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Year 3- Primary Care Tutorial Notes > Acute Emergencies + Pre-hospital Care > Flashcards

Acute Emergencies + Pre-hospital Care Flashcards

1
Q

Explain the A in ABCDE

A

Airway:

Can they talk?

Obstruction-> vital organ damage and death. Signs include;

See-saw respirations, use of accessory muscles.

Central cyanosis

Complete- No breath sounds
Partial- Noisy and diminished air entry

Treat: Airway opening maneoverues, intubation, airway adjunct
Target: 94-98% or 88-92% if hypercapnia risk

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2
Q

Explain the B in ABCDE

A

Signs: Sweating, Central cyanosis, use of accessory muscles

Assess resp rythm, symmetry and rate (12-20 is normal)

Sats, breath sounds, percussion, auscultation

If needed provide O2 ventilation

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3
Q

Explain the C in ABCDE

A

Circulation:

Initial suspect should be Hypovolaemia

Look for: Pallor, Cyanosis, Distended neck veins

Feel for: Limb temp, pulse rate and rythm

Assess capillary refill time and BP
Give fluids if needed

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4
Q

Explain the D in ABCDE

A

Disability:

Assess consciousness AVPU and GCS

Look for pupil size and reaction to light

Fingerpick glucose (If under 4 mM give glucose)

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5
Q

Explain the E in ABCDE

A

Exposure:

Respect dignity and keep patient warm
Look for rash/ injuries
Assess surroundings

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6
Q

What is the Acute Abdomen? (Consider T Torsion and Ectopic)

A

“Rapid onset of severe symptoms that can indicate life threatening pathology”

USUALLY painful, but more likely to be pain-free in children & elderly

Pain may radiate, referred or migrate.

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7
Q

Outline the initial assessment of Acute Abdomen

A
  • Do they look ill/ septic/ shocked?
  • Lying still or moving around in pain?
  • Asses and manage ABC
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8
Q

What do you ask in the history of Acute Abdomen

A

Pain features, Associated symptoms, PMx + Dx, Obs&Gyn history

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9
Q

Outline the Examination of an Acute Abdomen

A
  • Look at patient, Vitals, Resp rate & pattern (Peritonitis-> shallow, rapid), AVPU/ GCS
  • Inspection: Look for Jaundice, Anaemia, Abdominal distension, Visible peristalsis, Bruising around Umbilicus or Flanks (Cullen’s or Grey Turner’s), Signs of dehydration (dry mucous membranes, skin turgor)
  • Auscultation: All quadrants, blood vessel sounds, bowel sounds
  • Percussion: All quadrants, Liver & Spleen, Shifting dullness
  • Palpation: All quadrants, Rebound tenderness, Liver & Spleen, Lymph nodes
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10
Q

How do you treat Acute Abdomen if there are signs of shock/ being acutely unwell?

Compare in hospital and in primary care

A

Primary: Transfer to hospital for further assesment and treatment

In Hospital: Investigations, Keep Nil-By-Mouth and treat symptoms (Fluids, O2, NG Tube, Antibiotics if needed

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11
Q

What investigations can be done for Acute Abdomen

Laparoscopy can be used in Diagnosis and Management

A

Investigations: USS, Urine dipstick, FBC (and perhaps blood cultures), LFTs, U&Es, Radiology

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12
Q

Outline the us of Analgesia and Anti-emetics in treating Acute Abdomen

A
  • Previously, no pain relief was given until surgical review. One study and a Cochrane review showed that Morphine provides safe analgesia without compromising diagnostic accuracy
  • Avoid using this to treat symptoms without considering a diagnosis
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13
Q

Outline the history taking of Chest Pain

Consider psychological cause- Anxiety, Depression

A
  • If not in pain now, when was last episode (last 12 hours)?
  • Nature, onset, duration, site, radiation. Exacerbating and relieving factors.
  • Associated symptoms (Sweat, Pallor, N+V, SoB, Fatigue, Palpitations)
  • PMx (Conditions, Scans, ECGs) and PDx

Cardia Ischaemia: Restrosternal/ Epigastric, Tight+crushing, Radiate-> Arm, Neck, Jaw, Shoulder

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14
Q

Outline Examination of Chest Pain

Many patients will be fully normal

A
  • Full CVS, Auscultate for murmurs, Chest wall examination (tenderness, pain on movement)
  • Abdomen (tender), Neck (tender and stiff), Legs (tender or swollen), Temp (infection
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15
Q

List Investigation for Chest Pain

If in Primary, don’t delay management to arrange for investigations

A
  • ECG, Troponin testing, CXR
  • FBC, Blood glucose, Lipid profiles (To asses CVD risk)
  • Thyroid function tests, LFTs
  • CTPA if PE is suspected
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16
Q

What criteria are needed to admit to hospital if presenting with chest pain?

