Medical emergencies II

Question 1

What is a medical emergency

Answer 1

1. Any presentation that needs immediate intervention
2. Cannot wait for a routine appointment or referral
3. Needs to be seen by an appropriate professional on the same day

Question 2

High risk patient groups

Answer 2

1. Children
2. Elderly
3. Immunosuppressed patients
4. Pregnant women

Question 3

Common medical emergencies

Answer 3

• Sudden headache
• Epistaxis
• Breathing difficulties
• Worsening infections
• Anaphylaxis
• Angio-oedema
• Hypoglycaemia
• SEPSIS
• Trauma
• DVT/PE
• Overdose
• Psychosis
• Eye presentations

Question 4

Photophobia and headache

Presentation

Answer 4

• Teacher brought in colleague
• Sudden onset of headache and photophobia
• Patient holding head between hands, unable to move head due to discomfort
• No recent trauma
• No history of migraines or severe headaches

Question 5

Nose bleed- epistaxis

Question 6

Croup

Answer 6

• Barking cough that sounds like a seal
• Hoarse voice
• Breathing difficulties
• Rasping sounds when breathing in
• Worse at night

Question 7

Croup presentation and treatment

Answer 7

• 18 month old child
• Barking cough
• Had recent cold
• Mother concerned as struggling to breath
• Worse at night
• Dexamethasone oral solution (2mg/5mL)
  
  • PO (1 month -2 years) 150mcg/Kg single dose

Question 8

Asthma attack presentation

Answer 8

• 26 year old lady on salbutamol and clenil presents with worsening SOB
• Persistent dry cough
• Pulse 109 BPM
• RR 22 breaths per min
• Appers clammy and unable to speak in full sentences

Question 9

Angina or Suspected MI

Answer 9

• Aspirin dispersible tabs (300mg)
• GTN
• Call for 999

Question 10

Cellulitis

Answer 10

• Uncomplicated cellulitis is treatable in community
• Alarming if worsening despite treatment
• Potential complication of sepsis

Question 11

Sepsis presentation

Answer 11

• Patients returned from travel abroad to Nepal (Climbing Everest)
• Was treated for a bite on hand with fluclox 500mg QDS
• Returned after 5 days with tracking of symptoms (Lymphangitis)

Question 12

Anaphylaxis

Answer 12

• Itchy rash, throat or tongue swelling, SOB, vomiting, lightheadedness, and low blood pressure. These symptoms typically come on over minutes to hours
• Lightheaded
• Struggling to breath
• Wheezing
• Tachycardia
• Clammy skin
• Confusion and anxiety
• Collapsing or losing consciousness

Question 13

Anaphylaxis triggers

Answer 13

• Foods- including nuts, milk, fish, shellfish, eggs and some fruits/colourings
• Medication- Antibiotics/ NSAIDs/ General anaesthetics
• Insect bites
• Latex
• Idiopathic anaphylaxis

Question 14

Angio-oedema/ Allergic reaction

Answer 14

• First dose of ACEI
• 49 year old caucasian women took first dose
• Swollen lips, tongue and throat

Question 15

Diabetic hypoglycaemia

Answer 15

• Hungry
• Sweating
• Tingling lips
• Feels shaky or trembling
• Dizziness
• Tired
• Tachycardia
• Pale

Question 16

Left untreated

Answer 16

• Weakness
• Blurred vision
• Difficulty concentrating
• Confusion
• Slurred speech
• Sleepy
• Seizures
• Collapsing

Answer 17

Question 18

SEPSIS presentation

Answer 18

• High fever, shaking
• Struggling to breath
• Onset within few hours
• Young adult
• Lactate positive

Question 19

Purpuric rash- Non-blanching

Answer 19

Question 20

Trauma to the head

Answer 20

• Head injury
• Vomiting
• CT scan

Question 21

Overdose

Answer 21

• Paracetamol/ Alcohol
• Illicit drugs- Loss of consciousness/ RD

Question 22

DVT/PE

Answer 22

• Unilateral calf swelling and pain
• Heavy sensation
• Swelling
• Pain
• Redness
• Warmth to the touch
• Worsening leg pain when bending the foot
• Leg cramps (Especially at night and/or in the calf)
• Discoloration of skin

Question 23

DVT/PE presentation

Answer 23

• 69 year old lady
• Discharged from hospital after knee replacement
• Calls GP for a home visit due to leg swelling and pain
• WELLs score
• Risk factors
• Treatment D-0 dimer and US urgent
• See a lot of fo patients at the walk-in centre with this

Question 24

Fever- pyrexia

Answer 24

• Uncontrolled with regular paracetamol and ibuprofen
• Now feeling very unwell and weak

Question 25

Suicide attempt

Answer 25

• Patient no longer feel able to cope or be in control
• Emotional distress
• Can’t cope with day-to-day life or work
• Thinking about suicide or self-harm or experience hallucinations and hearing voices

Question 26

Warfarin and dental surgery

Answer 26

• Patient presenting at pharmacist/GP clinic post-dental surgery
• On warfarin
• Persistent bleeding

Question 27

Chemical burn

Answer 27

• Acute red eye
• Diabetic, acute red eye with lens
• Lose sight
• Girl sprayed body spray into eye

Question 28

Appendicitis

Answer 28

• Appendicitis typically starts with a pain in the middle of your abdomen that may come and go
• Within hours, the pain travels to your right-hand side, where the appendix is usually located and becomes constant and severe
• Pressing on this area, coughing, or walking may all make the pain worse
• If you have appendicitis, you may also have other symptoms, including Nausea, vomiting, loss of appetite, diarrhoea, fever

Question 29

Appendicitis

Presentation

Answer 29

• Young 37 year old male presented at A&E
• Examined and sent home with hyoscine 10mg tabs QDS
• Readmitted within 2 hours with unable to move
• Appendicitis- could have been sepsis
• Organ becomes septic and bursts

Question 30

Vasovagal- syncope

Answer 30

• Unpleasant sight
• Heat
• Sudden pain
• Coughing
• Sneezing
• Laughing
• Sitting or standing up suddenly