Common ward calls

Question 1

Sequence

Answer 1

Vital signs
Investigations (for nurse)
DDx (life threatening first)

Background (why at hospital, current problem list)

ABCs
Hist (SAMPLE)
Exam
Inv

Recent Labs, look at notes
Chart - Vitals, Fluid
Treat

Question 2

Chest Pain

• Management
• Things to be worried about

Answer 2

DDx - PAATTE M
Common - infection, musculoskeletal, Reflux/peptic ulcer, anxiety (RAMI)

Hist - Socrates, cardio, resp
Exam - Cardio, resp, legs

Inv - ECG (compare to prev)
Bloods - FBC, trop, U+E, coags
CXR

Management (STEMI)
OMI - oxygen, monitor, IV lines 
-Morphine + metoclopramide
-Nitrate (GTN)
-Aspirin 
Ring senior

Things to be worried about

• Hypotension
• Tachy/bradycardia
• Nausea, sweating
• Reduce GCS
• SOB
• ECG changes

Question 3

Specific management Chest pain

AD 
Pericarditis
Cardiac Tamponade
GORD
Esophageal rupture 
Musculoskeletal 
Panic attack

Answer 3

Aortic dissection
Sx - unequal pulses, diff BP in arms
-CXR –> CTA or TOE, ICU organise
-BB IV - lower BP and pulse rate

Pericarditis
ECG - ST elevated, PR depression
Tx - NSAIDs (or colchine), Prednisolone (or dexamethaosne)

Cardiac tamponade
Sx - tachy, hypotension, raised JVP
Echo, pericardiocentesis

GORD

• anatacid every 2 hrs, then TDS
• PPI

Esophageal rupture
-CT scan, endoscopy

Musculoskeletal
-Nsaids

Herpes

• opiod analgesia if need be
• anti-viral agent, steroids

Panic attack
-Diazapem 2-5mg PO

Question 4

Tachycardia

Answer 4

DR HAT SPAM
DDx - heart failure, hypoxia, MI, shock, PE
-hypovolaemia, sepsis, arrhythmia, drugs, renal failure, pain, hyperthyroid, anaemia

Hist - full systems, fam history sudden death
Exam - Fluid status, Infection, Cardio, Resp, legs
Inv - ECG
Bloods - U+E, VBG, septic screen

Management 
OMI 
Cardiac arrest trolley 
Find cause
Treat cause (specifics covered elsewhere) 

Red flags

• hypotension, AMS, chest pain, SOB (pulmonary oedema)
• HR>140 - MET Call

Question 5

Bradycardia

Answer 5

DDx - drugs, arrhythmia, MI, sick sinus syndrome, vasovagal, hypthermia, hypothyroid

Managemet
OMI
Cardiac arrest trolley

Atropine
Pacing

Red flags

• chest pain, SOB, hypotension, AMS
• HR<40 - MET CALL

Question 6

Shortness of breath

Answer 6

DDx
Cardiac -Arrhythmia, heart failure, MI, tamponade
Resp - PE, pulmonary oedema, plueral effusion, tension pneumothorax, pnuemonia, COPD, asthma, atelectasis
Anyphylaxis, aspiration, Anxiety
Upper airway obstruction

Hist
Exam
Inv - ECG, Cxray, VBG, septic screen

Management

• ABCs
• OMI
• Inv
• Treat cause (salbutamol, GTN - pulmonary edema ect)

Worrying factors

• confusion
• chest pain
• fatigue
• febrile
• Hypotension
• Reduced sats
• Brady/tachycardia
• RR >30bpm

Question 7

Management of common causes of SOB

• PE
• Pneumonia
• Pulmonary oedema
• Asthma
• COPD

Answer 7

PE
Wells score, d-dimer
CTPA/VQ scan
V/Q (allergic to contrast, renal failure, pregnant)

Management PE

• O2
• Pain relief
• Anticoagulate - LMWH (enoxaparin)

Pneumonia

• CAP score
• Abx

Asthma

• Oxygen
• Salbutamol nebs, ipratropium
• Prenisolone PO or hydrocortisone
• IV salbutamol, MgS (if severe)

COPD

• Venturi mask O2 88-92%
• salbutamol + ipratropium nebs
• Prednisolone + hydrocortisone
• Inf treat
• furesemide (if RV failure or fluid overloaded)

Question 8

Causes of acute LVF

• common causes
• Management

Answer 8

Underlying cause - IHD, HTN, Valve, cardiomyopathy, pericardial disease, congenital HD

• MI
• Arrythmia
• Fever, infection
• PE
• Increase Na or fluid
• Cardiac depressant drugs
• Renal disease
• Anaemia

Acute LVF (pulmonary oedema)

• Sit patient up
• Oxygen
• GTN (if BP>100)
• furesmide (overload)
• CPAP

Question 9

Hypo tension

Answer 9

DDx

• Obstructive, distributive, cardiogenic (arrhythmia, MI), hypovolaemic shock
• Drugs
• Postural
• diabetes, parkinsons, multi-system atrophy

Vitals
ABCs
Fluid balance chart
Exam - AMS, fluid status, infection sources, cardio, lungs
Inv - VBG, Septic screen, CXR (pulmonary oedema), ECG

Management

• OMI
• Fluid challenge
• Monitor urine output (Catheter)
• Treat cause
• Septic 6

Question 10

Hypertension (finish this)

Answer 10

DDx

• Anxiety/pain
• cardiac
• drugs
• AD
• Eclampsia
• Hypertensive encepahlopathy
• MI
• pulomonary oedema
• Raised CP
• stroke
• Autonomic dysreflexia
• Essentail HTN
• Secondary HTN - renal cause (RAS), endocrine (cushings, conns, thryoid) , autoimmune disease
• Phaechromocytome

Worrying symptoms

• Sudden onset chest or back pain (AD)
• arrhythmia, Dyspnoea (MI, acute Pulmonary oedema)
• Sudden headache (SAH)
• Vomiting
• Confusion
• Seizure (hypertensive encephalopathy)

Question 11

Confusion

Answer 11

DDx - DOG MIST

Hist - Orientation questions, drug/alcohol,
Exam - ABCs, Vitals, Peripheries/fluid status,
Pupils,
Neuro, septic screen,

Investigations
-Bloods - glucose, FBC, U+E, LFTs, Renal function, VBG

Immediate management (unresponsive)

• ABCs, call for help
• High dose O2, intubate
• IV access - bloods, fluids
• Gluocse low - give glucose
• ALcoholic - thiamine
• Naloxone - drug related
• Abx - meningitis
• CT - head trauma, anticagulated, neruo signs
• Benzo - if aggitated
• Diazepam or olanzipine PO
• IV - midazolam, diazepam, haloperidol - get ready

Worrying features

• Drowsy fever
• Focal neurology
• History of alcoholism
• Hypoxia
• Time of onset
• abnormal vitals
• Decreased level of consciousness