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Comm Serve - EBCHC > Comm Serve - Referrals/Cas Cases > Flashcards

Comm Serve - Referrals/Cas Cases Flashcards

1
Q

02 yo M. NAM. INUTD (missed 18/12). Brought in by mom with a 1/7 history of vomiting, no diarrhoea. O/E pt lethargic, sunken eyes, normal CRT, warm peripheries, moist mucus membranes.

A
  1. Given a trial of ORS - 5ml/kg every 15 min for 4 hours - not tolerating
  2. Given IVF (N/S) - 5% dehydration = 50 mls/kg/day or 10% dehydration = 100 mls/kg/day
  3. Referred to NDH for further Mx
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2
Q

42 y/o female, RVD on Rx. Septic shock secondary to LRTI. HR: 125. T: 37,9. BP: 86/51. Sats: 99% RA. CRP 254.

A
  1. IVF - R/L 30 mls/kg fluid bolus IVI over 30 min (fluid challenge - can repeat)
  2. IV ABx stat - Ceftriaxone 1 g IVI stat
  3. Referred to NDH

O2 if Hypoxic!!!!!
Always remember double O2 if severe CAP!!!

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3
Q

22 y/o female, G2P1 @ 8/40 (by SD). No known comorbidities. Hyperemesis gravidarum complicated by dehydration. BP: 121/60.

A
  1. U-dipstick: Ketones 2+
  2. IVF - 1L N/S
  3. IV anti-emetic stat - Maxalon 10 mg IVI stat
  4. Referred to NDH
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4
Q

41 y/o female, no known comorbidities, G3P2 @ 12/40 (by dates). PV bleeding + LAP. BP 132/66. HR 98. T 36.

Exam, Assessment & Plan

A
  1. Ward Hb - 9,9
  2. PV exam: blood on glove, os open

A - ? ICA

  1. IVF - 1L N/S
  2. Analgesia - Voltaren 75 mg IMI stat
  3. Referred to NDH for U/S and R/V
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5
Q

35 y/o male, no known comorbidities. Blunt force head trauma on 31/12/2022. + LOC on 31/12 + 1 episode seizure on 02/01 + persistent headache and vomiting. BP 116/55. Sats 99% RA. GCS 15/15. Clinically examined well. TBI.

A
  1. IVF - 1 L N/S
  2. Analgesia - Voltaren 75 mg IMI stat (or Panado + Brufen)
  3. Referred to NDH for further investigations
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6
Q

04 yo M. IUTD. NAM. Brought in by mom actively fitting with a 2/7 Hx of cough, fever and AGE. T: 38.2, Sats: 100% on RA. HGT 8.9. Not dehydrated. Systems: NAD.

Assesment + plan?

A

A) Febrile Seizures 2° AGE

  1. FM02
  2. Abort seziure - Diazepam 0.25 mg/kg IVI stat
  3. Paracetamol - 15 mg/kg PO stat or Empaped suppository 125 mg or 250 mg PR stat
  4. IVF - Maintenance fluids - N/S @ 80 mls/kg/day
  5. Referred to NDH for further Mx

Not dehydrated - so maintence
5% dehydrated - 50 mls/kg/day
10% dehydrated - 100 mls/kg/day

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7
Q

02 yo F. No RTHC. No known comorbidities. Brought in by mom unresponsive with a hx of ?ingesting coffee beans. HGT - 5.6, Sats - 96 % on RA, HR - 135. Pupils dilated. No seizures. Well hydrated.

Assessment + Plan?

A

A) ?Poisoning

  1. FM02
  2. Naloxone - 0.01 mg/kg IVI every 2 min for 4 repeated doses
  3. IVF - Maintenance fluids - N/S @ 100 mls/kg/day
  4. Referred to NDH for further Mx
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8
Q

32 y/o M. No known comorbidities. 3/7 history of left middle finger abscess. Spontaneous onset. Draining pus.

A
  1. Wash wound + Betadine dressing
  2. Analgesia - Voltaren 75 mg IMI stat
  3. IV ABx stat - Augmentin 1.2 g IVI stat
  4. Referred to NDH for further Mx
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9
Q

45 y/o M. Prev CVA. P/W 3/7 history of cough, SOB, fever and constitutional Sx. Also c/o constipation, abdo distension, no N/V.

