ICM - emergencies Flashcards
Investigations for a DVT? (3 things)
gold standard:
USS
- Measure the leg (if >3cm bigger than the other leg then consider DVT)
- Wells score
- If likely (2 or more points) then USS. If unlikely then D-dimer
Investigations for a ruptured aortic aneurysm?
Gold standard:
Abdominal USS
Link:
https://www.nice.org.uk/guidance/ng156/resources/abdominal-aortic-aneurysm-diagnosis-and-management-pdf-66141843642565
What is the guidance for referring a patient with an AAA?
1• Refer those with an AAA of 5.5cm or larger to vascular services to be seen within 2 weeks
2• Refer people with an AAA of 3.0 cm to 5.4 cm to vascular services, to be seen within 12 weeks of diagnosis.
What symptoms will indicate a ruptured AAA?
- Abdominal pain
- Back pain
- Hypotension
- Collapse/ loss of consciousness
A patient comes in with a sudden onset compartment syndrome type picture (6 P’s) in their leg. What is the likely diagnosis and what is the first line investigation?
Acute limb ischaemia.
Ix:
- CVS exam (Femoral, popliteal, and foot pulses)
- ABPI
(ratio of less than 0.9 indicates the presence of peripheral arterial disease BUT a number > than this doesn’t exclude the disease)
Note if the number is high such as 1.4 and they have diabetes also consider PAD
Link:
https://cks.nice.org.uk/topics/peripheral-arterial-disease/management/acute-limb-ischaemia/
What is the gold standard for diagnosing spinal cord compression?
MRI
When would you suspect a diagnosis of DKA? what are the 10 clinical signs of DKA?
- Type 1 Diabetic
- Fingerprick glucose >11mmol/L or significant hyperglycaemia and clinical features:
- Visual changes
- Increased thirst and urinary frequency.
- Weight loss.
- Inability to tolerate fluids.
- Persistent vomiting and/or diarrhoea.
- Abdominal pain.
- Lethargy and/or confusion.
- Fruity smell of acetone on the breath.
- Acidotic breathing — deep sighing (Kussmaul) respiration.
- Dehydration
What would you do next if a patient presented to you with CGA with acute visual changes?
- Arrange an urgent (same day) assessment by an ophthalmologist.
- Immediate IV glucocorticoid treatment
- if not possible then: 60–100 mg oral Prednisolone for 3/7.
Initial hospital management of acute pancreatitis? (5 things)
- Resuscitation with intravenous fluids.
- Supplemental oxygen.
- Intravenous analgesia.
- Intravenous antibiotics
- Early nutritional support
Gold standard for acute pancreatitis?
Abdominal CT or MRCP (but usually a clinical diagnosis)
A patient presents with a severe, sudden-onset (‘thunderclap’) headache. What is the diagnosis and first line investigation?
Subarachnoid headache
Ix:
Non contrast CT head
- If a CT head scan done more than 6 hours after symptom onset shows no evidence of a subarachnoid haemorrhage, consider a lumbar puncture.
- Allow at least 12 hours after symptom onset before doing a lumbar puncture to diagnose a subarachnoid haemorrhage.
Diagnosis confirmed in LP shows elevated bilirubin (xanthochromia) on spectrophotometry
How do you manage a SAH?
Neurosurgery referral within 24 hours
When would you suspect a diagnosis of HHS? Include both clinical signs and clinical symptoms
- An unwell patient with severe hyperglycaemia (blood glucose level typically above 30 mmol/L) for several days
AND:
- Clinical symptoms
- Disorientation, confusion, and/or drowsiness
- Polyuria and polydipsia
- Nausea - Clinical signs
- Severe dehydration and hypovolaemia.
- No significant signs of ketosis, or blood or urinary -
ketones on testing.
What is the first line investigation for HHS?
HbA1c of >48
If symptomatic a single blood or fasting glucose can be used
If asymptomatic then test twice
HHS management? (4 things)
- IV fluids
- Insulin
- Monitor fluids, glucose, U+E
- Treat underlying cause
