Care Pathway Flashcards
Gastric irritants (drugs)
Non-steroidal anti-inflammatories (NSAIDs), steroids, bisphosphonates.
Headache (causes)
Primary: occur spontaneously or the patient has Hx e.g. migraine, cluster, tension etc.
Secondary: are pathological or caused by injury e.g. head trauma, infection, haemorrhage etc.
Procoagulant medication
Oral contraceptive pill, hormone replacement therapy (HRT).
ALS Drugs
Adrenaline 1mg/10ml
Non-shockable rhythms: ASAP after access is achieved.
Shockable rhythms: After 3rd shock and then after every other loop.
Amiodarone Hydrocloride 300mg/10ml
Shockable rhythms: If unresponsive, administer after 3rd shock. Further bolus after 5th shock if unresponsive VF or pVT.
Gastrointestinal (Alimentary) symptoms
Symptoms: Abdominal pain, dysphagia, heartburn, vomiting, haematemesis, diarrhoea, constipation, rectal bleeding.
MJ THREADS Ca (Past Medical History)
- *M**yocardial infarction (MI)
- *J**aundice
- *T**uberculosis
- *H**ypertension
- *R**heumatic fever
- *E**pilepsy
- *A**sthma
- *D**iabetes
- *S**troke
- *C**ancer (and treatment if so)
Psychiatric symptoms
Depression, anxiety, psychosis, suicidal thoughts.
Gastrointestinal haemorrhage (red flags)
DDx
S/S
DDx: ? Gastroenteritis, ?GI haemorrhage, ?duodenal ulcer, ?malignancy ?toxins/drugs.
S/S: Pain, hyporvolemia, infection, pyrexia.
ABCDE compromise.
Genito-urinary (GUM) symptoms
Dysuria, discharge, lower urinary tract symptoms.
Haemoptysis
DDx
S/S
DDx: ?chronic bronchitis, ?tuberculosis (TB), ?malignancy, ?pneumonia, ?bronchiectasis.
S/S: Cough, pyrexia, Hx.
?pseudohaemoptysis (not blood, not from the lungs etc).
ABCDE compromise.
Headache (key points)
Headaches with different or unusual characteristics are significant (not normal for the patient)
Do not exclude based on normal neuro exam (Hx is key)
Migraines increased risk of intracranial events
Check BP (and Temp)
Cardiovascular symptoms
Chest pain, palpitations, peripheral oedema, paroxysmal nocturnal dyspnoea (PND), orthopnoea.
Risk factors for pneumothorax
Tall, thin men in particular
Known connection tissue disease (e.g. Marfans)
Smoking history
Limb pain and/or swelling (red flags)
DDx
S/S
DDx: ?Trauma, ?anaphylaxis, ?cardio.
S/S: SOB, laryngeal oedema, pyrexia.
ABCDE compromise.
Abdominal, loin, scrotal, pain (red flags)
DDx
S/S
DDx: ?Testicular torsion, ?pyelonephritis, ?renal colic, ?appendicitis.
S/S: Oedema, infection, temp, severity.
ABCDE compromise.
Neurological symptoms
Numbness, weakness, tingling, blackouts, visual change (GCS or behaviour change reported by 3rd party).
Vomiting (red flags)
DDx
S/S
DDx: ?Head injury, ?cardio, ?anaphalaxis ?sepsis, ?ICP, ?toxins/drugs.
S/S: Haematemesis, rash, oedema, temp.
Any ABCDE compromise.
SOCRATES
- *S**ite
- *O**nset (time of onset. sudden/gradual, etc)
- *C**haracter of pain
- *R**adiation of the pain
- *A**ssociations signs and symptoms associated with the pain
- *T**ime course (Does the pain follow any pattern)
- *E**xacerbating/Relieving factors
- *S**everity (e.g. 1-10, paeds = Wong-Baker faces)
SAMPLE (Presenting Complaint)
Signs and Symptoms (S/S) of the presenting complaint
Allergies (particularly to medication, food allergies might be relevant)
Medications (DH)
Past medical history (PMH)
Last oral intake
Events that led to current illness or injury
Neck and back pain ‘non-trauma’ (red flags)
DDx
S/S
DDx: ?Meningococcal meningitis, ?septicaemia, ?MSK
S/S: Photophobia, infection, pyrexia.
ABCDE compromise.
Respiratory symptoms
Cough, shortness of breath (and exercise intolerance), haemoptysis, sputum production, wheeze.
Headache (red flags)
DDx
S/S
DDx: Head trauma (<3 months), ?sepsis, ?meningitis, ?narrow angle glaucoma.
S/S: Reduced GCS (<15 without Hx), >temp, rash, stiff neck/photophobia, nausea/vomiting, visual disturbance, red-eye, neurological/cognitive/personality change, neuralgia or palsy.
Triggered by exercise, cough, posture or Valsalva.
Sudden-onset, thunderclap or vertex headache.
ABCDE compromise.
ATMIST
(trauma survey)
Age
Time of incident
Mechanism of injury
Injuries
Signs and symptoms
Treatment given / immediate needs
Risk factors for cardiovascular disease
Hypertension
Hypercholesterolemia
Diabetes
Smoking
Family history (heart attack under 60 years old, familial hypercholesterolemia)
Social history (SAL)
- *S**moking history (packs/years)
- *A**lcohol intake (units per week)
- *L**ifestyle/exercise
4 Hs & 4 Ts
(reversible causes of cardiac arrest)
Hypoxia
Hypovolemia
Hypo/Hyperkalemia (metabolic)
Hypothermia
Thrombosis (cardiac or pulmonary)
Tension pneumothorax
Tamponade (cardiac)
Toxins
Confused state (red flags)
DDx
S/S
DDx: ?Diabetes, ?neurological aetiology, ?toxins/drugs, ?DKA/AKA.
S/S: Infection, pyrexia, pain.
ABCDE compromise.
CRANE MU
Cardio
Respiratory
Alimentary (GI)
Neurological
Endocrine
Musculoskeletal (MSK)
Urinary (GUM)
(S/S, injuries, surgery, PMH/DH?)
FLAPS TWELVE
(chest trauma)
Feel
Look
Auscultate
Percuss
Search sides and back
Tracheal deviation
Wounds, bruising or swelling
Emphysema (surgical)
Laryngeal crepitus
Venous engorgement
Exclude open/tension pneumothorax, flail chest or massive haemothorax.
Visual disturbance/red eye (red flags)
DDx
S/S
DDx: ?Narrow angle glaucoma, ?neurological aetiology, ?foreign object.
S/S: Non-reactive pupil, pressure/pain over the eye, nausea/vomiting.
ABCDE compromise.
Risk factors for DVT/PE
Recent surgery (under three months), malignancy, immobility
Relevant medications (e.g. oral contraceptive pill/HRT)
Inherited coagulopathy (e.g. protein C or S deficiency)
Cardiac medications
Alpha/Beta/Calcium-blockers, diuretics, antiplatelet agents (warfarin, clopidogrel ect), GTN spray.
METHANE (Major Incident)
- *M**ajor Incident Declared
- *E**xact location
- *T**ype of incident
- *H**azards
- *A**ccess
- *N**umber and type of casualties
- *E**mergency services present and required
Cushing’s Triad
>SBP
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