O/E: + confused. acutely ill-looking, cold peripheries, weak volume pulses. Apyrexial. BP 81/41(61) HR 86 Sats 76% on RA 95% on double oxygen. Distressed. Widespread creps. Abdo: mild distension, no ascites. Mild epigastric tenderness. No organomegally. CNS- gcs 14/15, residual left hemiparesis.

Assessment & Plan

A

A - Hypoxic LRTI complicated by septic shock

  1. Double O2
  2. IVF - R/L 30 mls/kg IVI bolus over 30 min (fluid challenge - can repeat)
  3. IV ABx Stat - Ceftriaxone 1 g IVI stat
  4. Referred to NDH for further Mx
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10
Q

31 y/o female, HPT on Rx, Hx prev complicated UTI requiring IV ABx in private. P/W 1/7 Hx of suprapubic + lower back pain with burning urine, rigors, fever, vomiting x1. BP 155/95, HR 125, sats 100% RA, GCS 15/15. Positive renal angle tenderness B/L.

Assessment + Plan

A

A - ? Pyelonephritis.

  1. Dipstick - 2+ blood, 1+ leuko
  2. Preg test - negative
  3. IVF - IL N/S
  4. IV ABx - Ceftriaxone 1 g IVI stat
  5. Analgesia - Voltaren 75 mg IMI stat + Panado 1 g PO stat (anti-pyretic)
  6. Referred to NDH for further work up & Mx
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11
Q

22yo male Ellicit drug use presented w 1/52 hx of left hand swelling and pain following self injection with Heroine. O/E Temp 37,9, pulse 102, sats 99% RA, Bp 118/71, RR 18. Left hand swollen++, erythematous poor ROM due to pain (appropriate)

Assessment & Plan

A

A - Left forearm cellulitis

  1. Analgesia - Voltaren 75 mg IMI stat
  2. IV ABx - Augmentin 1.2g IVI stat
  3. Ref NDH casualty for further mx
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12
Q

3yo female NRTHC slipped and fell while playing at home presented with inability to weight-bare + pain of right foot > over the ankle joint. OE pulse 102, sats 100 RA. Mild swelling noted R foot poor ROM due to pain.

Right ankle injury.

A
  1. Analgesia - Panado 15 mg/kg PO stat + Brufen 10 mg/kg PO stat
  2. Below knee backslab applied
  3. Ref NDH for XRs
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13
Q

AGE with dehydration, BP 88/50, HR: 90, sats 98% RA, temp 38.

A
  1. IVF - IL R/L as rapid bolus (30 mls/kg bolus)
  2. Loperimide 4 mg PO stat
  3. Buscopan 10 mg IVI stat
  4. Flagyl 400 mg IVI stat
  5. Panado 1 g PO stat (anti-pyretic)
  6. Ref to NDH for further Mx
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14
Q

36 yo male post community assault sustained closed elbow injury, multiple tram lines , + 3cm laceration sutured.

Assessment & Plan

A

A - ? Crush Injury

  1. U-dipstick - 3+ blood
  2. U- catheter
  3. IVF - 1L R/L (30 mls/kg bolus)
  4. IV ABx (for sutured wound) - Augmentin 1.2 g IVI stat
  5. Analgesia - Voltaren 75 mg IVI stat or Morphine 2 mg IVI stat or Pethidine 50 mg IVI stat
  6. Ref to NDH
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15
Q

31 yo M. Nil co morbidities. Assaulted with hockey stick. Sustained a right middle and ring finger metacarpal fractures.

A
  1. Analgesia - Voltaren 75 mg IMI stat
  2. Volar slab applied
  3. Referred to NDH for further Mx
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16
Q

27 yo M. Assaulted with a steel rod 4/7 prior to presentation-sustained an injury to the left mandible. Swollen, tender, warm to touch.

A
  1. XR - shows a left mandibular fracture
  2. Analgesia - Voltaren 75 mg IMI + Panado 1g PO
  3. IV ABx - Augmentin 1.2 g IVI stat
  4. Referred to NDH for further Mx
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17
Q

30 yo M. Assaulted with a wooden stick. No LOC, No seizures. Sustained a ?mandibular fracture + 4cm skull laceration.