A

• RR>30, HR>130, Systolic< 90, Diastolic< 60, O2< 92% or Central Cyanosis, Altered consciousness, High temp (especially> 38.5).

Suspected ACS with;

• Current chest pain, Signs of complications, Chest pain in last 12 hours + ECG abnormal or N/A

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17
Q

Outline Chest Pain referral if admission not required

A
  • Urgent same-day Assesment: Suspected ACS + Pain-free, with chest pain in last 12 hours + Normal ECG + No complications (Alternatively, pain in last 12-72 hours + no complications)
  • Within 2 weeks: Suspected ACS + Pain-free, with pain more than 72 hours ago + no complications
  • Routinely: Suspected SA, non-specific chest pain, persistent symptoms despite management
18
Q

Outline chest pain management in Primary care

A
  • Arrange for hospital admission-> Sit patient up, Give O2 if needed
  • If Suspected ACS: Aspirin, GTN/ Opioid (Fentanyl).
  • If Suspected Acute Pulmonary Oedema: Diuretic, Opioid, Anti-emetic, Nitrate
  • If Suspected Tension Pneumothorax: Large bore cannula in 2nd ICS at the Mid-Clavicular line
  • Monitor Symptoms, Pulse/ BP/ Heart Rythm, SpO2, ECG, Pain relief
19
Q

Why can chest pain come with cough?

Other than pulmonary cause

A

Small Intercostal Muscles get sore-> Bone pain

20
Q

Normal RR ranges for ages;

<1:

1-2:

2-5:

5-12:

> 12:

A

<1: 30-40

1-2: 25-35

2-5: 25-30

5-12: 15-25

> 12: 12-20

21
Q

Outline the 3 steps in the structured approach of assessing an acutely unwell child

A
  1. Primary ABCDE assessment and resuscitation
  2. Secondary assessment and emergency treatment
  3. Stabilisation and transfer
22
Q

Outline Primary ABCDE assessment and resuscitation of an acutely unwell child

(Normal ABCDE)

A

Breathing;

  • Effort: Resp rate, Grunting, Nostril flaring, Accessory muscle use
  • Efficacy: Chest expansion, SpO2, Auscultation for air/ breathing sounds
  • Effect: Hypoxia-> Tachycardia-> Bradycardia, Cyanosis, Agitation/ drowsiness

Provide high flow O2 (15L/min

23
Q

Outline Secondary assessment and emergency treatment of an acutely unwell child

A

Reassess ABCDE, History, Examinations, Investigations

  • Ask about Fever onset, duration, pattern and method of measurement.
  • Associated symptoms? Perinatal complications? PMx and PDx, Recent travel? Vaccinations?

Use NICE ‘traffic light system” to assesses risk of serious illness;

  • Life-threatening Red features: Arrange emergency ambulance to A&E
  • Non-life threatening Red features: Arrange urgent F2F assessment within 2 hours
  • Amber features: Arrange F2F assessment
  • Green features: Child can be managed at home
24
Q

Outline Stabilisation and Transfer of an acutely unwell child

A

Monitor SpO2, HR&R, BP, Urine output, Core temp

25
Q

Outline the 3 classes of Dyspnea

A

Acute- Over mins
Subacute- Over hrs/days
Chronic- Over wks/mths

26
Q

Outline history taking of a pt with SoB

A
  • Pack years, Duration+ Severity of SoB, PMx + PDx + Family history
  • Associated symptoms (Sputum, Breath sounds, Haemoptysis, Palpitations, DVT signs, Anxiety, Weight loss, Fatigue
27
Q

Outline examination of a pt with SoB

A

• Resp and CVS exams, BP, SpO2, BMI, PEFR, Leg oedema, Heart sounds

28
Q

What investigations for a pt presenting with SoB

A

• Sats, FBC, ECG, ABG, V/Q , D-Dimer, Spirometry, U&Es, Radiology (High-res CT, CXR, CTPA

29
Q

How can unstable pts with SoB present?

