Care Pathway

Question 1

Gastric irritants (drugs)

Answer 1

Non-steroidal anti-inflammatories (NSAIDs), steroids, bisphosphonates.

Question 2

Headache (causes)

Answer 2

Primary: occur spontaneously or the patient has Hx e.g. migraine, cluster, tension etc.

Secondary: are pathological or caused by injury e.g. head trauma, infection, haemorrhage etc.

Question 3

Procoagulant medication

Answer 3

Oral contraceptive pill, hormone replacement therapy (HRT).

Question 4

ALS Drugs

Answer 4

Adrenaline 1mg/10ml

Non-shockable rhythms: ASAP after access is achieved.

Shockable rhythms: After 3rd shock and then after every other loop.

Amiodarone Hydrocloride 300mg/10ml

Shockable rhythms: If unresponsive, administer after 3rd shock. Further bolus after 5th shock if unresponsive VF or pVT.

Question 5

Gastrointestinal (Alimentary) symptoms

Answer 5

Symptoms: Abdominal pain, dysphagia, heartburn, vomiting, haematemesis, diarrhoea, constipation, rectal bleeding.

Question 6

MJ THREADS Ca (Past Medical History)

Answer 6

• *M**yocardial infarction (MI)
• *J**aundice
• *T**uberculosis
• *H**ypertension
• *R**heumatic fever
• *E**pilepsy
• *A**sthma
• *D**iabetes
• *S**troke
• *C**ancer (and treatment if so)

Question 7

Psychiatric symptoms

Answer 7

Depression, anxiety, psychosis, suicidal thoughts.

Question 8

Gastrointestinal haemorrhage (red flags)

DDx

S/S

Answer 8

DDx: ? Gastroenteritis, ?GI haemorrhage, ?duodenal ulcer, ?malignancy ?toxins/drugs.

S/S: Pain, hyporvolemia, infection, pyrexia.

ABCDE compromise.

Question 9

Genito-urinary (GUM) symptoms

Answer 9

Dysuria, discharge, lower urinary tract symptoms.

Question 10

Haemoptysis

DDx

S/S

Answer 10

DDx: ?chronic bronchitis, ?tuberculosis (TB), ?malignancy, ?pneumonia, ?bronchiectasis.

S/S: Cough, pyrexia, Hx.

?pseudohaemoptysis (not blood, not from the lungs etc).

ABCDE compromise.

Question 11

Headache (key points)

Answer 11

Headaches with different or unusual characteristics are significant (not normal for the patient)

Do not exclude based on normal neuro exam (Hx is key)

Migraines increased risk of intracranial events

Check BP (and Temp)

Question 12

Cardiovascular symptoms

Answer 12

Chest pain, palpitations, peripheral oedema, paroxysmal nocturnal dyspnoea (PND), orthopnoea.

Question 13

Risk factors for pneumothorax

Answer 13

Tall, thin men in particular
Known connection tissue disease (e.g. Marfans)
Smoking history

Question 14

Limb pain and/or swelling (red flags)

DDx

S/S

Answer 14

DDx: ?Trauma, ?anaphylaxis, ?cardio.

S/S: SOB, laryngeal oedema, pyrexia.

ABCDE compromise.

Question 15

Abdominal, loin, scrotal, pain (red flags)

DDx

S/S

Answer 15

DDx: ?Testicular torsion, ?pyelonephritis, ?renal colic, ?appendicitis.

S/S: Oedema, infection, temp, severity.

ABCDE compromise.

Question 16

Neurological symptoms

Answer 16

Numbness, weakness, tingling, blackouts, visual change (GCS or behaviour change reported by 3rd party).

Question 17

Vomiting (red flags)

DDx

S/S

Answer 17

DDx: ?Head injury, ?cardio, ?anaphalaxis ?sepsis, ?ICP, ?toxins/drugs.

S/S: Haematemesis, rash, oedema, temp.

Any ABCDE compromise.