A
  1. Cleaned + suture laceration
  2. Analgesia - Voltaren 75 mg IMI stat
  3. ABx - Augmentin 1.2 g IVI stat
  4. Referred to NDH for XR & further Mx
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18
Q

27 yo male - P/W 2/7 hx of left back stab chest, was referred to NDH 2/7 ago, absconded. Today c/o SOB. Sats of 96% on RA.

A
  1. CXR done - Left haemopneumo
  2. ICD inserted - drained 500mls of blood
  3. CXR post ICD insertion improved
  4. FMO2
  5. Analgesia - Voltaren 75 mg IMI stat
  6. Ref to NDH
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19
Q

26 yo M. No known comorbidities. Physically assaulted. C/O visual impairment to the right eye. O/E ?corneal laceration.

A
  1. Analgesia - Panado + Brufen
  2. Eye patch
  3. Referred to NDH for further Mx
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20
Q

36 yo M. Known MCHU. Had came in for psych clinic F/U. Brought in by mom with a hx of disorganised behaviour at home, defaulted treatment. Refuses to eat, sleep and bath. Substance user (Cannabis). O/E pt disorientated. Unkempt. Actively hallucinating. Grandiose delusions.

A
  1. Sedate - Midazolam (Dormicum) 7.5 - 15 mg IMI stat or Ketamine 5 mg/kg IMI stat or Ativan 4 mg IVI stat
  2. Bloods - FBC/ U&E/ LFT/ CMP/ CRP/ TFT/ RPR
  3. Referred to NDH for further Mx
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21
Q

24 y/o F. No known comorbidies. Allegedly sexually assaulted earlier this morning by unknown person.

A
  1. VCT - Non reactive
  2. HIV PEP - TLD 1 Tab stat & Dly PO x 1/12
  3. Preg test - Negative
  4. Emergency contraception - Levonorgestral 1.5 mg PO stat
  5. STI prophylaxis - Ceftriaxone 250 mg IMI stat, Azithromycin 1 g PO stat, Metronidazole (Flagyl) 2 g PO stat
  6. Hep B PEP - HBIG 500 U IMI stat + Hep B Vaccine
  7. Bloods - FBC/ U&E/ LFT/ HBsAb/ HCVAb/ RPR/ ELISA
  8. SAPS called for sexual assault kit
  9. Transport to Thuthuzela centre

Give PEP w/in 72 hrs of assault

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22
Q

28 yo M. RVD on TLD. Allegedly assaulted with a steel rod. Sustained an injury to the right eye. O/E corneal laceration noted, decreased visual acuity. Scleral injection & tearing.

A
  1. Analgesia - Voltaren 75 mg IMI stat
  2. Eye patch
  3. Referred to NDH for further Mx
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23
Q

16 yo F. No known comorbidities. Allegedly sexually assaulted by known person.

A
  1. VCT - Non reactive
  2. Preg test - Negative
  3. HIV PEP - TLD 1 Tab Dly PO x 1/12
  4. Emergency contraception - Levonorgestral 1.5 mg PO stat
  5. STI prophylaxis - Ceftriaxone 250 mg IMI stat, Azithromycin 1 g PO stat, Metronidazole (Flagyl) 2 g PO stat
  6. Hep B PEP - HBIG 500 U IMI stat + Hep B Vaccine
  7. Bloods - FBC/ U&E/ LFT/ HBsAb/ HCVAb/ RPR/ ELISA
  8. SAPS called for sexual assault kit
  9. Transport to Thuthuzela centre
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24
Q

33 yo M. Allegedly assaulted by known person with a steel rod. Sustained an injury to the head. No LOC, No seizures. 5cm laceration cleaned and sutured. Depressed skull.

A
  1. Analgesia - Voltaren 75 mg IMI stat
  2. IV ABx - Augmentin 1.2 g IVI stat
  3. Referred to NDH for XRs
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25
Q

62 yr old male. C/O abdominal pain not passing stools 4/7, + obstipation. Nil N/V. ++ abdominal distended, generalized tenderness.

