Acute Presentation Assessment

Question 1

Introduction

-what would you do differently to a normal history

Answer 1

Wash hands
Introduce self
Patient ID, DOB
Explain - I’d like to ask you some questions and examine them

If critically ill => ABCDE
-give O2, fluids, analgesia as soon as you realise they need them => ask a nurse to administer them whilst you continue asking questions

Question 2

Focused history

-how would this differ from a normal history

Answer 2

PC
HPC - explore symptoms, relevant systems to rule in and out differentials

PMHx - focus on ones relevant to problem
DHx, allergies
FHx - if relevant to PC
SHx - smoking, alcohol

Question 3

Focused examination

Answer 3

NEWS - HR, BP, RR, SaO2, temp

Focused exam 
General 
-surroundings 
-patient - well/unwell, breathing pattern, pain, pale, sweaty?
-hands - tremor, pale, CRT
-peripheral, central pulse - rate, rhythm, volume
-eyes - pallor, jaundice
-mouth - dry mucus membranes, cyanosed?
Appropriate focused system examination

Question 4

Investigations you may consider

-mnemonic

Answer 4

BOXES - to include, exclude differentials
Bloods, cannulate - ABG/VBG, FBC, CRP, U&E, LFTs, amylase, lipase, G&S/M, INR, culture, cap glucose
Orifices - urine dip, pregnancy, sputum culture, stool culture
Xrays/imaging
ECG
Special tests

Question 5

Acute management tetrad

Answer 5

Oxygen - low SaO2 (15L NRM if no COPD)
Fluids - low BP or dehydrated (500ml bolus saline/Hartmans)
Analgesia
Disease specific treatments

Question 6

Closing

Answer 6

Check for patient concerns
Explain what is going on
Discuss with seniors and refer