A

Abnormal vitals, altered mental status, hypoxia, unstable Arrythmia

Breathing sounds, Effort without air movement, Tracheal deviation, Cyanosis, Low SpO2

30
Q

Criteria for Emergency admission in a pt with SoB?

A
  • ECG suggesting Cardiac Arrythmia/ MI
  • Rapid onset of/ worsening symptoms of suspected Heart Failure
  • Suspected PE, PT, Sepsis or Severe/ Life-threatening Asthma
  • CURB65 score>0
31
Q

Outline the Initial Management of a pt with SoB if Admission is needed

A
  • ABCDE assessment, BP, Pulse, RR, Temp, SpO2, PEFR, ECG, Level of consciousness
  • Give O2, Consider intubation, Give IV fluids, Treat any other symptoms
  • If needed administer Diuretic, Nebulised Bronchodialtor or Perform needle thoracentesis in Tension PThorax
32
Q

Outline History taking of a pt with Unilateral Weakness

A
  • Neurological deficits, Associated symptoms, Risk Factors (CVD, DM, Hyperlipidiaemia, Smoking, Pregnancy, Trauma, Alcohol, PMx PDx and Fx- Family History)
  • Time of Onset, Activity at onset, Symptom progression
  • Features that may indicate alternate diagnosis (Migraine, GCA, Seizure
33
Q

Outline Examination of a pt with Unilateral Weakness

A
  • ABC, Vitals (BP, HR, Sats, Temp)
  • Fundoscopy (Identify intraocular haemorrhage)
  • CVS exam (HF, Arrythmia, Murmurs, Valvular pathology)
  • Neuro exam (Unilateral weakness, Visual/speech disturbance, Sensory loss, Ataxia, Nystagmus)
  • FAST test: Facial weakness, Arm weakness, Speech difficulty (Slurring/ naming objects
34
Q

What investigations in a pt with Unilateral Weakness?

A

• Blood glucose to rule out Hypoglycaemia, ECG to rule out Arrhythmia

35
Q

Outline Primary Care Management for Suspected Acute Stroke/ Emergent TIA

A
  • Emergency admission to stroke unit (Include ToO, Symptom progression, Medications)
  • Avoid antiplatelet treatment until haemorrhagic cause has been ruled out
  • Monitor ABC, Vitals and Symptoms. Give O2 if <95% and safe
36
Q

Outline Primary Care Management for Suspected TIA

A

300mg Aspirin unless contraindicated, regularly taken, coagulopathy or on an anticoagulant.

Arrange assessment by stroke specialist if a TIA occurred within last week

Advise not to drive until definitive guidance received from specialist

37
Q

Outline Primary Care Management if TIA occured >1wk ago

A
  • Refer for specialist assessment ASAP within 7 days

* Assess for AFib/ other arrhythmias

38
Q

When to follow up a pt with Unilateral Weakness?

A

6mths and Annually after treatment

39
Q

Outline Hospital Management of a pt with Unilateral Weakness

A
  • If not Haemorrhagic, Thrombolysis (with Alteplase/tPA if within 4.5hrs of symptom onset)
  • Thrombectomy ASAP within 6hrs of symptom onset (with TLysis if safe)
40
Q

Outline Bell’s Palsy Management

A

If presenting within 72 hours of symptom onset, Prednisolone;

  • 50mg daily for 10 days
  • 60mg daily for 5 days followed by a daily 10mg reduction in dose
41
Q

List signs of Anaphylaxis

A
  • Sudden onset, rapid progression of symptoms
  • Airway and/or Breathing and/or Circulation problems
  • ACCOMPANYING Skin and/or mucosal changes (Flushing, Urticaria, Angioedema)
  • ACCOMPANYING GI Symptoms
  • Can have general symptoms (Palpitatons, TachyC, N+V, Ab Pain
42
Q

Outline Anaphylaxis Management

A

IM Adrenaline in Anterolateral aspect of middle 1/3 of thigh;

  • Adult dose: 500 micrograms
  • Child >12 dose: 500 micrograms (300 if small or pre-pubertal)
  • Child 6-12 dose: 300 micrograms
  • Child <6: micrograms
  • Repreat IM Adrenaline after 5 mins if no improvement

Year 3- Primary Care Tutorial Notes (15 decks)

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