Assessment & plan

A

A - ?Bowel obstruction

  1. Keep NPO
  2. IVF - 1L R/L
  3. NGT inserted
  4. Referred to NDH for abdominal XR & further Mx
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26
Q

36 yo male post community assault sustained closed elbow injury , multiple tram lines , + 3cm laceration

A
  1. Wash + suture laceration
  2. U-dipstix - 3+ blood
  3. U-catheter inserted
  4. IVF - 1L RL (30 mls/kg bolus)
  5. IV ABx (for wound) - Ceftriaxone 1 g IVI stat
  6. Analgesia - Voltaren 75 mg IMI stat or Morphine 2 mg IVI stat or Pethidine 50 mg IMI stat
  7. Referred to NDH for further Mx
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27
Q

41 y/o male, RVD and PTB on Rx. P/W 3/12 Hx perianal mass + LOW + altered bowel habits + PR bleeding. O/E: fungating anal mass. BP 101/64. HR 115. Ward Hb 9,7.

Assessment & Plan

A

A - ?Colorectal ca

  1. Discussed with Grey’s General Surgery
  2. Booked for SOPD
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28
Q

19 year old female. Polypharmacy overdose- ingested arvs, antibiotics, other unknown agents. Had one episode of vomiting prior. Presented asymptomatic with stable vitals.

A
  1. IVF - 1L N/S
  2. Sx Mx: Vomiting - Maxalon 10 mg IVI stat; Stomach Cramps - Buscopan 10 mg IVI stat
  3. Referred to NDH for further MX

Poison Information Centre 0861 555 777

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29
Q

22yo male, whoonga user presented with hx of alleged assault to the head with back of the gun 4/7 ago, hx of LOC unknown duration. C/0 severe headache. O/E bp 88/49 temp 38,9 sats 99% RA, pulse 123, Gcs 15/15. + 3cm laceration parietal region septic with pus/slough, + maggots

A
  1. Cleaned laceration + betadine dressing
  2. IV ABx - Augmentin 1.2g IVI stat
  3. IVF - 1L N/S
  4. Analgesia given - Voltaren 75 mg IMI stat
  5. Ref NDH casualty for imaging + further mx
30
Q

Parasuicide, 19 yo male nil known comorbidities ingested 2 bottles of ARVs following an argument at home. Vomited x1 bp 107/89 sats 99 pulse 119 RR 22, Gcs15/15

A
  1. IVF - 1L N/S
  2. Sx Rx - Maxalon 10 mg IVI stat or Buscopan 10 mg IVI stat
  3. Ref NDH casualty for further mx
31
Q

6 y/o male, Rvd exposed, pcr negative. INUTD, spastic CP with previous VP shunt insertion in 2015. Now brought in with a 1/7 history of fever with no other associated symptom symptoms. Mum reported a decrease in playfulness. He had seizures on arrival. O/E p: 185, sats: 90% RA, Gr:17, RR: 16, temp: 39,9. No alar flaring, no tachypnoea. Chest was clear.

A
  1. Supplemental O2 - NPO2 or FMO2
  2. Abort seizure - Ativan 0.1 mg/kg IVI stat
  3. Load with Epilim - 20 mg/kg IVI stat
  4. IVF - maintenance - N/S 60 mls/kg/day
  5. Anti-pyretic - Empaped 125 mg / 250 mg PR stat
  6. Referred to NDH for further management
32
Q

24 y/o male, nil comorbidities. Now brought in with history of being stabbed to his lower back with unknown object. Clinically BP: 90/56, p:97, sats:100% RA. Chest: GAE, 13cm laceration on right lower back. Abdo: SNT, not peritonitic.

Assessment & Plan

A

A - Thoraco-abdominal stab

  1. Suture laceration for haemostasis
  2. IV ABx - Ceftriaxone 1 g IVI
  3. IVF bolus - R/L 30 mls/kg IVI bolus
  4. Analgesia - Voltaren 75 mg IMI stat
  5. Referred to NDH imaging and further management
33
Q

65 y/o female, HPT on Rx, Prev. DVT + PE in 2013 - on Warfarin. P/C: 7/7 Hx pleuritic chest pain + cough + dyspnoea. Sats: 85-87% RA (96% FMO2). Chest auscultation: decreased air entry.

