Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Emergency Cases 101 CW: Overdose & Mental Health Case 1 A 67 Year Gentleman comes to you in A&E complaining of chest pain. Acute Coronary Syndrome Myocardial Infarction/Angina Pulmonary Embolism Dyspepsia Differential Anxiety Attack Diagnoses Costochondritis/MSK Pain Acute Lung Infection Pneumonia Chronic Lung Condition Asthma/COPD Aortic Dissection Boerhaave’s Syndrome Investigations What investigations can you do? TROPONIN ECG ANGIOGRAM Troponin is one of the main ECG should be done as soon as Angiograms is a much later investigations for an MI, but can possible as it can give an investigation, but can be useful take several hours at a minimum indication of MI to identify arteries occluded CHEST X-RAY SPUTUM CULTURE BLOOD WORKS Important to rule out certain If the patient had a productive FBC, U&Es, ESR, CRP conditions such as pneumothorax cough, it is worth taking a and chest infections (and possibly sputum culture (this does take aortic dissection) days to do) to identify organisms and their sensitivitiesWell’s Score Treatment If PE Likely => Admission & CTPA Consider interim anticoagulation (Apixaban, Rivaroxaban or LMWH) If PE Unikely =-dimer Provoked PE => 3month anticoagulation Unprovoked PE => 6month anticoagulationInitial Assessment C Confusion U Urea >7 R RR > 30 B BP ≤ 90/40 65 Over 65 Case 1 A 67 Year Gentleman comes to you in A&E complaining of chest pain. Upon further questioning, he tells you that he was doing some gardening, when suddenly he had a sharp central chest pain. Myocardial Angina Infarction Ischaemic Damage No Ischaemic Damage Angina does noschaemicdamage, and as such you Myocardial infarction is split into either El vatshouldn’t see any change in an ECG or troponin. Myocardial Infarc-nT-Elevated Myocardial Infarction Angina is split into stable and unstable angina depending on if it appears on exertion Complete occlusion of vessel Leads to transmuraischaemicinjury STEMI Troponin is raised Partial occlusion of vessel NSTEMI Leads to subendocardiaschaemicinjury Troponin is raised PaNo ischaemicinjury vessel Unstable Angina Occurs at rest Troponin normal Partial occlusion of vessel Stable Angina No ischaemicinjury Occurs at exertion only Troponin normal Typical Angina LOCATION PROVOCATION RELIEF Sub-sternal chest pain with Provoked by exertion or emotion Relieved with rest or nitroglycerine characteristic character and duration Management MONA BASH MONA BASH DISCHARGE? Morphine Beta-Blockers Oxygen ACE Inhibitor Nitroglycerin Statin Aspirin HeparinNICE ACS PATHWAYSTEMI MANAGEMENT Case 2 A 23-year-old woman is brought in by ambulance unconscious. Her boyfriend is with her and tells you that he found her lying on the floor of her bedroom, unable to be woken. She smells strongly of alcohol. When you call out her name, she does not wake. Investigations What investigations can you do? GLASGOW COMA SCORE DETAILED HX FROM ECG PARTNER Key to assessing whether the This is especially useful if the Perhaps to look for any current situation needs to be partner witnessed the fainting arrythmias which caused her escalated and if this person may episode or know of any prior ones faint need ventilation BLOOD TESTS FBC, U&Es, LFTs Case 2 A 23-year-old woman is brought in by ambulance unconscious. Her boyfriend is with her and tells you that he found her lying on the floor of her bedroom, unable to be woken. She smells strongly of alcohol. When you call out her name, she does not wake. You take a collateral history from the partner and let’s you know that she’s previously been having a low mood. She is currently seeing a therapist, but he does not think it’s been working. He thinks he saw several open packs of paracetamol on the bed.Case 2 Management ACTIVATED CHARCOAL N-ACETYLCYSTEINE LIVER TRANSPLANT If the patient This is the main Arterial pH < 7.3, 24 hours after presents within 1 treatment for ingestion or all of the following: hour of ingestion – paracetamol prothrombin time > 100 seconds they may benefit overdose creatinine > 300 µmol/l from charcoal grade III or IV encephalopathy Case 3 A 19-year-old lady presents to you with abdominal pain on the right side. Case 3 A 19-year-old lady presents to you with abdominal pain on the right side. She says that the pain is a sharp stabbing pain, and points towards the RLQ. She says that the pain seems like it goes towards the umbilical region. She was not doing anything particular at the time the pain came on, and the pain suddenly. Investigations What investigations can you do? PREGNANCY TEST URINE DIP ULTRASOUND Essential test for any female Can check for any indications of Can be used to confirm diagnosis between ages 13 – 50. Should be UTI of appendicitis and ovarian considered regardless of whether torsion pt thinks they could be pregnant or not CHEST X-RAY BLOODS Can see if there is any free air FBC, U&Es, CRP under the diaphragm – best to look on right side rather than left Ectopic Pregnancy Acute Appendicitis Ovarian Torsion Differential Inflammatory Bowel Disease Diagnoses Irritable Bowel Syndrome Obstruction UTI/Pyelonephritis Kidney Stones Case 4 A 12-year-old boy is brought in by ambulance, after his mother rangis already on oxygen but is still struggling to breathe. he Acute Exacerbation of Asthma Chest Infection Anaphylaxis Differential Anxiety Attack Diagnoses Pneumothorax Case 4 A 12-year-old boy is brought in by ambulance, after his mother rang 999 as he had trouble breathing. When you speak to him, he is already on oxygen but is still struggling to breathe. Mum says that they were at a friend’s birthday party, when the patient came to her and complained of shortness of breath. The patient has a previous history of asthma and has already had more than 10 puffs of his blue inhaler. This helped somewhat but still had the same shortness of breath. Treatment IM Adrenaline 500mcg / 0.5ml (1:1,000) Serum tryptase can banaphylaxisdentify if the person did have Cardiac Arrest 1 mg / 10 ml (1:10,000) Treatment Oxygen SABA Corticosteroids Ipratropium Bromide Magnesium Sulphate Primary Secondary Rim <2cm & Pt >50 yrs old NO SOB Rim >2cm Rim <1cm and/or SOB Discharge Aspiration Chest Drain Aspiration Admission & Oxygen Chest Drain Chest Drain