Where should a life-threatening emergency be directed to?
999
Where should a traumatic but non-life threatening emergency be directed to?
A+E
In how many hours should a patient be seen by a physician in A+E?
Dependent on urgency (standard, urgent or very urgent) but within 4 hours
State 5 factors which contribute to a decision of hospital admission in A+E.
- Age
- Social
- Comorbidities
- Access to hospital
- Resources: available beds and time
- Condition requiring admission – severity/urgency
- FU care
- Time of presentation
What should be done to allow a safe discharge from the emergency department?
- Inform and educate patient: event, process (Hx, CEX, Ix, Ddx, Tx)
- Post-ED discharge care (management plan – medications, wound care, suture removal, use of crutches)
- Safety net (Red flags and who to contact)
- Liaise with other care providers (referral; communicate with GPs; community care)
State a handover framework
- SBAR
- AT MIST
- METHANE
Outline an SBAR
Situation
Background
Assessment
Recommendation
Outline an ATMIST
Age Time Mechanism of injury Injuries Signs Treatment
What is the primary survey?
A systematic method of managing life-threatening conditions. The principles are conducted in order of urgency. Any intervention or change in status requires reassessment starting from A.
State the primary survey.
Danger – environment, people, surroundings Response – of patient Airway Breathing Circulation Disability Exposure
What is the relevance of the c-spine in the primary survey?
First 7 vertebrae of vertebral column. Increased risk of injury during high mobility flexion, extension and rotation.
How may you assess the c-spine?
NEXUS Criteria
Mechanism of Injury
Outline the NEXUS criteria.
- Neuro deficit
- Spinal midline tenderness in C-spine
- Alertness
- Intoxication
- Distracting injury
How may you manage a C-spine?
MILS
Collar
Block
Tape
Triple immobilisation: hard collar + head block + tape
How may you assess the airway?
- Talk to patient
- Look for chest and abdominal wall movements
- Listen for breathing and abnormal sounds
- Feel for expired air and chest movements
State 3 potential signs of airway obstruction.
- Absent breath sounds (complete obstruction)
- Stridor
- Crowing
- Gurgling
- Snoring
- Paradoxical chest movements
- Use of accessory muscles
- Reduced consciousness
How may you manage the airway
- Positioning – ensure you or the patient is in a comfortable position. You may be in that position for a substantial period of time.
- Consider C-spine: hands splayed alongside patient’s head
- Consider need to suction airway – clears debris from the airway
- Manoeuvre the airway: head-tilt (C-spine unsuspected) or jaw-thrust (C-spine suspected)
- Airway ladder
Outline the airway ladder.
Position (head-tilt chin lift/ jaw thrust) - OPA/NPA - SGA - ETT - Surgical airway
How may you clear an airway that is obstructed with blood or vomit or sputum?
Position (recovery)
Suction
Magill’s forceps
State the indication for suction.
- Audible secretion
- Noisy crackles of secretions
- Ineffective cough and physical deterioration
State the contraindications for an oropharyngeal or nasopharyngeal airway.
- Mandible fracture
- Oral trauma
- Trismus
How would you insert a Guedel (OPA) Airway in an adult?
Measure from front teeth to angle of mandible
Insert pointing up and rotate 180º
How do you insert a Guedel (OPA) Airway in an adult?
Measure from front teeth to angle of mandible
Insert facing downwards
How do you size up a NPA?
Done according to height
M = 7
F = 6
Child = 5