Assessment?

A
  1. ? PE
34
Q

27 Year old male. Whoonga and Dagga user. Came in with single stab to chest at left inferior scapular border and assault with swolen right dorsum of hand. On exam - Stable Resp - GAEB nil signs of haemo or pneumothorax. MSK - Swolen dorsum of hand with tenderness over metacarpals. A - Stab chest with nil haemo or pneumo thorax, +/- Metacarpal fracture +/- Crush injury.

A
  1. Sutured with consent
  2. IVF - IL R/L
  3. Analgesia - Voltaren 75 mg IMI stat
  4. Refer to NDH for XRs + further Mx
35
Q

30 Yr old male, whoonga user. Patient was assaulted with a hammer at 1h00 and presented with multiple injuries to the torso and upper limbs as well as laceration to forehead, Right hand index and ring finger. Urine dipstick: ketones and blood. BP 109/65 P84 sats 100% on RA.

Assessment & Plan

A

A - ? Crush syndrome

  1. Wounds - cleaned and sutured with consent
  2. U-catheter
  3. IVF - 1L R/L
  4. IV ABx - Ceftriaxone 1 g IVI stat
  5. Analgesia - Voltaren 75 mg IMI stat or Morphine 2 mg IVI stat or Pethidine 50 mg IVI stat
  6. Ref to NDH for further Mx
36
Q

35 year old female. G2P1 @ 7/40 by dates. HPT and RVD on Rx. Presented with PV bleeding and LAP. Preg test +. BP 159/94 P125 sats 100% on RA.

Exam, Assessment & Plan

A

Exam: PV - os closed, No blood on glove

A - Threatened miscarriage

  1. BP control - Aldomet 250 mg PO stat
  2. Analgesia - Voltaren 75 mg IMI stat
  3. IVF - 1L N/S
  4. Ref to NDH for further management (U/S)
37
Q

31 yr old male , nil known comorbidities. Patient was assaulted to the head with unknown object. No open wounds. Patient was intoxicated on arrival and uncooperative. Vitals stable. Periorbital ecchymosis noted. Patient unable to open eyes due to swelling.

A
  1. Analgesia - Voltaren 75 mg IMI stat
  2. IVF - 1L R/L
  3. Thiamine 100 mg IVI stat
  4. Ref NDH for further Mx
38
Q

? New onset of seizures. 34 year old male nil known comorbidities. Nil hx of head trauma. Prev well. Brought in casualty having seizures GTC. ? Seizure 1x Wednesday, 1x Saturday and 1x Sunday.

A
  1. Airway maintained + supplemental O2
  2. Abort seizure - Ativan 4 mg IVI stat or Diazepam 10 mg IVI stat
  3. Loaded with Epilim - 10 mg/kg IVI stat (400 - 800 mg depending on body size)
  4. IVF - 1L R/L
  5. Ref to NDH for assessment
39
Q

16 yr old MHCU known at EDH plus Thuthuzela known victim of sexual assault, defaulted medication now came in to report the pregnancy and the ongoing sexual Assault.

A
  1. Discussed with EDH
  2. Admitted for social issues to be resolved multidisciplinary
40
Q

39 yo male whoonga user, with 1/52 hx of stab to the left deltoid region, seen and sutured with consent @ EBCHC now painful swollen left forearm with frank pus draining from the wound, foul smelling, +suture break down cellulitic around the elbow joint. Bp 112/68, hr 110, temp 38.8, RR 22, Sats 95%

Assessment + Plan

A

A - Left forearm cellulitis

  1. IVF - 1L N/S
  2. Analgesia - Voltaren 75 mg IMI stat + Panado 1 g PO stat (anti-pyretic)
  3. IV ABx - Augmentin 1.2g IVI stat
  4. Ref NDH for further mx
41
Q

Chemical burn to genital area. 32 yo male, presented with 2/7 hx of a burn on the genital due to an unknown chemical (cleaning chemical) at work. Also had urinary symptoms. Clinically BP 116/74 HR 85 Temp 37.2. Deep ulcerative lesion in the penile shaft.

