Acute Emergencies + Pre Hospital Care

Question 1

If a patient presents with chest pain in primary care, what is the only investigation required while hospital referral is being made?

Answer 1

ECG

Question 2

Life threatening differentials of chest pain (must not miss)

Answer 2

• ACS
• PE
• aortic dissection
• spontaneous pneumothorax

Question 3

Differential diagnosis of chest pain (non-traumatic)

Answer 3

• ACS
• PE
• aortic dissection
• spontaneous pneumothorax
• acute pericarditis
• pneumonia
• GORD
• PUD
• acute cholecystitis?
• costrochondritis

Question 4

Difference in the quality of chest pain + any radiation of:
- cardiac ischaemia
- aortic dissection
- pericarditis
- GORD

Answer 4

• cardiac ischaemia: central tight, crushing pain which can radiate to L arm, shoulder + jaw
• aortic dissection: tearing + ripping pain which can radiate to inter-scapular area
• pericarditis: sharp stabbing pain
• GORD: burning pain

Question 5

For patients with chest pain not requiring immediate hospital admission, where can they be referred to?

Answer 5

Chest pain clinics

Question 6

Function of chest pain clinics

Answer 6

For patients no requiring immediate hospital admission
- enable rapid confirmation of diagnosis
- initiation of treatment
- further investigations + interventions if needed

Question 7

If a patient presents to primary care with chest pain and is high risk of coronary artery disease, what should be done?

Answer 7

Order ECG
Give O2 + aspirin
Arrange urgent transport to ED

Question 8

When is admission to hospital required when a patient presents to primary care with chest pain?

Answer 8

• RR >30
• > 130bpm
• <90mmHg systolic or <60mmHg diastolic
• O2 <92%
• altered consciousness
• suspected ACS with current chest pain or signs of complications (e.g. pulmonary oedema) or pain free but chest pain in last 12 hours + ECG is abnormal

Question 9

Normal range of resp rate in:
- <1
- 1-2
- 2-5
- 5-12
- >12

Answer 9

-** <1**: 30-40
- 1-2: 25-35
- 2-5: 25-30
- 5-12: 15-25
- >12: 12-20

Question 10

Signs of respiratory distress in children

Answer 10

• grunting
• flaring of nostrils
• tracheal tug
• accessory muscle use
• Tachypnoea
• tachycardia
• gasping (late sign of hypoxia)

Question 11

Management of children with respiratory difficulties or hypoxia

Answer 11

High flow O2 (15L/min) through oxygen mask with reservoir bag

Question 12

Unwell child

Question 13

Unwell child

Question 14

Unwell child

Question 15

Unwell child

Question 16

Differential diagnosis of unilateral weakness

Answer 16

Stroke
TIA
Bell’s palsy
Ramsay Hunt Syndrome
Tumour/trauma to facial nerve?

Question 17

Ramsay Hunt Syndrome vs Bell’s palsy

Answer 17

_Ramsay hunt syndrome_
- varicella zoster virus (shingles) affects facial nerve
- rash/vesicles on ear
- ear pain
.
_Bell’s palsy_
- idiopathic facial nerve paralysis

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