A case of emergency medicine Flashcards
Learning differential diagnosis and treating acute conditions
For each NEWS2 score, give the response?
For each NEWS2 score gicve the frequency of monitoring and detailed clinical response
What is a Diverticulum and where does it normally occur?
A disease where a small pocket or pouches protrudes from the digestive tract.
Can occur anywhere but normally affects the colon (most commonly sigmoid colon- pressure is highest here)
It happens when the inner layer of digestive tract pushes through weak spots in outer layer
How prevelant is diverticula?
Half of the people have it by the time they’re 50
Nearly 7/10 have it by the time they’re 80
What causes diverticula?
Usually low dietary fibre
This makes stool drier and smaller so colon has to contract more forcefully to move it
High pressure can cause inner lining of gut to move through muscle wall and form diverticula
Why are so many people unaware they have diverticula?
3 out 4 people with diverticuli do not get symptoms. We call this diverticulosis
Hence diverticuli is found incidentally during a colonoscopy or flexible sigmoidoscopy when looking for a polyps.
What other imaging tests can be used to look for a diverticuli?
- Barium Xrays
- CT
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Sometimes diverticuli presents with symptoms, what are they?
Tis is diverticular disease
Symptoms are:
- fever
- severe abdominal pain (normally lower left)
- bloating
- abdominal cramps
- constipation.
What is Diverticular Disease? Give relevant features
Diverticuli but it presents with intermittent lower abdominal pain or bloating (without inflammation and infection).
the pain is normnally in left lower abdomen, crampy and comes and goes, and the pain/bloating can be relieved wioth passing stools.
Some people develop diarrhoea /constipation and some people pass mucus in the stool.
what other disease is Diverticular disease similar to and how can you differentiate them?
IBS- but it affects younger people unlike diverticuli disease.
However if the symptoms occur in older people, early bowel cancer needs to be excluded.
What is diverticulitis ? Give symptoms
When diverticuli becomes inflamed and infected. Feaces are trapped in diverticulum and gut bacteria multiply.
Symptoms:
- A constant pain in the abdomen. Commonly in the lower left side of the abdomen, but can occur in any part of the abdomen. Indeed, in people of Asian origin, it sometimes occurs on the right side.
- High temperature (fever).
- Constipation or diarrhoea.
- Some blood mixed with your stools.
- Feeling sick (nauseated) or being sick (vomiting).
How often does a diverticula develop into diverticulitis?
About 1 in 5 people with diverticula develop a bout of diverticulitis at some stage.
An infected diverticuli can become serious and cause complications. what are they?
- Obstruction of the colon
- Abscess forming inthe abdomen
- fistula to other organs like the bladder
- Hole in bowel wall that can lead to perotinitis
Why does bleeding sometimes occur with a diverticulum? What is the nature of the bleeding?
The bleeding is usually abrupt and painless.
The bleeding is due to a burst blood vessel that sometimes occurs in the wall of a diverticulum and so the amount of blood loss can be heavy.
Bleeding stops on ints own is 3/4 cases but sometimes needs transfusion if very heavy
Not common in diverticulitis since blood vessels become scarred form inflammation. More common with diverticulosis.
what are the treatment options for diverticulosis
high fibre (soluble) diet. need to get between 18g-30g of fibre each day.
There are other treatments that prevent it to escalate to diverticular idsease or diverticulitis. which ARE:
- STOP smoking
- exercise
- lose weight
what are the treatment options for divertiuclar disease
- Diverticulosis diet
- lots of fluids -avoid fizzy drinks
- paracetamol - ease pain. DO NOT USE NSAIDS or opiods
- antispasmodics such as mebevrine.
What is the approach to all critically ill pts?
- Use the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach to assess and treat the patient.
- Do a complete initial assessment and re-assess regularly.
- Treat life-threatening problems before moving to the next part of assessment.
- Assess the effects of treatment, remembering it can take a few minutes for treatments to work
- Recognise when you will need extra help. Call for appropriate help early.
- Use all members of the team. This enables interventions (e.g. assessment, attaching monitors, intravenous access), to be undertaken simultaneously.
- Communicate effectively - use the Situation, Background, Assessment, Recommendation (SBAR) or Reason, Story, Vital signs, Plan (RSVP) approach.
Airway.
What are the potential problems of the airway
- Decreased GCS (GCS ≤8 usually requires intubation)
- Excessive secretions
- Foreign body
- Airway swelling / inflammation
- Trauma
AIRWAY.
How do you assess this?
- There may be paradoxical chest and abdominal movements (Reverse to expected movements e.g. chest up when expirating)
- There may be use of accessory muscles - In partial obstruction there may be noisy breathing (snoring, stridor, wheeze) with diminished air entry
- In total obstruction there will be no breath sounds at the nose or mouth
- Central cyanosis is a late sign
AIRWAY
What actions can you take if the somehow the airway is compromised?
- Airway opening manoeuvres - head tilt and chin lift, or jaw thrust
- Suction to remove debris (don’t ever use your fingers!).
- Simple airway adjuncts – nasopharyngeal airway, oropharyngeal airway (aka Guedel)
- Supraglottic airway (eg iGel)
- Advanced airway interventions – intubation, emergency surgical airway
- Then give oxygen at high concentration
Breathing.
What are the potential problems affecting breathing?
- Reduced GCS
- Acute severe asthma or COPD
- Pneumonia or lung infection
- Pulmonary oedema
- Pneumothorax or tension pneumothorax
- Pulmonary embolism
- Haemothorax (blood in the pleural cavity, often secondary to trauma)
- Respiratory depression (e.g. secondary to drug toxicity)
What is the Glasgow Coma Scale?
- A brain injury severity scale that assesses depth and duration of impaired consciousness and coma.
- Eye response
- Motor response
- Verbal Response
What is the progression of sepsis?