A
  1. U-Dipstick - nitrates + leukocytes
  2. Wound cleaned & dressed with jelonet
  3. Analgesia - Voltaren 75 mg IMI stat + Panado
  4. ABx - Ceftriaxone 1 g IMI stat
  5. Ref to NDH for further Rx
42
Q

DOA - 45 yo male brought to casualty by friend with unknown duration under water allegedly ( was intoxicated at the time of swimming in Bergstreet swimming pool) , unresponsive on arrival to casualty.

Examination + Who to call?

A
  1. Vitals - No recordable
  2. Pupils - fixed & dilated
  3. Nil signs of life
  4. Declared DOA @ 16:50
  5. SAPS informed @ 19h45 arrived after 21h00
  6. Forensics arrived at 22h25
43
Q

17 y/o male, no known comorbidities, P/W 3/7 Hx headache + fever + neck stiffness. T 41. HR 110. BP 139/97.

Assessment + Plan

A

A - Acute Meningitis

  1. Analgesia - Panado 1 g PO stat
  2. IVF - 1L R/L
  3. IV ABx - Ceftriaxone 1 g IVI stat
  4. Ref to NDH for further investigations and management.
44
Q

27 y/o female, no known comorbidities, previous C/S in 2014 and “uterine surgery” in 2019 (in Malawi, unsure indication). Secondary dysmenorrhoea. Haemodynamically stable.

A
  1. Ref to NDH GOPD for imaging

Booked for 07/02/2023

45
Q

40 y/o male, rvd +, p/w right eye growth for 6 months. Loss of vision in eye. Growth covers conjunctiva and sclera.

A
  1. Ref to NDH eye clinic for W/U and Mx
46
Q

23 yo F. RVD on TLD. VL:LDL . C/O fatigue, headache, palpitations of 1/12. Preg Test Neg. Formal Hb done 3/52 ago came back as 4.2, MCV: 56.0, ht: 0.177. Ward Hb done today - 5.6 . Pallor ++

Assessment + plan

A

A - Sx anaemia (Microcytic ?Fe Def)

  1. Bloods - Anaemia w/u done - FBC + diff/ Reticulocytes/ Peripheral smear/ Fe studies/ Folate/ B12
  2. Ref to NDH for further Mx
47
Q

26 YO male #nil known comorbidities. P/W SOB and productive cough. Sats on RA 83% P 134. Sats on O2 rebreather 92%. O/E : pallor, decreased AE bilaterally + cough.

Assessment + plan

A

A - Hypoxic LRTI

  1. FMO2
  2. IVF - 1 L R/L
  3. IV ABx - Ceftriaxone 1 g IVI stat
  4. IV steroids - Dexamethasone 6 mg IVI stat
  5. Ref to NDH for further Mx
48
Q

27 YO female #nil known comorbidities. P/W PV bleeding with clots for 1/7. C/O LAP and back pain. Preg test + 3/7 ago.

Tests + exam + Assessment

A
  1. Preg test - negative
  2. PV - os closed
  3. A - Complete M/C
  4. Ref to NDH for further management.
49
Q

43 YO male #RVD + on rx # prev TB in 2018. Patient C/O productive cough for 2/52, diarrhoea and blood in stool. Sats on RA 89%. Patient looks chronically Ill and wasted. Chest: bilateral crepe with laboured breathing.

Assessment + Plan

A

A - Hypoxic LRTI + AGE

  1. FMO2
  2. IVF - 1 L R/L
  3. IV Abx - Ceftriaxone 1 g IVI stat
  4. IV steroids - Dexamethasone 6 mg IVI stat
  5. Anti-diarrhoeal - Loperamide 4 mg PO stat
  6. Ref to NDH for further Mx
50
Q

? Penile CA. 72 yr old male, smoker nil other known comorbidities.c/o dysuria 3/7.+ LOW significant +- 10kg over few months, back pain and painless lesions on the penis for more than 2 years. Vitals normal, chronically ill- looking and wasted. RPR negative. ++ penile lesions, + foul smelling penile discharge.

