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GP block > Emergency presentations > Flashcards

Emergency presentations Flashcards

1
Q

What is the acute abdomen?

A

Pain in abdomen coming on in the last 24 hours. There are other sx too - vom, diarrhoea, constipation

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2
Q

Causes of pathology of sudden onset

A

Vascular accident - dissection, bleeding, infarction or perforations.

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3
Q

Abdo pain that migrates/radiates

A 
Migrates = appendicitis, para umbilical vague to RIF localised
Radiates = pancreas or AAA radiates to back
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4
Q

Markers of local vs systemic illness

A

Local - haematemesis, dysuria, faeculent vom, absolute constipation
Systemic - anorexia, weight loss, vom

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5
Q

Differentials for acute abdo

A
  • GORD, PUD, gastritis, perforated oesophagus
  • HPB - hepatitis, cholecystitis, cholangitis, acute pancreatitis
  • Bowel - appendicitis, diverticulitis, obstruction, IBD
  • Vascular - AAA, mesenteric ischaemia, dissection, haemorrhage
  • Male - torsion, renal colic
  • Female - ovarian cyst rupture, ectopic pregnancy, PID, UTI
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6
Q

What are some specific signs on exam for acute abdomen?

A
  • Anaemia/cachexia - acute on chronic
  • Abdo distension
  • Cullen’s/Grey Turners
  • Rebound tenderness
  • Peritonism
  • Guarding
  • McBurney’s sign
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7
Q

What can you test for on urine dip?

A
  • UTI
  • Pregnancy
  • DKA
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8
Q

How do you assess a patient with chest pain?

A

Hx - SOCRATES, previous eps, MI? angina? CVS RF, ask about sx of none cardio causes eg. resp, GORD, MSK, trauma, anxiety and depression
O/E - CVS, chest wall, abdo, neck (tender and stif), legs (DVT), skin (shingles and bruises), temp
Ix - ECG, bloods, TFTs, LFTs, CRP, CXR

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9
Q

What are the cardiac causes of chest pain?

A
  • ACS
  • Stable angina
  • Aneurysm
  • Pericarditis/tamponade
  • HF
  • Arrhythmias
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10
Q

What are the resp causes of chest pain?

A
  • PE
  • Pneumothorax
  • Pleural effusion
  • Pneumonia
  • Asthma
  • Lung collapse
  • Lung cancer
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11
Q

How do you assess a seriously unwell child?

A
  1. AtoE assessment and resus
  2. Secondary assessment and emergency treatment
  3. Stabilise and transfer
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12
Q

What is stridor?

A

Noisy breathing that occurs due to obstructed air flow through a narrowed airway.

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13
Q

A resus

A

Airways - naso pharyngeal airways, Guedel airways.

If stridor call senior immediately. Anaesthetic help may be needed.

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14
Q

What are some signs of resp distress in children?

A
  • Grunting
  • Flaring nostrils
  • Tracheal tug
  • Accessory muscle use
  • Gasping = late severe hypoxia
  • Silent chest
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15
Q

B resus in child

A
  • High flow O2 through reservoir bag

- Coughing if chocking or 5 back blows then 5 chest thrusts

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16
Q

C resus in child

A

20 ml/kg bolus 0.9% NaCl then reassess. Get IV access ASAP.

17
Q

D resus in child

A
  • Intubation if poor conscious level or not conscious
  • Hypoglycaemia = bolus 2ml/kg 10% glucose IV or IO then glucose infusion
  • Suspect ICP = mannitol
18
Q

What is AVPU?

A

Alert
Voice
Pain
Unresponsive

19
Q

What is involved in the secondary assessment of the acutely unwell child?

A
  • Reassess response to resus
  • Focused Hx and systems based exams
  • Ix
20
Q

What are the causes and what is the emergency treatment of stridor?

A
  • Harsh stridor and barking cough = croup = oral dex, NEB budesonide and adrenaline
  • Soft and drooling = epiglottitis = intubation and then IV Abc
  • Sudden and hx inhalation = foreign body = laryngoscopy
  • Anaphylaxis = IM adrenaline
21
Q

What does a bubbling sound in unwell child suggest? How do you treat?

A

Excessive secretions = suctioning

22
Q

What needs to be monitored in an unwell child?

A
  • O2 sats
  • Pulse - rate and rhythm
  • BP
  • Urine output
  • Core temp
23
Q

How do you assess a patient w unilateral weakness, suspected stroke?

A

CF - headache, vom, reduced consciousness
Hx - onset, fluctuation, duration
RF - PMH, chronic conditions, cancer, recent trauma or surgery, FH, meds
O/E - GCS, AtoE, FAST, CVS
Ix - BM, ECG

24
Q

What is Bells Palsy?

A

Acute, unilateral facial nerve weakness/paralysis of rapid onset of unknown cause.

  • Dry eye, incomplete closure, numbness of mouth
  • Hyperacusis
  • Speech articulation problems
25
Q

What are the signs of anaphylaxis?

A
  • Flushing, urticaria, angio oedema, rhinitis, conjunctivitis,
  • Difficulty breathing = stridor, wheeze
  • Palpitations, tachy, N+V
  • Hx of allergy
  • Recent exposure to new drug
26
Q

What are early pregnancy emergencies?

A
  • Miscarriage
  • Ectopic pregnancy
    If you suspect one you should suspect the other.
27
Q

What are the qs to ask about a child with suspected infection

A

Where is the infection and is the child significantly unwell?
Check dehydration and sepsis.

28
Q

What are the signs of sepsis in children?

A
  • Floppy and lethargic
  • Fast/laboured breathing
  • Having seizures
  • Unblanching rash/pale or mottled skin
  • Cold to touch
29
Q

What are the signs of sepsis in babies?

A
  • Not feeding
  • Repetitive vom
  • No wet nappies for 12 hours
30
Q

TIA vs stroke

A

Can’t diagnose a TIA until the symptoms have to resolved completely. Even if the patient is getting better you still have to treat as a stroke.

31
Q

How do you manage Bell’s Palsy?

A
  • Most people fully recover w/i 3-4 months
  • Need to keep eye lubricated and tape it closed at bedtime
  • Prednisolone if present w/i 72 hours
32
Q

When should you refer patients with Bell’s Palsy to secondary care?

A
  • Have worsening or new neurologicaly findings
  • Upper motor neurone cause - limb paresis, facial paraesthesia, CN involvement
  • Cancer cause - grad onsetn sex, pain in facial nerve region
  • Trauma
  • Severe local infection
33
Q

How should you manage anaphylaxis in primary care?

A

Need epipen injection if anaphylaxis whilst in GP, then will need referral to allergy service. Will need an epipen to have whilst wait for appointment - educate patient on how to use and how to avoid suspected trigger and how to recognise anaphylaxis.

GP block (14 decks)

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