Week 1: Consulting and acute emergencies Flashcards
Why remote consulting?
- More efficient use of time
- More efficient use of space
- Reduced carbon footprint
- Reduced risk of infectious disease (COVID-19)
pitfalls of remote consulting
- Not appropriate consultation method
- Confusing landscapes for patient
- Not accessible for everyone
- IT literacy
- language barriers
- disabilities
- confidentiality
- new way of consulting: new skills required
types of remote consulting
- asynchronous
- telephone
- video
before you start consultation
“Is face to face necessary”
- Is this mode of consulting right?
- What is the consultation for?
- Triage
- Acute illness
- Chronic disease management
- Follow uo
- Do you have the right equipment
- IT
- Phone/video
- Headset
When remote consultation may be appropriate
- straightforwar treatment reques
- access to PMH
- can give pt all information they want and need remotley
- dont need to examine patient
- safe system in place to prescribe
- patient has capabity
face to face preferable when
- complex clinical needs
- not patient susual GP and they have no guven consent to share info
- you do not have access to patients medical record
- you need to examin patient
- unsure of patients capacity to decide about treatment
Telephone consulting
- Most common now
- May be for triage
- Complete consultation without need for face to face
- Suits some patients more than others
- Telephone triage may increase overall workload
top tips for telephone consultation
- Empathetic statements
- Echoing patient words
- Summarising
- Tone important
- Chunking and checking pieces of info
- Avoid jargon
undertaking telephone consultation
-
Initiating
- Confirm identify (3 point check)
- Introduce yourself
- Gain consent
- Establish where the patient is and who is with them
-
Bulk of consultation
- Same as face to face
- Remember golden minute
- Start with open questions
- Pay attention to verbal causes
- Ideas, concerns, expectations
-
Examination
- How is the pt speaking? Short of breath?
- Home BP machine or thermometer
- Can they describe rash
-
Explaining
- Keep explanations clear and confirm understanding
-
Ending
- Be clear with diagnosis and plan
- Ensure you have given patient an appropriate safety net
- Send information
-
Record keeping
- Record that the consultation was over the phone
video consultation when
(don’t need to use when telephone consult will do)
- Assessing an unwell child e.g. observing behaviour and resp effort
- Seeing rash
- Establishing/maintaining rapport
human factors definition
Enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture and organisation on human behaviour and abilities and application of that knowledge in clinical settings.
understanding human error
All humans make mistakes, we get distracted, we are susceptible to fatigue and performance can vary depending on the time of day, length of shift and if we are hungry, angry or emotional. To exacerbate the issue we live and work in complex social structures that are often hierarchical.
Traditionally in healthcare fallible human beings are then tasked with providing a skilled service in a high stress and high workload health service with very little defence against mistakes beyond their own vigilance.
This idea is probably best known through the “Swiss cheese” model of organisational accidents (Reason 1990). The idea is that within healthcare there are a number of defences against error. These defences are not perfect and have little holes in known as “latent conditions”. The size of these holes depends upon the design of the defences. Poorly designed defences increase the size of the holes and place a greater burden on the frontline staff to avoid errors through vigilance alone.
reducing human error
ABCDE approach: rapid primary survery involes
airway
breathing
circulation
disability
exposure
general principles of rapid primary survey
Treat life-threatening problems before moving to the next part of the assessment
- Recognise when you need extra help
- Use all members of the team
- First step: is this cardiac arrest
Airway
- Check for obstruction i.e. can the patient speak normally
- Listen for obstruction e.g. stridor or gurgling → do jaw thrust
- Intubate if needed
- Give O2 if required
Breathing
- 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 the trachea
- Feel chest wall to detect surgical emphysema
Circulation
- Colour of hands
- Temp of limbs
- CRT
- Radial pulse
- BP
- Heart rate
- JVP
- ECG
- Give fluid resus if needed
Disability
- AVPU
- Check pupil
- Blood glucose
- Plantar reflexes
Exposure
- Fully expose the body → look for trauma or rashes
- Inspect posterior
- Respect dignity of pt and minimise heat loss
Is this cardiac arrest?
Remember: If the patient is unconscious, unresponsive, and is not breathing normally (occasional gasps are not normal) start CPR according to the resuscitation guidelines. If you are confident and trained to do so, feel for a pulse to determine if the patient has a respiratory arrest. If there are any doubts about the presence of a pulse start CPR.
- Listen for normal breathing
- Is there a carotid pulse
common emergency presentations
- Coma,
- Difficulty breathing,
- Chest pain,
- Collapse with hypotension,
- Collapse with altered consciousness,
- GI bleeding,
- Abdominal pain,
- Headache,
- Seizures
acute abdomen major causes
how can the acute abdomen be classified