A
  1. U-dipstick - leuc 2+, Gluc 1+
  2. Abx - Ceftriaxone 1 g IMI stat
  3. Analgesia - Panado + Brufen
  4. Bloods - FBC/ U&E/ LFT/ CMP/ CRP/ PSA/ CEA/ CA 19-9
  5. Ref to NDH for further Mx
51
Q

35 year old male with haemorrhoids, known at NDH SOPD prev surg ? Haemorrhoidectomy done in 2016. C/O +++ pain peri- anal, bleeding and not passing stools 3/7. Vitals normal and clinically stable. PR : ++ pus draining (foul smell). Haemorrhoids grade 2 - not bleeding, Irreducible.

Assessment + Plan

A

A - ? Peri- anal abscess vs fistula

  1. Analgesia - Voltaren 75 mg IMI stat
  2. ABx - Ceftriaxone 1 g IMI stat
  3. Ref to NDH for EUA and further Mx
52
Q

29 yo F. Newly diagnosed RVD. Came in with a 3/7 hx of right facial swelling +nasal abscess. Vitals stable.

Assessment + Plan

A

A - Right Para-nasal sinus abscess

  1. Analgesia - Panado + Brufen
  2. ABx - Ceftriaxone 1 g IMI stat
  3. Ref to Grey’s ENT for draining and IV ABx
53
Q

62 y/o Female with 1/7 hx of slipping and falling, injured her left elbow. C/o pain and swelling. O/E vitals stable. Left elbow oedematous, tender with decreased ROM. No open injuries. No obvious deformities.

A
  1. Analgesia - Voltaren 75 mg IMI stat + Panado 1 g PO stat
  2. Above elbow backslab
  3. Ref to NDH for XRs & further Mx
54
Q

20 y/o Male hit his right middle finger with a brick 4/7 ago now presents with septic finger. O/E vitals stable, right middle finger oedematous, erythematous, tender with decreased ROM , some nail lifting with periungual pus.

A
  1. Analgesia - Voltaren 75 mg IMI stat + Panado 1 g PO stat
  2. IV Abx - Ceftriaxone 1 g IVI stat
  3. Ref to NDH for XRs and further mx
55
Q

23 y/o Female with 2/7 of falling and injuring her left hand. C/o pain and swelling. O/E left hand oedematous with decreased ROM at wrist and MCP joints. No open injuries. No obvious deformities.

A
  1. Analgesia - Voltaren 75 mg IMI stat + Panado 1 g PO stat
  2. Volar slab applied
  3. Ref to NDH for XRs and further mx
56
Q

24 y/o Male allegedly (+accidentally) shot by SAPS on the right upper arm. O/E vitals stable. GSW x 1 (entry no exit) on anteromedial aspect of right upper arm + abrasions below the wound, moderately bleeding. Arm oedematous but soft + tender with good volume radial pulse. Bullet not visualised , not palpable.

A
  1. Wound cleaned + dry dressing applied
  2. IV ABx - Ceftriaxone 1 g IVI stat
  3. Analgesia stat - Voltaren 75 mg IMI stat + Panado 1 g PO stat
  4. Ref to NDH for XRs & further Mx
57
Q

36 y/o male, no known comorbidities. Multiple stab wounds: abdomen + L shoulder + scalp. BP 69/35 - 117/65 - 130/68. HR 78. Sats 99% RA. Ward Hb 12.

Assessment + Plan

A

A - Stab abdomen complicated by hypotension

  1. ATT
  2. 2 large-bore IV lines inserted
  3. IVF - R/L x3 L given (30 mls/kg boluses)
  4. U-catheter inserted
  5. IV ABx - Ceftriaxone 1 g IVI stat
  6. Analgesia - Voltaren 75 mg IMI stat or Morphine 2 mg IVI stat
  7. Keep NPO
  8. Ref to GH for laparotomy
58
Q

27 y/o female, no known comorbidities. Sudden onset SOB + chest tightness after fall-out with partner. BP 102/65. HR 88. Sats 98% RA. T 36. HGT 6,2. Ward Hb 15,5. ECG: NAD.

