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ISCE BOOST Acute Station and SBAR Devon WardWhat’s your biggest concern or question about the acute station and SBAR station?Our Series and Rough Timeline W/B 20 Nov – Introduction and CBDs W/B 27 Nov – SBAR and Important Conditions th W/B 4 Dec – Pharmacology (how to explain and which ones?) W/B 11 Dec – Paeds W/B 18 Dec – O+G ------- W/B 1 Jan – Data interpretation (ABGs, FBC, LFTs, TFTs) th W/B 26 Feb – Neuro W/B 11 Mar – Psych W/B 25 Mar – Imaging (CXR, CT head, MSK) th W/B 8 Apr – Common and Important PresentationsCBD Review We heard you last time! CBDs are difficult to know if you’ve picked the right topic and if you’ve got the right content Email us and we can review your topic and/or CBD document! Email: wardde1@cardiff.ac.ukOverview Today, we will look at: • Overview of the Acute Station and SBAR – including key information and conditions • SBAR – how to use it (and how to use it well!) • Example stations Any questions put them in the chat and we’ll get to them as we can!ACUTE STATIONAcute and SBAR Station Acute 4 min data 4 min history 2 min summary 4 min skill interpretation + station and DDx Qs x2 SBAR 4 min data station 4 min history 1 min write up 4 min SBAR interpretation + Qs x14-minute history This is not a lot of time! Remember the safety alerts: rude, allergies, psychiatric RFx! Often acute and The histories will be Don’t forget to Try and make them simple limited introduce yourself feel like you have presentations lots of time Ask about harming FHx and systems Always thank the Ask allergies early review are least patient for their self or others early important timeMark schemeMark scheme Signpost the patient to demonstrate your structure Ask patient for their thoughts Answer their questionsMark scheme Be familiar with the skills – start now!Mark scheme Have a structure for data interpretation Aim for at least 2 differentials and justify Be honest if unsure!Mark scheme Have an Ix structure but don’t say everything! Consider long-term and holistic implicationsMark scheme Introductions Don’t engage others unless consent from PtConditions to consider Like earlier, these are simple and often acute histories Look at your own revision lists – how long would it feasibly take to get to this diagnosis? They are likely to have many easy to spot, red flag features for conditions eg“chest pain radiating to left arm”or“unable to breathe with wheeze” Unlike PassMed, they’re not trying to catch you out! If it sounds like barndoor MI, it probably is (in these stations, anyway!) Not an exhaustive list! Conditions to consider But short histories! * Paracetamol, Opiate, Aspirin, Alcohol Cardiovascular Gastrointestinal Respiratory Surgery • MI • Acute asthma • UGIB • AAA rupture • Pericarditis • PE • Pancreatitis • Testicular torsion • Aortic dissection • Appendicitis Endocrinology Neurology Psychiatry • Diabetes, DKA • Migraine Ophthalmology • Depression • Addisonian crisis • Meningitis • Glaucoma • Mania • Stroke Acute Musculoskeletal Obs and Gynae Paediatrics • Sepsis • Gout • Ectopic pregnancy • Asthma • Anaphlyaxis • Septic arthritis • STI • Otitis media • Overdose*SBARSBAR Communication skill for handing over a patient Really useful in practice Can practice when presenting SLEs like CBDs and mini-CEXs (super useful to your superiors if you can too!)SBAR Structure Situation Background Assessment Recommendations • Your main DDx • What you want • Who they are • Presenting • Anything done so them to do • Who you are symptoms • Who you’re calling • PMHx far • What you need to about • Investigation do • Main concern results • NEWSSBAR Example Situation Background Assessment Recommendations Hi, are you the ___? They came in ___ My name is ___ and I’m concerned this I’m the ___. with symptoms of I have a patient I ___. patient has ___. I would like you to would like some There is a PMHx of I’m not sure what the come and review this advice on, do you ___. diagnosis is, but I’m patient as soon as They did not have worried/they are possible. have time to listen? ___. deteriorating. Is there anything I can I’ll use an SBAR Their NEWS is ___ ___ has been given so do in the meantime? approach. far. I’m concerned due to ___. because ___. Their Ix are ___.SBAR Example Hi, are you the med reg? My name is Devon and I’m the FY1.I have a patient I would like some advice on, do you have time to listen? I’ll use an SBAR approach. I’m concerned because they’re 82 and have worsening chest pain and hypotension. In terms of their Background, they came in 1 hour ago with symptoms of chest pain, sweating and nausea.There is a PMHx of HTN and PVD.They did not have dizziness, LOC or resolution of their Sx with analgesia. Their NEWS is 2 due to BP of 80/60. No other Ix available. My Assessment is that this patient has an MI. Nothing has been given so far. I would like you to come and review this patient as soon as possible. Is there anything I can do in the meantime?SBAR Example Questions What do you think is If you’ve followed the If you’ve said you don’t structure, you will have know, they may still It’s okay to be wrong! the most likely Be