Computer generated transcript

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

I think it's over 5040 or 50 is a red flag just because it's very unusual to have, um, specifically point tenderness in the thoracic region that's not caused by a malignancy unless there's, unless there's been a clear trauma. And at the end, yeah. And like I said, so the second question in every back pain history should be, is this called equina? So I'd always ask these three questions, which form the triad. So, is there any bilateral level in urology? Are their bladder and bowels affected? And have they lost sensation in the perianal area? The way I sort of always ask that question is sorry, this might sound like a bit of a strange question. But when you go to the toilet and you wipe, have you noticed that the area down there is numb and then you get a straight up answer of yes and no. And it's pretty clear to the patient as well. Just a, just a point with the bilateral lower limb sign. So, in reality, you will see a lot of patients who come in with back pain, you're querying called equina in your head because you want to rule it out. But the patient might also have a background of sciatica, for example, um the key thing to know is that it, it's quite important to differentiate between the two. So sciatica is essentially nerve root compression because of, for example, a prolapsed disc or, or whatever. Um But that same prolapse disc is also one of the most common causes of called aqui. So, differentiating between the two is essentially done by thinking is the lower limb neurology that you're seeing unilateral or bilateral. So, if someone has symptoms of sciatica, bilaterally in the emergency setting, that's never bilateral sciatica. You should always be querying called equina just because you can, it's, it's very rare for you to have a prolapsed disc, compressing both nerve roots on the left and right side simultaneously. What's more likely is that lower down a disc has prolapsed onto the actual cor equina um centrally in the spine and that's what's causing the bilateral sciatica. So that's just, that's just the point to remember. So we've had a chat about differential diagnosis already. But do, do people wanna put in the chat? What they'd, what sort of differentials would, would bring to mind in this, in this patient? You know, in addition to, to what we've already diagnosed with the abscess, some of them have already been mentioned to be fair. Any ideas too. Yeah, exactly. So spinal, spinal stenosis, both very good suggestions. Things we were wanting to rule out, we'll just move on to what we have on the list. So, um I think similar to the headache, I think it's, it's the same sort of themes coming back up here. So, things to think about is infection and malignancy. So under the infection bracket, you have a simple infection of the spinal discs or a collection, which is the abscess. And both of these are more likely in someone who uses intravenous drugs. Um just through sort of hematogenous spread from the skin, um causing staph aureus infection. Um depending on where you are, I think, you know, depending on the location if you're in, for example, somewhere like London or Liverpool where actually the instance of TB is higher things like spinal TB should be thought of. Um like we said, met the liver fracture and one of the most common causes of cordo is still just a simple prolapse of the disc. So, you know, some that's something like I said, that can cause just simple sciatica or it can cause Cordona. Um And just from a practical point of view in when you are in A&E when you see someone with back pain, just think slightly sort of to the left, to the right and front as well because back pain can be a very vague presentation of abdominal pathology, especially if someone's elderly and they have vascular risk factors, always just think about AAA. And could this be a sort of a very sort of vague presentation of abdominal aortic pathology from the front. But in this patient, it wasn't very likely because you had localized tenderness along the spine and you had a fever. So it didn't really point towards that uh in this patient specifically. Cool. So we've been through, we've been through sort of how to do this earlier on. Um So we'll move on to the third case. OK. Great. Um So this is the last place that we've got. Um, I'm just a bit conscious of time. I know we did, um, advertise that this event would finish at 830. So, um, if anyone does need to head off, what I'll do is just quickly pop the feedback form in the chat. Um And you can fill that out before you go and then you'll just get your certificate of attendance automatically emailed through after you've done that. Um But, um, if not, if you're free to stay for a bit, I'll try and get through this one as quickly as possible, um, to not take up too much of your Sunday evening. Um So this last case, um, it will be an A to E type station. Um So a bit different from what we've been doing previously. Um And in this case, you are in Ed and you are reviewing Tony, he's a 46 year old man and he has been brought in by ambulance with severe abdominal pain. Um So what you need to do is take a focus history. So when focused, I mean, we literally just want you to just try and get to the bottom a little bit about what sort of symptoms are going on. Don't bother about anything to do with his past medical history or that type of thing. And you wanna do that for three minutes. Um Then I want you to talk through your eight week examination. Um and as you're going through each stage of the 83 examination, we'll give you the relevant findings and things. Um, and then you can just do a short presentation at the end as well. Um So does anyone want to volunteer for this case? Yeah, great. Uh Is that manage? Sorry, II didn't know that was um how do you, how do you pronounce your name? Um, Mindy is fine, Mindy. Ok. Sure. Nice to meet you. Um ok, so um if you wanna start by harsher is gonna be to me for us. Um, so if you wanna start by taking your history. Yeah. Hi Tony, I'm the doctors here today. Um, can I just confirm your full name and date of birth? Yeah. Um, my name is Tony. I'm, I'm 46 years old. Ok, Tony, I understand that you've been having some abdominal pain, is that right? Yeah, I've just had some, yeah, it's been so bad. Honestly, it just started, it started a couple of hours ago. It's, it's just not great. Oh, I'm sorry to hear that. Have you had, have you taken any pain relief? Um, I mean, I've, I've tried some paracetamol but it, it's not really helped. Ok. Well, we'll see what we can do for you and if there's anything we can give straight away. Um, can you tell me a bit more about the pain? Um, like I said, it's been getting worse over the last few hours slightly at the top of my tummy. Is it on one side or both? No, it's sort of, it's sort of like right in the middle of the top. Ok. Have you had any vomiting? Um, I've, I've, yeah, I vomited a couple of times to be fair. Yeah. Was there any blood in the vomit? Uh, no, there's no blood. Ok. And when's the last time you went to the toilet? Um, y yesterday, I think, yeah, early yesterday or late, uh, like yesterday evening, I think. Ok. Um, do you have any chest pain? Uh, no, any yellowing of your skin? Uh, no, not that I've noticed any problems with your waterworks. No, not that I've noticed, um, any other problems elsewhere. Um, not really. It's just, it's just, well, I've been feeling a little bit dizzy to be fair, been feeling a little bit lightheaded since all this happened. Um, but I don't know if that was just to the throwing up or? Ok. Have you noticed any blood in your stools or in your urine? Uh, No. OK. All right. I'll move on to my A three now then. So I'm happy that the airway is patent because he's speaking to me in terms of breathing. I want respirate and oxygen saturations. Uh Yeah, great. So, um your respirate is 24 And your oxygen saturation is 95%. OK. So I'm happy with the O2 stats at the moment, but I'll key box nearby. Um And then is the tricky central. Yeah, chest expansion uh equal bilaterally. And how does, how do the lungs sound? Uh chest sounds clear. Ok. Um Fine. I'll do cap refill now. Yeah. Um So your cat refill is slightly prolonged. It's three seconds peripherally. Um temperature per freeze.