Acute emergencies and pre hospital care Flashcards
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
unstable patients with dyspnoea present with which symptoms\?
- 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
what is the initial treatment for a patient with dyspnoea
- 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
what investigations should be arranged when a person is experiencing SOB?
- CXR
- ECG
- spirometry or peak expiratory flow
- FBC
what three diagnosis would you suspect if a patient presented with unilateral weakness?
stroke, TIA or bells palsy
what is the main difference between a stroke and a TIA?
TIA completely resolves wihtin 24 hrs whereas stroke is ongoing/persisted for no loner than 24 hours
name the presentations of stroke or TIA?
- unilateral weakness or sensory loss
- dysphasia
- ataxia, vertigo, or loss of balance,
- syncope
- sudden transient loss of vision in one eye
- cranial nerve defects
hwo do you manage a patient experiencing a stroke?
- 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%
how do you manage a pt. experiencing/ experienced a TIA?
- 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
what are is the presentation of bells palsy?
- 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 !
what is the management of bells palsy in primary care?
if presenting within 72 hours of onset then give prednisolone (50mg for 10days)
what is the presentation of a patient who is experiencing anaphylaxis?
- 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
treatment for anaphylaxis?
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
