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(3) GP > 2 - Acute Emergencies and Pre-Hospital Care > Flashcards

2 - Acute Emergencies and Pre-Hospital Care Flashcards

1
Q

What is the ABCDE approach to emergency presentations?

A
  • LOOK LISTEN FEEL ensuring personal safety
  • Check patients drug chart for disability for any changes in consciousness
  • Respect patients dignity when exposing and prevent uneccessary heat loss
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2
Q

What are some major causes of acute abdominal pain that may present to primary care?

A
  • Shingles
  • Hernia
  • UTI/Pyelonephritis
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3
Q

If a patient described abdominal pain in each of the regions shown, what may be some differentials?

A
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4
Q

What are some important questions to ask a female presenting with acute abdominal pain?

A
  • History of STIs or PID
  • Contraceptive method e.g IUD
  • LMP
  • History of ectopic pregnancies
  • Any vaginal bleeding
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5
Q

What pathologies can cause back pain as well as abdominal pain?

A
  • Pancreas
  • Abdominal aorta
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6
Q

How do you examine a patient that you have assessed/taken a history for with abdominal pain?

A

Inspection: look for anaemia or jaundice, Grey-Turners and Cullens, ab distension, visible peristalsis, assess hydration

Auscultation: listen for absent bowel sound, bruit

Percussion: shifting dullness, fluid thrill, organomegaly

Palpitation: start away from pain and move towards it, rebound tenderness, look for hernia in groin, examine scrotum, look at groin and supraclavicular lymph nodes

Extra: urine, pregnancy test, lower limb pulse, rectal or pelvic exam

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7
Q

How do you manage a patient with acute abdominal pain?

A
  • Admit if likely surgical cause or IV antibiotics needed
  • Nil by mouth if transfer
  • IV fluids if in shock and check blood group
  • Antibiotics if sepsis, UTI, peritonitis
  • Analgesia and antiemetic

Urgent surgical/gynaecological review

Arrange investigations e.g ECG

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8
Q

How should you help a child who has respiratory difficulty or is choking?

A

- Resp difficulty: High flow oxygen (15L/min) or bag valve mask if poort effort

- Choking: Encourage coughing, if not 5 back blows then 5 chest thrusts

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9
Q

What are some red flags with abdominal pain?

A
  • Hypotension
  • Confusion
  • Dehydration
  • Patient lying still or writhing
  • Rebound tenderness
  • Guarding
  • Rigid abdomen
  • Tenderness to percussion
  • History of haematemesis or melaena
  • Testicular pathology
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10
Q

What is the diagnosis and management for the following clinical findings in a child?

A
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11
Q

What is the traffic light system used for identifying a child’s risk of serious illness?

A
  • Any red features that are a life threatening cause of febrile illness (e.g sepsis) need emergency ambulance to A+E
  • Any red non-life threatening need face to face assessment within two hours
  • Any amber face to face assessment on clinical judgment
  • Any green can be managed at home with support e.g hydrate and ibuprofen, and safety net
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12
Q

What are some major causes of acute chest pain?

A
  • PE
  • Pneumothorax
  • Pericarditis
  • Cardiac Tamponade
  • Pneumonia
  • Pleural effusion
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13
Q

What symptoms would make you think a patient’s acute chest pain is due to ACS?

A
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14
Q

What management should a patient with pre-existing angina be given when undergoing an angina attack?

A
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15
Q

How can chest pain be classified?

A

- Cause: cardiac/non cardiac

- Type: localised/poorly localised and pleuritic or non-pleuritic

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16
Q

How should you investigate and manage a patient with acute chest pain?

A
  • Full CVS exam
  • ECG 12 lead
  • Cardiac enzymes/troponin
  • Call 999 if urgent admission needed
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17
Q

If a patient presents with chest pain and does not require an immediate admission, where should they be referred to?

A

REFER TO CHEST PAIN CLINIC

- Urgent same day assessment: if suspected ACS but pain-free with chest pain in the past 12 hours and a normal ECG or chest-pain in past 12-72 hours with no complications

- 2 Weeks: suspected ACS with pain in past 72 hours, suspected malignancy, suspected pleural effusion, suspected lobar/lung collapse

- Routinely if stable angina or unknown chest pain

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18
Q

What should you do if you suspect a patients pain is due to ACS?

A
  • Call 999

- Aspirin 300mg PO single loading dose chewed as antiplatelet

  • Give clopidogrel 300mg PO ​loading
  • Maintain sats >94% using oxygen if pulmonary oedema or hypoxia
  • Offer morphine and antiemetics to relieve ischaemic pain
19
Q

What signs associated with acute chest pain should encorage you to admit a patient to hospital urgently?

A
  • Resp rate >30
  • Tachycardia >130
  • BP <90 <60 unless normal
  • Temp >38.5
  • Sats <92% or central cyanosis
20
Q

Where do patients with suspected STEMIs go when they get to the hospital?

A

If had an ECG in the ambulance they go straight to the cardiology catheter lab

21
Q

Why are patients given aspirin when ACS is suspected?

A

Lowers risk of myocardial infarction and stroke

22
Q

How should you manage a patient in primary care that presents with a suspected PE?

A

- Immediate admission for anyone who is haemodynamically unstable or pregnant/given birth in past 6 weeks

  • If none of these then do the Well’s criteria. If >4 admit to hospital for CTPA, if <4 offer D-dimer test with result in 4 hours with interim anticoagulation if takes longer. If test positive send for CTPA
23
Q

What interim anticoagulation is given whilst awaiting results of a D-dimer test for a likely PE?