Assessment + Plan

A

A - ?Malingering vs upper airway obstruction vs panic attack

  1. Ref to NDH to rule out airway obstruction.
59
Q

24 y/o male, no co-morbidities.history of stab with bottle to the abdomen( LUQ). Clinically: bp: 103/60,p:87. Abd: 3cm laceration on LUQ, soft, localised tenderness to the LUQ.

A
  1. ATT
  2. 2 large bore IV lines
  3. IVF - R/L 30 mls/kg IV boluses
  4. U-cath
  5. IV ABx - Ceftriaxone 1 g IVI stat
  6. Analgesia - Voltaren 75 mg IMI stat or Morphine 2 mg IVI stat
  7. Ref to NDH for further Mx
60
Q

Unknown homeless male brought in by another with a history of vomiting and frothing. Known to using substances. O/E frothing ++, sweating ++, constricted pupils and fasciculation on face, arms and abdomen. BP 123/92, P55 bmp, R18 bmp, GR 13. 1mmol/l, Hb 13.6g/dl, T 36, GCS 10/15, sats 99%. T/F to NDH GCS Improved to 13/15.

A
  1. Airway - Suctioning of secretions
  2. Breathing - FMO2
  3. Circulation - 2 large bore IVL - R/L
  4. Atropine - 2 mg IVI stat - reasses & double dose every 5 min (2 mg - 4 mg - 8 mg)
  5. Dipstick - 2+protein, 2+blood, 1+glucose
  6. Ref to NDH w/ advanced medical service

Cholinergic toxidrome – DUMBELS
* Defaecation
* Urination
* Miosis
* Bronchorrhea/Bronchospasm/Bradycardia
* Emesis
* Lacrimation
* Salivation/Sweating

61
Q

Mx Cellulitis (open wound):

A
  1. Wash wound (NEVER suture) + Betadine dressing stat
  2. TCB 2/7 for dressing change
  3. ABx - Ceftriaxone 1 g IMI stat + Augmentin 1 g BD PO x 7/7
  4. Analgesia - Voltaren 75 mg IMI stat + Panado 1 g QID PO x 2/52 + Brufen 400 mg TDS PO x 2/52
62
Q

Zones of the Neck:

A
63
Q

When to NEVER suture wounds?

A
  1. > 24 hrs
  2. Septic wounds
64
Q

Location for digital (ring) block:

A
65
Q

Possibility when pt. presents with swelling of lips & tongue and on anti-HPT Rx?

A
  1. Angioedema secondary to ACE-I
66
Q

Rx for angioedema:

A
  1. Cetirizine 10 mg Dly PO x7/7
67
Q

Post suturing Mx:

A
  1. Panado 1 g QID PO x7/7
  2. Brufen 400 mg TDS PO x7/7
  3. Flucloxacillin 500 mg QID PO x 5/7
68
Q

Human Bite Mx:

Bitten pt. - unvaccinated or vaccination incomplete
Source pt. - HBsAg unknown

A
  1. Wash wound - soap + water 5 - 10 min
  2. Apply Chlorhexidine solution
  3. Apply povidone-iodine solution
  4. ATT
  5. Augmentin 1 g BD PO x 5/7
  6. Azithromycin 500 mg Dly x 3/7
  7. Metronidazole 400 mg TDS PO x 5/7
  8. Analgesia - Voltaren stat, TTO - Panado + Brufen

  1. HBIG 500 U IMI
  2. Hep B vaccine - 3 doses @ monthly intervals
69
Q
  • [ ] Mx open #:
A
  • [ ] ATLS
    • [ ] ATT
    • [ ] Analgesia
    • [ ] ABx:
      • [ ] Ranzol first line
      • [ ] Add Flagyl + Genta for triple cover
      • [ ] Check renal Fx before starting genta
    • [ ] Washout:
      • [ ] With N/S
      • [ ] Can add some iodine
      • [ ] Wash until macro clean
    • [ ] Dress wound:
      • [ ] Jelonet + gauze
      • [ ] No jelonet - N/S soaked gauze or betadine ointment on gauze
      • [ ] Then crepe
    • [ ] Immobilise
      • [ ] Back slab since lots of swelling
70
Q

Loading dose Epilim:

A

10 mg/kg IVI
(400 - 800 mg IVI stat)

Comm Serve - EBCHC (4 decks)

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