffic light systme (green, amber, red) is used to identify risk of serious illness in under 5s - used to assess whether to admit child to hopsital or urgent f2f or manage at home
name some of the red (high risk) symptoms in an acutely unwell child that would suggest admission to hsopital/
- pale/mottled/blue
- no response to social cues, appears ‘ill’
- weak or continuous cry
- grunting
- tachypnoea RR>60
- chest indrawing
- reduced skin turgor
- non blanching rash, neck stiffness
- bulging fontanelle
- focal seizures/nuerological signs
- ages <3 months and temp >38
name some of the amber (immediate risk) symptoms an acutely unwell child that would suggest urgent f2f?
- pallor
- no smile, decreased activity
- nasal flaring
- tachypnoea
- O2 sats <95%
- chest crackles
- tachycardia
- CRT >3 secs
- dry mucous membranes
- reduced urine output
- fever for >5dyas
- rigors
- non weight bearing a limb /swelling of limb
