Acute Emergencies + Pre-hospital Care Flashcards
(42 cards)
Explain the A in ABCDE
Airway:
Can they talk?
Obstruction-> vital organ damage and death. Signs include;
See-saw respirations, use of accessory muscles.
Central cyanosis
Complete- No breath sounds
Partial- Noisy and diminished air entry
Treat: Airway opening maneoverues, intubation, airway adjunct
Target: 94-98% or 88-92% if hypercapnia risk
Explain the B in ABCDE
Signs: Sweating, Central cyanosis, use of accessory muscles
Assess resp rythm, symmetry and rate (12-20 is normal)
Sats, breath sounds, percussion, auscultation
If needed provide O2 ventilation
Explain the C in ABCDE
Circulation:
Initial suspect should be Hypovolaemia
Look for: Pallor, Cyanosis, Distended neck veins
Feel for: Limb temp, pulse rate and rythm
Assess capillary refill time and BP
Give fluids if needed
Explain the D in ABCDE
Disability:
Assess consciousness AVPU and GCS
Look for pupil size and reaction to light
Fingerpick glucose (If under 4 mM give glucose)
Explain the E in ABCDE
Exposure:
Respect dignity and keep patient warm
Look for rash/ injuries
Assess surroundings
What is the Acute Abdomen? (Consider T Torsion and Ectopic)
“Rapid onset of severe symptoms that can indicate life threatening pathology”
USUALLY painful, but more likely to be pain-free in children & elderly
Pain may radiate, referred or migrate.
Outline the initial assessment of Acute Abdomen
- Do they look ill/ septic/ shocked?
- Lying still or moving around in pain?
- Asses and manage ABC
What do you ask in the history of Acute Abdomen
Pain features, Associated symptoms, PMx + Dx, Obs&Gyn history
Outline the Examination of an Acute Abdomen
- Look at patient, Vitals, Resp rate & pattern (Peritonitis-> shallow, rapid), AVPU/ GCS
- Inspection: Look for Jaundice, Anaemia, Abdominal distension, Visible peristalsis, Bruising around Umbilicus or Flanks (Cullen’s or Grey Turner’s), Signs of dehydration (dry mucous membranes, skin turgor)
- Auscultation: All quadrants, blood vessel sounds, bowel sounds
- Percussion: All quadrants, Liver & Spleen, Shifting dullness
- Palpation: All quadrants, Rebound tenderness, Liver & Spleen, Lymph nodes
How do you treat Acute Abdomen if there are signs of shock/ being acutely unwell?
Compare in hospital and in primary care
Primary: Transfer to hospital for further assesment and treatment
In Hospital: Investigations, Keep Nil-By-Mouth and treat symptoms (Fluids, O2, NG Tube, Antibiotics if needed
What investigations can be done for Acute Abdomen
Laparoscopy can be used in Diagnosis and Management
Investigations: USS, Urine dipstick, FBC (and perhaps blood cultures), LFTs, U&Es, Radiology
Outline the us of Analgesia and Anti-emetics in treating Acute Abdomen
- Previously, no pain relief was given until surgical review. One study and a Cochrane review showed that Morphine provides safe analgesia without compromising diagnostic accuracy
- Avoid using this to treat symptoms without considering a diagnosis
Outline the history taking of Chest Pain
Consider psychological cause- Anxiety, Depression
- If not in pain now, when was last episode (last 12 hours)?
- Nature, onset, duration, site, radiation. Exacerbating and relieving factors.
- Associated symptoms (Sweat, Pallor, N+V, SoB, Fatigue, Palpitations)
- PMx (Conditions, Scans, ECGs) and PDx
Cardia Ischaemia: Restrosternal/ Epigastric, Tight+crushing, Radiate-> Arm, Neck, Jaw, Shoulder
Outline Examination of Chest Pain
Many patients will be fully normal
- Full CVS, Auscultate for murmurs, Chest wall examination (tenderness, pain on movement)
- Abdomen (tender), Neck (tender and stiff), Legs (tender or swollen), Temp (infection
List Investigation for Chest Pain
If in Primary, don’t delay management to arrange for investigations
- ECG, Troponin testing, CXR
- FBC, Blood glucose, Lipid profiles (To asses CVD risk)
- Thyroid function tests, LFTs
- CTPA if PE is suspected
What criteria are needed to admit to hospital if presenting with chest pain?
• RR>30, HR>130, Systolic< 90, Diastolic< 60, O2< 92% or Central Cyanosis, Altered consciousness, High temp (especially> 38.5).
Suspected ACS with;
• Current chest pain, Signs of complications, Chest pain in last 12 hours + ECG abnormal or N/A
Outline Chest Pain referral if admission not required
- Urgent same-day Assesment: Suspected ACS + Pain-free, with chest pain in last 12 hours + Normal ECG + No complications (Alternatively, pain in last 12-72 hours + no complications)
- Within 2 weeks: Suspected ACS + Pain-free, with pain more than 72 hours ago + no complications
- Routinely: Suspected SA, non-specific chest pain, persistent symptoms despite management
Outline chest pain management in Primary care
- Arrange for hospital admission-> Sit patient up, Give O2 if needed
- If Suspected ACS: Aspirin, GTN/ Opioid (Fentanyl).
- If Suspected Acute Pulmonary Oedema: Diuretic, Opioid, Anti-emetic, Nitrate
- If Suspected Tension Pneumothorax: Large bore cannula in 2nd ICS at the Mid-Clavicular line
- Monitor Symptoms, Pulse/ BP/ Heart Rythm, SpO2, ECG, Pain relief
Why can chest pain come with cough?
Other than pulmonary cause
Small Intercostal Muscles get sore-> Bone pain
Normal RR ranges for ages;
<1:
1-2:
2-5:
5-12:
> 12:
<1: 30-40
1-2: 25-35
2-5: 25-30
5-12: 15-25
> 12: 12-20
Outline the 3 steps in the structured approach of assessing an acutely unwell child
- Primary ABCDE assessment and resuscitation
- Secondary assessment and emergency treatment
- Stabilisation and transfer
Outline Primary ABCDE assessment and resuscitation of an acutely unwell child
(Normal ABCDE)
Breathing;
- Effort: Resp rate, Grunting, Nostril flaring, Accessory muscle use
- Efficacy: Chest expansion, SpO2, Auscultation for air/ breathing sounds
- Effect: Hypoxia-> Tachycardia-> Bradycardia, Cyanosis, Agitation/ drowsiness
Provide high flow O2 (15L/min
Outline Secondary assessment and emergency treatment of an acutely unwell child
Reassess ABCDE, History, Examinations, Investigations
- Ask about Fever onset, duration, pattern and method of measurement.
- Associated symptoms? Perinatal complications? PMx and PDx, Recent travel? Vaccinations?
Use NICE ‘traffic light system” to assesses risk of serious illness;
- Life-threatening Red features: Arrange emergency ambulance to A&E
- Non-life threatening Red features: Arrange urgent F2F assessment within 2 hours
- Amber features: Arrange F2F assessment
- Green features: Child can be managed at home
Outline Stabilisation and Transfer of an acutely unwell child
Monitor SpO2, HR&R, BP, Urine output, Core temp