honest! diagnosis? said this already ask Pick one or two What investigations Consider your most investigations that can Justify your answer do you want to do? likely diagnosis be done quickly Can it wait? Do I The majority of the have to see them time, it can’t wait Tell them that! Justify your answer now?SBAR Example Answers What do you think is I think the most likely diagnosis is an MI, I’m not sure what the most likely given the chest pain and arm radiation, diagnosis is, but I’m worried that they the most likely are deteriorating. diagnosis? although it could also be pericarditis. Immediately, it would be the most useful to get an ECG.I can also send off some What investigations troponin and other bloods whilst I wait for you to come down. Is there anything else do you want to do? you’d like me to do? Can it wait? Do I Unfortunately, this patient is rapidly Whilst this patient is stable for now, I’m deteriorating and I don’t think it can quite concerned about them so I would have to see them wait.Is there anything I can do whilst like you to come down as soon as now? you’re on the way? possible.EXAMPLE CASESCase 1 24-year old Ms Rodriguez attends GP with sudden-onset head pain. You are a medical student running a minor illness clinic.Case 1 – History 24yo F Severe headache started yesterday R sided started at back of head, radiates forwards Sensitive to light No neck stiffness No neuro symptoms Hx tension headaches, but different Takes ibuprofen occasionally for tension headachesCase 1 - DDx 24-year old Ms Rodriguez attends GP with sudden-onset head pain. What are your most likely diagnoses? What skills might they ask you to complete?Case 1 - NEWSCase 1 - SBAR Situation Background Assessment RecommendationsCase 1 - SBAR Situation Background Assessment Recommendations Unilateral throbbing Review To GP headache Started yesterday May need 24yo w/ ?Migraine Photophobia, nausea ?Migraine sumatriptan or other No neck stiffness or analgesia rash NEWS 0Case 2 - Questions What do you think is Migraine due to unilateral throbbing headache the most likely May need to rule out SAH but unlikely diagnosis? What investigations No immediate investigations are needed – clinical diagnosis do you want to do? Blood sugar and imaging may be useful down the line Can it wait? Do I Patient is stable for now, it can wait have to see them She will need review for appropriate analgesia now?Case 2 56 year old Mr Vinder attends A&E with haemoptysis and chest pain. You are an FY1 who reviews him.Case 2 – History 56yo M Sudden onset chest pain started yesterday Sharp pain on L hand side Started at rest, hasn’t stopped Worse on inspiration Never had anything like this before Productive of clear sputum with streaks of blood – about a cup in past 24 hours No PMHx or DHx Returned from holiday two days ago and is concerned as having to take time off workCase 2 - DDx 56 year old Mr Vinder attends A&E with haemoptysis and chest pain. What are your most likely diagnoses? What skills might they ask you to complete?Case 2 - NEWSCase 2 - SBAR Situation Background Assessment RecommendationsCase 2 - SBAR Situation Background Assessment Recommendations L sharp pleuritic chest pain Haemoptysis Need med reg Just had long haul Please r/v 56yo M concerned as flight PE Anything I can do? ?PE No PMHx or other symptoms Not smoker NEWS 3 due to O2 and tachy at 110bpmCase 2 - Questions What do you think is the most likely PE due to inspiratory chest pain and haemoptysis diagnosis? Like to rule out an MI What investigations ECG D-dimer do you want to do? ABG Can it wait? Do I Whilst this patient is stable for now, I’m quite concerned about them so I would like you have to see them to come down as soon as possible. now?Case 3 35-year-old Mr Thompson is brought into the emergency department unconscious. You are the FY2.Take a collateral history from his partner.Case 3 – History 35yo M presenting with loss of consciousness, abdo pain and confusion Been increasingly tired over past 3-4 days Worsening generalised abdominal pain Not eating due to pain Drinking more water than normal PMHx T1DM DHx insulin Been off insulin past few days because of the pain (not eating) Never had anything like this before Unsure of BM and urineCase 3 - DDx 35-year-old Mr Thompson is brought into the emergency department unconscious. What are your most likely diagnoses? What skills might they ask you to complete?Case 3 - NEWSCase 3 - SBAR Situation Background Assessment RecommendationsCase 3 - SBAR Situation Background Assessment Recommendations Fatigue, abdo pain To med reg and increased thirst past 3 days Urgent review as 35yo M presenting Now confused ?DKA unstable with confusion, PMHx T1DM on concerned about DKA insulin NEWS 5Case 3 - Questions What do you think is DKA due to being off insulin, increased thirst and abdo pain the most likely Could be hypoglycaemic episode diagnosis? What investigations Blood sugar and ketones immediately do you want to do? Send off other bloods Can it wait? Do I Patient is very unwell and I am worried. Needs urgent review and management.Is there have to see them anything I can do in the meantime? now?QUESTIONS