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Year 3 - GP > SLA 1 - Acute Emergencies and Pre-Hospital Care > Flashcards

SLA 1 - Acute Emergencies and Pre-Hospital Care Flashcards

1
Q

The ABCDE approach is a rapid primary survey technique, involving:

A

Airway
Breathing
Circulation
Disability
Exposure

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2
Q

What are the general principles of the rapid primary survey?

A

To identify and treat life-threatening problems in order of priority before moving onto the next part of the assessment.

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3
Q

How do you assess the airway in a rapid primary survey?

A

Check for obstruction ie. can the patient speak normally?

Listen for obstruction (e.g. stridor or gurgling)

Intubate if needed or give O2

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4
Q

How do you assess the breathing in a rapid primary survey?

A
  • look, listen and feel for signs of resp distress (chest expansion)
  • count RR
  • look at depth and pattern of breathing
  • note any chest deformity
  • record pO2
  • listen to the chest
  • check position of trachea
  • feel chest wall to detect surgical emphysema
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5
Q

How do you assess the circulation in a rapid primary survey?

A
  • colour of hands
  • temp of limbs
  • CRT
  • radial pulse
  • BP
  • HR
  • JVP
  • ECG

Give fluid resuscitation if indicated.

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6
Q

How do you assess disability in a rapid primary survey?

A
  • AVPU
  • pupillary light reflex
  • blood glucose
  • plantar reflexes
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7
Q

How do you assess exposure in a rapid primary survey?

A

Full body exposure to look for trauma or rashes, including the posterior surface of the body.

Respect the dignity of pt and minimise heat loss by covering the patient between exposure.

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8
Q

What is the acute abdomen?

A

The rapid onset of severe symptoms that indicate life-threatening intra-abdominal pathology.

Pain is a common feature but some patients may present pain-free.

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9
Q

Give some differentials of the acute abdomen.

A
  • acute cholecystitis
  • acute appendicitis
  • acute pancreatitis
  • ectopic pregnancy
  • diverticulitis
  • peptic ulcer disease
  • intestinal obstruction
  • testicular torsion

Note that non-surgical disease (e.g. myocardial infarction) may cause acute abdominal symptoms.

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10
Q

Give some common causes of acute abdominal symptoms in the RUQ.

A
  • acute cholecystitis
  • hepatitis
  • pyelonephritis
  • appendicitis
  • pneumonia
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11
Q

Give some common causes of acute abdominal symptoms in the epigastrum.

A
  • myocardial infarction
  • peptic ulceration
  • acute cholecystitis
  • perforated oesophagus
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12
Q

Give some common causes of acute abdominal symptoms in the LUQ.

A
  • splenic rupture
  • gastric ulcer
  • aortic aneurism
  • perforated colon
  • pyelonephritis
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13
Q

Give some common causes of acute abdominal symptoms in the LLQ.

A
  • diverticulitis
  • ruptured ectopic pregnancy
  • perforated colon
  • Crohn’s disease
  • ulcerative colitis
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14
Q

Give some common causes of acute abdominal symptoms in the RLQ.

A
  • appendicitis
  • ruptured ectopic pregnancy
  • incarcerated hernia
  • Crohn’s disease
  • ulcerative colitis
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15
Q

Give some red flags of the acute abdominal presentation.

A
  • hypotension
  • confusion or impaired consciousness
  • dehydration
  • rigid abdomen
  • absent or altered bowel sounds
  • tenderness to percussion
  • haematemesis or malaena
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16
Q

Why is a pregnancy test always indicated if a female of child-bearing age is presenting with acute abdominal symptoms?

A

Risk of ectopic pregnancy.

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17
Q

What are the risk factors for bile stones?

A

5 Fs:

Fat
Female
Fertile
Forty
Family history

Other risk factors include pregnancy, oral contraceptives and haemolytic anaemia.

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18
Q

What is the pre-hospital management of suspected abdominal symptoms?

A
  • keep pt nil by mouth
  • give O2 if SpO2 < 94%
  • analgesia (e.g. morphine)
  • contact 999 or send patient to A&E
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19
Q

What are the hallmarks of cardiac chest pain?

A
  • dull / crushing pain
  • centralised
  • worse with exertion
  • poorly localised
  • radiates to left jaw / arm
20
Q

Suggest some differentials for cardiac chest pain.

A
  • ACS / angina
  • aortic dissection
  • pericarditis
21
Q

Suggest some differentials for non-cardiac chest pain.

A
  • gall stones
  • GORD
  • PE
  • MSK (e.g. costocondritis)
  • anxiety / depression
22
Q

Give the risk factors for CHD.

A
  • smoking
  • hypertension
  • hyperlipidaemia
  • diabetes mellitus
  • obesity
23
Q

What are the hallmark symptoms of ACS?

A
  • cardiac chest pain, radiating to the left side of the jaw, shoulder and arm
  • nausea and vomiting
  • breathlessness
  • sweating
  • new onset
24
Q

What are the symptoms of cardiac ischaemia?

A

A retrosternal or epigastric pain, which is tight and crushing, and may radiate to the arms, neck or jaw.

25
Q

What are the hallmarks of pleuritic chest pain?

