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Y3 GP > Acute emergencies and pre hospital care > Flashcards

Acute emergencies and pre hospital care Flashcards

1
Q

What is the approach used in an emergency when assessing a patient?

A

A-E approach

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2
Q

what is the A-E approach

A 
A - airway 
B - breathing 
C - circulation 
D - disability 
E - exposure
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3
Q

what needs to take place during the airway assessment of an acutely ill patient?

A
  • look for obstruction
  • listen to chest
  • jaw thrust/head tilt/chin lift
  • give O2?
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4
Q

what needs to take place during the breathing assessment of an acutely ill patient?

A
  • check chest expansion
  • listen to lungs
  • non rebreathe mask 15L/min O2
  • monitor O2 sats and resp rate
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5
Q

what needs to take place during the circulation assessment of an acutely ill patient?

A
  • do the C on arm then listen to heart sounds
  • venous access and send bloods
  • get VBG and ABG if under 95%
  • give fluids
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6
Q

what needs to take place during the disability assessment of an acutely ill patient?

A
  • check AVPU
  • check glucose
  • check pupils
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7
Q

what needs to take place during the exposure assessment of an acutely ill patient?

A
  • feel temperature (warm if hypothermic)

- expose and check everywhere (head to toe)

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8
Q

what should be the initial assessment of a patient with an acute abdomen?

A
  • 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
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9
Q

what is the pre-hosp/emergency dept. care of a patient with suspected acute abdo?

A
  • nil by mouth
  • O2
  • IV fluids
  • NG tube consider
  • analgesia
  • antiemetic
  • ABX
  • arrange investigations
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10
Q

what important investigations need to take place in a patient with an acute abdo

A
  • 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
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11
Q

name some important red flag signs in a patient who has an acute abdo?

A
  • 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
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12
Q

what symptoms may indicate a patient is having an ACS?

A
  • 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
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13
Q

what should patients experiencing an angina attack take

A

GTN spray or tablets - and second dose after 5 mins if pain not eased

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14
Q

what is the typical presentation of a pt. with chest pain due to cardiac ischameia\?

A
  • retrosternal or epigastric
  • tight adn crushing
  • may radiatie to arm, sshoulders, neck or jaw
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15
Q

what is pleuritic chest pain a sign of?

A

pericarditis or pulmonary pain (worse on inspiration)

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16
Q

what examinations are important in a pt. with chest pain?

A 
CVS exam 
pulse rate and rhythm 
BP 
Heart sounds 
Lungs 
tenderness of chest wall 
epigastric tenderness ? due to peptic ulcer 
focal lung signs?
17
Q

name the main differential diagnoses of chest pain?

A
  • angina, ACS
  • acute pericarditis
  • pneumonia, PE, pneumothroax
  • GORD, oesophageal spasm
  • peptic ulcer
  • gallstones, cholecystitis
  • acute pancreatitis
  • chest wall pain
  • aortic dissection
  • anxiety, depression
18
Q

what investigations need to be done in a pt. with chest pain?

A

CXR (pneumonia)
abdo US (gallstones)
serum amylase (pancreatitis)
bloods (cardiac enzymes, lipids, glucose, FBC)
ECG
maybe echo, pulmonary angiography, CT aortography ,endoscopy

19
Q

what is the management in primary care of a pt. who is has chest pain and suspected acute coronary syndrome?

A
  • GTN spray 2.5mg to 5mg over 5 mins
  • apsirin 300mg
  • take resting 12 lead ECG
20
Q

what is the management in primary care of a pt. with chest pain and suspected acute pulmonary oedema?

A

give an IV duiretic
give IV opioid
give IV antiemetic
give nitrate e.g. GTN spray

21
Q

what is the management in primary care of a pt. with chest pain and suspected tension pneumothorax?

A

consider inserting large bore cannula through second intercostal space in mid clavicular line on side of pneumothorax

22
Q

what is the traffic light system when assessing an acute unwell child

A

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

23
Q

name some of the red (high risk) symptoms in an acutely unwell child that would suggest admission to hsopital/

A
  • 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
24
Q

name some of the amber (immediate risk) symptoms an acutely unwell child that would suggest urgent f2f?

A
  • 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
25
Q

unstable patients with dyspnoea present with which symptoms\?

A
  • hypotension (altered mental state, hypoxia or usntable arrythmia)
  • stridor + breathing effort
  • unilateral tracheal deviations, hypotnesion and unilateral breath sounds
  • resp rate >40, retractions, cyanosis, low o2 sats
26
Q

what is the initial treatment for a patient with dyspnoea

A
  • O2 administration is sats <94%
  • consider intubation
  • establish IV line access and start fludis
  • thoracentesis in tension pnuemothorax
  • nebulised bronchodilator (salbutaml 5mg) and prednis (40mg) possible if obstructive pulmonary disease
  • IV or IM furosemide 20mg-50mg, opioid and antiemetic if pulmonary oedema present
27
Q

what investigations should be arranged when a person is experiencing SOB?

A
  • CXR
  • ECG
  • spirometry or peak expiratory flow
  • FBC
28
Q

what three diagnosis would you suspect if a patient presented with unilateral weakness?

A

stroke, TIA or bells palsy

29
Q

what is the main difference between a stroke and a TIA?

A

TIA completely resolves wihtin 24 hrs whereas stroke is ongoing/persisted for no loner than 24 hours

30
Q

name the presentations of stroke or TIA?

A
  • unilateral weakness or sensory loss
  • dysphasia
  • ataxia, vertigo, or loss of balance,
  • syncope
  • sudden transient loss of vision in one eye
  • cranial nerve defects
31
Q

hwo do you manage a patient experiencing a stroke?

A
  • immediate emergency admission
  • DON’T start anticoagulation until intracerebal heamorrhage has been ruled out
  • monitor and manage deterioration (A-E)
  • give o2 if sats belwo 95%
32
Q

how do you manage a pt. experiencing/ experienced a TIA?

A
  • aspirin 300mg
  • refer fro specialist assessment wihtin 24 hours of onset
  • if have bleeding disorder/taking anticoagulant then immediate CT to exlcude bleeding
  • offer secondayr rpevention after TIA diagnosis confirmed
33
Q

what are is the presentation of bells palsy?

A
  • unilateral facial weakness but no other symptoms (tingling, numbness, slurred speech, double vision, difficulty swallowing)
  • occurs in hours to few days and in ages 20-50s
  • forehead NOT spared !
34
Q

what is the management of bells palsy in primary care?

A

if presenting within 72 hours of onset then give prednisolone (50mg for 10days)

35
Q

what is the presentation of a patient who is experiencing anaphylaxis?

A
  • develop skin symptoms - itching, urticaria, erythema, rhinitis, conjuctivitis, angio-oedema
  • itching of palate
  • dyspnoea
  • laryngeal odema (stridor)
  • wheezing
  • tachycardia
  • N+V
  • abdo pain
  • collapse and LOC
  • cyanosis
36
Q

treatment for anaphylaxis?

A

A-E assessment

  • high flow O2
  • lay patient flat, raise legs
  • adrenaline IM 0.5mg (1:1000) if <12 yrs 300mg, if <6 yrs 150mg (repeat after 5 mins if no response)

when airway established, large bore IV cannulae and give fluids + chlorphenamine and hydrocortisone given

Y3 GP (10 decks)

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