Emergency presentations Flashcards
What is the acute abdomen?
Pain in abdomen coming on in the last 24 hours. There are other sx too - vom, diarrhoea, constipation
Causes of pathology of sudden onset
Vascular accident - dissection, bleeding, infarction or perforations.
Abdo pain that migrates/radiates
Migrates = appendicitis, para umbilical vague to RIF localised Radiates = pancreas or AAA radiates to back
Markers of local vs systemic illness
Local - haematemesis, dysuria, faeculent vom, absolute constipation
Systemic - anorexia, weight loss, vom
Differentials for acute abdo
- 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
What are some specific signs on exam for acute abdomen?
- Anaemia/cachexia - acute on chronic
- Abdo distension
- Cullen’s/Grey Turners
- Rebound tenderness
- Peritonism
- Guarding
- McBurney’s sign
What can you test for on urine dip?
- UTI
- Pregnancy
- DKA
How do you assess a patient with chest pain?
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
What are the cardiac causes of chest pain?
- ACS
- Stable angina
- Aneurysm
- Pericarditis/tamponade
- HF
- Arrhythmias
What are the resp causes of chest pain?
- PE
- Pneumothorax
- Pleural effusion
- Pneumonia
- Asthma
- Lung collapse
- Lung cancer
How do you assess a seriously unwell child?
- AtoE assessment and resus
- Secondary assessment and emergency treatment
- Stabilise and transfer
What is stridor?
Noisy breathing that occurs due to obstructed air flow through a narrowed airway.
A resus
Airways - naso pharyngeal airways, Guedel airways.
If stridor call senior immediately. Anaesthetic help may be needed.
What are some signs of resp distress in children?
- Grunting
- Flaring nostrils
- Tracheal tug
- Accessory muscle use
- Gasping = late severe hypoxia
- Silent chest
B resus in child
- High flow O2 through reservoir bag
- Coughing if chocking or 5 back blows then 5 chest thrusts
C resus in child
20 ml/kg bolus 0.9% NaCl then reassess. Get IV access ASAP.
D resus in child
- Intubation if poor conscious level or not conscious
- Hypoglycaemia = bolus 2ml/kg 10% glucose IV or IO then glucose infusion
- Suspect ICP = mannitol
What is AVPU?
Alert
Voice
Pain
Unresponsive
What is involved in the secondary assessment of the acutely unwell child?
- Reassess response to resus
- Focused Hx and systems based exams
- Ix
What are the causes and what is the emergency treatment of stridor?
- 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
What does a bubbling sound in unwell child suggest? How do you treat?
Excessive secretions = suctioning
What needs to be monitored in an unwell child?
- O2 sats
- Pulse - rate and rhythm
- BP
- Urine output
- Core temp
How do you assess a patient w unilateral weakness, suspected stroke?
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
What is Bells Palsy?
Acute, unilateral facial nerve weakness/paralysis of rapid onset of unknown cause.
- Dry eye, incomplete closure, numbness of mouth
- Hyperacusis
- Speech articulation problems
What are the signs of anaphylaxis?
- Flushing, urticaria, angio oedema, rhinitis, conjunctivitis,
- Difficulty breathing = stridor, wheeze
- Palpitations, tachy, N+V
- Hx of allergy
- Recent exposure to new drug
What are early pregnancy emergencies?
- Miscarriage
- Ectopic pregnancy
If you suspect one you should suspect the other.
What are the qs to ask about a child with suspected infection
Where is the infection and is the child significantly unwell?
Check dehydration and sepsis.
What are the signs of sepsis in children?
- Floppy and lethargic
- Fast/laboured breathing
- Having seizures
- Unblanching rash/pale or mottled skin
- Cold to touch
What are the signs of sepsis in babies?
- Not feeding
- Repetitive vom
- No wet nappies for 12 hours
TIA vs stroke
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.
How do you manage Bell’s Palsy?
- 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
When should you refer patients with Bell’s Palsy to secondary care?
- 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
How should you manage anaphylaxis in primary care?
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.
