Medical Conditions

Question 1

Sickle cell crisis

Answer 1

Symptoms:
▪️Most common symptom is pain in the long bones, joints, back, chest and abdomen
▪️ Rare cases may be pain free
▪️SOB, possibly with reduced SPO2
▪️Pyrexia
▪️Lethargy
▪️Reduced consciousness
▪️Priapism
▪️A crisis may follow as a result of infection, pregnancy, stress or post surgery

Treatment:
🔹 ALWAYS administer Oxygen regardless of SPO2
🔹 Administer analgesia NOT IV
🔹 Not all pt’s with SCC will need to be conveyed
🔹 ATMIST if appropriate
🔹 Assess and treat for Acute Chest Syndrome, often precipitated by a chest infection and characterised by hypoxia, tachypnoea & tachycardia. Chest pain and bi-basal crackles may also be present

Question 2

Pulmonary Embolism

Answer 2

Symptoms:
▪️Dyspnoea
▪️Tachypnoea
▪️Pleuritic pain
▪️Tachycardia
▪️Apprehension
▪️Cough/ haemoptysis
▪️ Leg pain/ DVT/
▪️ Wells score over 2

Treatment:
🔹Monitor & record 12 lead ECG throughout (S1,Q3,T3 may or may not be present)
🔹Provide analgesia as needed
🔹Monitor SPO2 and provide oxygen if needed
🔹TIME CRITICAL provide ATMIST and convey rapidly IN ALL CASES

Question 3

Appendicitis

Answer 3

Symptoms:
▪️Central abdo pain moving to LRQ, worse on palpation
▪️Nausea
▪️Vomiting
▪️Diarrhoea or constipation
▪️Pyrexia
▪️Rebound tenderness

Special tests:
🔸Roving’s sign- Pain in RLQ when LLQ is palpated
🔸Psoa’s sign- Pain in RLQ when R leg is raised and movement is resisted
🔸McBurney’s point tenderness- Pain on palpation of the area 1/3 of the way between the R anterior superior iliac spine and the umbilicus

Treatment:
🔹Analgesia
🔹Antiemetic if appropriate
🔹Conveyance to ED
🔹ATMIST and time critical transfer are not appropriate unless pt is deteriorating or AAA, testicular torsion, ectopic, sepsis, perforation or traumatic disruption of organ is suspected

Question 4

Ischaemic Bowel

Question 5

Thoracic Aortic Dissection

Answer 5

Symptoms:
▪️Acute severe tearing chest pain radiating to scapula
▪️History of AAA
▪️Risk factors of Male, hypertension and increased age
▪️BP/ radial pulse differential
▪️Syncope
▪️SOB
▪️Paraplegia/ paraesthesia

Treatment:
🔹TIME CRITICAL TRANSFER to ED
🔹ATMIST
🔹Analgesia
🔹Do not delay on scene to obtain IV access