A
  • Take FBC, renal and hepatic function, PT and APTT before commencing but do not wait for results

- Apixiban or Rivaroxiban first line for at least 5 days

  • If not suitable use LMWH followed by dabigatran for 5 days OR LMWH with Vit K antagonist for 5 days
24
Q

What are some differential diagnoses for acute shortness of breath in primary care?

A
  • Silent MI
  • Cardiac arrhythmia
  • Acute pulmonary oedema/heart failure
  • COPD
  • Asthma
  • Pneumona
  • PE
  • Lung cancer
  • Pleural effusion
  • Anaemia
  • Diaphragmatic splinting
  • Psychogenic breathlessness
25
Q

What are some questions you would ask a patient presenting with an acute presentation of SOB?

A
  • B.P
  • Pulse
  • Resp rate
  • Sats
  • ECG
  • PEFR
  • Temperature
26
Q

What features would warrant an admission to hospital when a patient presents to primary care with SOB?

A
  • If sats less than 94% oxygen should be given and monitored while awaiting transfer to hospital, unless at risk of hypercapnia
  • Only admit chronic breathlessness, e.g COPD, if exacerbation
27
Q

What would define whether asthma is severe asthma and life threatening asthma?

A
28
Q

What is the management for acute asthma?

A

OSHIT

- O2 5l to maintain sats between 94-98%

- Salbutamol 5mg or Terbutaline 10mg nebulised with O2

- IV hydrocortisone 100mg or 40-50mg PO prednisolone

  • Add ipratropium bromide 0.5mg/6h to nebuliser is life threatening
  • Magnesium sulfate and theophylline added by specialists

If life threatening hospital admission, if improved 24 hour follow up

29
Q

How do you manage an acute exacerbaton of COPD?

A
30
Q

What is the difference between a TIA and stroke?

A

Suspect stroke if the neurological deficit (e.g numbness, weakenss, slurred speech, visual disturbance) is ongoing or over 24 hours

31
Q

How do you manage a suspected acute stroke in primary care?

A
  • Emergency admission to stroke unit
  • Give information to ambulance control and admitting hospital
  • Avoid antiplatelet treatment until haemorraghic stroke excluded
32
Q

How do you manage a suspected TIA?

A
  • Give aspirin 300mg unless contraindicated or taking aspirin regularly

- Arrange assessment by TIA clinc within 24 hours if TIA occured in last week, if more than a week ago refer to specialist within 7 cays

  • Arrange urgent admission if patient has had more than one TIA, if patient lacks reliable observer at home or if patient has bleeding disorder/taking anticoagulant
  • Advise patient not to drive until review by specialist
  • After TIA have follow up with GP to discuss lifestyle changes and drug therapies
33
Q

How does Bell’s palsy present and what are some complications?

A

Acute unilateral facial nerve weakness or paralysis of rapid onset (<72 hrs)

Presentation: rapid onset, difficulty chewing, dry mouth, numbness in cheek or mouth, drooling, hyperacusis, facial weakness so drooping

Complications: eye injury, facial pain, dry mouth, psychological sequele, abnormal facial muscle contractions, hyperacusis

34
Q

What differential diagnoses would you think of for unilateral facial weakness?

A
  • TIA
  • Stroke
  • Bell’s Palsy
35
Q

How would you distinguish between Bell’s Palsy and a stroke?

A
  • Bell’s often has longer acute onset with peak in hours or days but stroke is in minutes
  • Stroke often can wrinkle forehead as central lesion but cannot in Bell’s
  • Bell’s will have absence of other neurological symptoms
36
Q

How would you manage Bell’s palsy in primary care?

A
  • If presenting within 72 hours of onset prescribe prednisolone 50mg for 10 days
  • Possible antiviral treatment aciclovir as herpes and v.zoster could be involved
  • Keep eye lubricated with eye drops, sunglasses and tape eye shut at night. Consider referal to opthalmologist
  • Use straw
  • Refer to facial nerve specialist if no improvement after 3 weeks of treatment or incomplete recovery in 5 months
37
Q

When should you refer someone with Bell’s Palsy urgently to secondary care?

A

Should be no hearing loss with Bell’s

38
Q

How would you treat suspected anaphylaxis in primary care?

A

ABCDE assessment

  • Call ambulance
  • High flow oxygen >10L
  • Lay patient flat and raise legs (if pregnant left lateral tilt)
  • IM adrenaline into anterolateral aspect of middle third of thigh
  • Repeat IM after 5 minutes if no improvement
39
Q

How would you treat anaphylaxis once specialist help has arrived?

A

- Constantly monitor pulse, sats, bp and ECG

- Establish airway

- IV fluid challenge with 500ml 0.9% saline in 5-10 minutes if normotensive, 1000ml if hypotensive

  • Chlorphenamine

- Hydrocortisone

  • If still breathing difficulty give IV or inhaled bronchodilators etc
40
Q

What dosage of IM adrenaline do you need to give in anaphylaxis?

A

- Adult or child>12: 0.5mg (500ug) IM

- Child 6-12 years or small>12: 0.3mg (300ug) IM

- Child <6: 0.15mg (150ug)

41
Q

After emergency treatment for anaphylaxis what should the patient be offered?

A
  • Referral to specialist allergy service
  • Two autoinjectors and advice on how and when to use them
42
Q

What signs would make you suspect anaphylaxis?

A
  • Low b.p
  • High HR
  • High RR
  • High temperature
  • Using respiratory muscles
43
Q

What type of drug is chlorphenamine?

A

Antihistamine

Symptomatic relief of hay fever, urticaria, food allergy, drug reactions,
Relief of itch associated with chickenpox

(3) GP (21 decks)

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