AE revision

Question 1

drowsy pt ddx

Answer 1

heads
drugs
endocrine
heart
glucose
sepsis
bleeding

Question 2

ix of drowsy pt

Answer 2

Urine dip (ketones, drugs, other)
bloods
ECG
CT head
drug levels-paracetamol
ck

salicylate-only do if say, signs of it (tinnitus, acid-base), coma after unkown substance

Question 3

Mx of drowsy

Answer 3

generally-supprotive of airway, o2, fluids
call senior
psych if overdose–risk assess and further steps
vulnerable adult support team
consider admission/where to accomodate/give antidote for hours
capacity
contact NOK

Question 4

restless pt after party

Answer 4

cocaine, amphetamine, MDMA
anti-psych-Neurolepic malignant syndrome
ECG-NSTEMI/ischemia-points to cocaine vasospasm
ACS

mx-benzodiazepine
nitrates
DONT use B-blockers

Question 5

cocaine overdose mx

Answer 5

Benzodiazepines for agitation and temp
nitrates for chest pain
DONT USE b-blockers-it limits blood flow
consider ACS mx

toxbase can help with recogn and mx

Question 6

tearing chest pain/back

Answer 6

aortic dissection-
need to be in resuss cause can decompensate fast even if well

Ix- tell senior
transoesophageal echo if unstable, CT aortogram if time
ABG/ECG/TOE
before calling cardiothoracic

mx-
Type A- surgery and BP management
Type B- BP management
IV labetalol

Question 7

Pleuritic chest pain

Answer 7

Wells q and VTEq (and more-cancer etc)
consider pneuthorax

ix- abg, cxr (other cause), ECG, fbc
d-dimer
CTPA

Mx- thrombylisis if unstable
DOACs loading dose/LMWH loading dose

Question 8

Old woman sob-thought she was drowning

Answer 8

SOB in ED–think HF/pulm oedema
other- Sepsis/pneumo, PE, ashtma, Pneumo
immediate sit up, A->E
CXR, ECG, BNP, FBC, ECHO
IV Furosemide 40mg, O2, Nitrates, opiates
BiPAP

Question 9

Tall young man with SOB

Answer 9

Pneumothorax, Asthma
ask- pain, smoke, other lung

exam- trachea deviation, breath sounds, percuss hyperresonant, absent expantion
ABG, CXR, bedside USS

Mx-
if <2cm and no SOB-leave alone
needle aspiration-18G->chest drain if cant