Question 18

SOCRATES

Answer 18

• *S**ite
• *O**nset (time of onset. sudden/gradual, etc)
• *C**haracter of pain
• *R**adiation of the pain
• *A**ssociations signs and symptoms associated with the pain
• *T**ime course (Does the pain follow any pattern)
• *E**xacerbating/Relieving factors
• *S**everity (e.g. 1-10, paeds = Wong-Baker faces)

Question 19

SAMPLE (Presenting Complaint)

Answer 19

Signs and Symptoms (S/S) of the presenting complaint

Allergies (particularly to medication, food allergies might be relevant)

Medications (DH)

Past medical history (PMH)

Last oral intake

Events that led to current illness or injury

Question 20

Neck and back pain ‘non-trauma’ (red flags)

DDx

S/S

Answer 20

DDx: ?Meningococcal meningitis, ?septicaemia, ?MSK

S/S: Photophobia, infection, pyrexia.

ABCDE compromise.

Question 21

Respiratory symptoms

Answer 21

Cough, shortness of breath (and exercise intolerance), haemoptysis, sputum production, wheeze.

Question 22

Headache (red flags)

DDx

S/S

Answer 22

DDx: Head trauma (<3 months), ?sepsis, ?meningitis, ?narrow angle glaucoma.

S/S: Reduced GCS (<15 without Hx), >temp, rash, stiff neck/photophobia, nausea/vomiting, visual disturbance, red-eye, neurological/cognitive/personality change, neuralgia or palsy.

Triggered by exercise, cough, posture or Valsalva.

Sudden-onset, thunderclap or vertex headache.

ABCDE compromise.

Question 23

ATMIST

(trauma survey)

Answer 23

Age

Time of incident

Mechanism of injury

Injuries

Signs and symptoms

Treatment given / immediate needs

Question 24

Risk factors for cardiovascular disease

Answer 24

Hypertension

Hypercholesterolemia

Diabetes

Smoking

Family history (heart attack under 60 years old, familial hypercholesterolemia)

Question 25

Social history (SAL)

Answer 25

* *S**moking history (packs/years) * *A**lcohol intake (units per week) * *L**ifestyle/exercise

Question 26

4 Hs & 4 Ts (reversible causes of cardiac arrest)

Answer 26

**H**ypoxia **H**ypovolemia **H**ypo/**H**yperkalemia (metabolic) **H**ypothermia **T**hrombosis (cardiac or pulmonary) **T**ension pneumothorax **T**amponade (cardiac) **T**oxins

Question 27

Confused state (red flags) DDx S/S

Answer 27

DDx: ?Diabetes, ?neurological aetiology, ?toxins/drugs, ?DKA/AKA. S/S: Infection, pyrexia, pain. ABCDE compromise.

Question 28

CRANE MU

Answer 28

**C**ardio **R**espiratory **A**limentary (GI) **N**eurological **E**ndocrine **M**usculoskeletal (**MSK**) **U**rinary (**GUM**) (**S/S, injuries, surgery, PMH/DH?**)

Question 29

FLAPS TWELVE (chest trauma)

Answer 29

**F**eel **L**ook **A**uscultate **P**ercuss **S**earch sides and back **T**racheal deviation **W**ounds, bruising or swelling **E**mphysema (surgical) **L**aryngeal crepitus **V**enous engorgement **E**xclude open/tension pneumothorax, flail chest or massive haemothorax.

Question 30

Visual disturbance/red eye (red flags) DDx S/S

Answer 30

DDx: ?Narrow angle glaucoma, ?neurological aetiology, ?foreign object. S/S: Non-reactive pupil, pressure/pain over the eye, nausea/vomiting. ABCDE compromise.

Question 31

Risk factors for DVT/PE

Answer 31

Recent surgery (under three months), malignancy, immobility Relevant medications (e.g. oral contraceptive pill/HRT) Inherited coagulopathy (e.g. protein C or S deficiency)

Question 32

Cardiac medications

Answer 32

Alpha/Beta/Calcium-blockers, diuretics, antiplatelet agents (warfarin, clopidogrel ect), GTN spray.

Question 33

METHANE (Major Incident)

Answer 33

* *M**ajor Incident Declared * *E**xact location * *T**ype of incident * *H**azards * *A**ccess * *N**umber and type of casualties * *E**mergency services present and required

Question 34

Cushing's Triad

Answer 34

\>SBP * * *

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