A
  • sharp
  • well localised
  • non-central
  • worse with chest movement (ie. inspiration, coughing)
26
Q

What are the symptoms of pericarditis?

A

A retrosternal, pleuritic chest pain that is relieved when sitting forwards.

Patient may also have an associated fever and dyspnoea.

27
Q

What is anaphylaxis?

A

A severe, life-threatening hypersensitivity reaction which involves the airway and circulatory system.

28
Q

What are the signs of anaphylaxis?

A
  • flushing
  • urticaria
  • angio-oedema
  • dyspnoea
  • stridor / wheeze
  • palpitations
  • tachycardia
  • nausea
  • vomiting
  • abdominal pain
  • sense of impending doom
29
Q

Outline the aetiology of anaphylaxis.

A
  1. Allergen reacts with specific IgE antibody on mast cells and basophils.
  2. Type 1 hypersensitivity reaction triggers the rapid release of histamine.
  3. Histamine results in capillary leakage, mucosal oedema, shock and asphyxia.

Note anaphylaxis usually occurs rapidly but is occasionally biphasic.

30
Q

Give some common triggers of anaphylaxis.

A
  • peanuts
  • eggs
  • milk
  • venom (e.g. bee sting)
  • drugs (e.g. penicillin)
31
Q

Outline the pre-hospital management in a patient with anaphylaxis.

A
  1. Rapid primary survey (A-E)
  2. Lye patient flat and raise legs
  3. Administer adrenaline IM on the anterolateral aspect of the middle third of the thigh

Contact 999 for emergency transport to hospital.

32
Q

Define the dose of adrenaline to be administered in patients aged:

a) adult (>18yrs)
b) 12-18yrs
c) 6-12yrs
d) <6yrs

A

a) 500mg
b) 500mg
c) 300mg
d) 150mg

33
Q

Define:

a) acute breathlessness
b) subacute breathlessness
c) chronic breathlessness

A

a) develops over minutes
b) develops over hours or days
c) develops over weeks or months

34
Q

Give some cardiac causes for breathlessness.

A
  • silent MI
  • cardiac arrhythmia
  • acute pulmonary oedema
  • chronic heart failure
35
Q

Give some pulmonary causes of breathlessness.

A
  • asthma
  • COPD
  • pneumonia
  • PE
  • lung cancer
  • pleural effusion
36
Q

Which symptoms alongside breathlessness would warrant emergency hospital admission?

A
  • stridor
  • confusion / drowsiness
  • tachypnoea
  • tachycardia
  • hypotension
  • pregnancy
  • CRB ≥ 1

Note if SpO2 < 94% on air oxygen should be given and saturation levels continuously monitored.

37
Q

Give some differentials for a patient presenting with unilateral weakness.

A
  • stroke
  • TIA
  • Bell’s palsy
38
Q

What is the general presentation of a stroke / TIA?

A

The sudden onset of focal neurological symptoms, which cannot be explained by other conditions (e.g. hypoglycaemia).

Symptoms include:
- numbness
- weakness
- slurred speech
- visual disturbances

39
Q

What is a stroke?

A

A clinical syndrome of presumed vascular origin characterised by the rapidly developing signs of focal or global disturbance of cerebral functions, lasting longer than 24hrs or leading to death.

Note 85% of strokes of ischaemic aetiology; 15% of haemorrhagic aetiology.

40
Q

What is a transient ischaemic attack?

A

A transient neurological dysfunction lasting less than 24 hours, caused by focal brain, spinal cord or retinal ischaemia, without evidence of acute infarction.

41
Q

What is Bell’s palsy?

A

The acute, unilateral facial nerve weakness or paralysis, causing facial drooping.

Note Bell’s palsy may follow infection (e.g. varicella zoster virus, herpes simplex virus) or have autoimmune aetiology.

42
Q

Give the symptoms of a Bell’s palsy.

A

Unilateral facial muscle weakness, without forehead sparing.

The patient may also complain of otalgia and sialorrhoea.

43
Q

What is the management of Bell’s palsy?

A

Use of lubricating eye drops to ensure the eye is hydrated during the day, with the eye taped closed at night if the ability to close the eye is impaired.

Prednisolone can be prescribed if presentation is within 72hrs of symptom onset.

44
Q

What is the FAST system when assessing a patient with unilateral weakness?

A

Facial drooping
Arms (cannot raise)
Slurred speech
Time (acute onset)

Any pts who are FAST + should be urgently referred to A&E.

Note blood glucose should be checked to exclude hypoglycaemia as a cause for neurological deficit.

45
Q

If a patient presents to the GP with a red eye, which conditions would warrant a same-day referral to opthamology?

A
  • acute glaucoma
  • trauma
  • chemical injuries
  • neonatal conjunctivitis
46
Q

How should a chemical related eye injury be managed in primary care?

A

Irrigate with saline solution and arrange urgent transfer to opthamology.

47
Q

What are the red flags of a patient presenting with a red eye?

A
  • reduced visual acuity
  • deep pain within the eye
  • unilateral red eye
  • photophobia
  • unequal pupils

Year 3 - GP (17 decks)

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