Computer generated transcript

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

Hi. Um, we'll just give it maybe two more minutes and then I think we'll get, get, get it started. Um All right, I think, I think let's get started. It's three minutes past. Um, so I'm sure whoever else wants to join us think I'm just gonna trickle in. Um So yeah, um I hope you guys can hear me. Ok? If not, please give me a shout and also you can see the slides coming up. So we're just on the um starting page now. Um So this is our final session. So some of you might have attended the previous weekend sessions that we felt before. Um, so all we're doing is we're gonna have three different sessions in one broad topic together as broadly speaking, we're gonna do some questions, we're gonna do some answers and we're gonna discuss um, and teach on the topics that are gonna be involved in the questions today. We're gonna finalize. So we've done surgical, we've done GP. So now we're gonna do A&E A&E so we're gonna focus on the medical stuff. Um, and we're also gonna do a bit of psychiatry as well because you see a lot of psychiatry in ae. So, yeah, let's get started. So I'll be doing the 1st, 1st set. Um So we have um, chest pain and breathlessness. Um We've got a bit of collapse, major trauma sepsis and psychiatric emergencies as well. So, um, question one. So we've got a 24 year old man. He's got shortness of breath, wheeze and chest tightness. Um He does have a history of asthma and he's used his um reliever inhaler quite frequently over the past few days. Um You've got his examination results here. Um How would you manage this patient? That's just present to you in A&E. Yeah. All right. I've got a seat good. Well, actually very intense. Anyone else, any other options apart from see? Yeah, I've got one D coming in as well that all gonna a moving as well? Ok. Very, very even split. Ok. Fine. Um So yeah, so yeah, the, the correct answer is, is, is d in fact, um So I'll explain a little bit about why that is, um I think from the question stem. Um Hopefully the the that would have been between A and D they're quite similar in terms of the answers, but it's the fine print when it comes to managing someone um with asthma to see what's happening. So, yeah. Um let's talk a bit about asthma. So, um I presume that everyone knows what asthma is. So you get um this kind of, it's a chronic lung condition where you get, um, bronchospasm, um, and when it comes to acute asthma, so, things that you'll see in A&E, or maybe sometimes GP as well, actually, um, you want to assess them, so you wanna take a history and in the history it's really important that you, um, ask about, um, the previous exacerbations. So you wanna know how many they've had, how many they've had recently and how severe they were. Um, it's important to note to everybody in itu if they have been intubated for it, um, if they're taking their medications, um, and then you can also, when you do your clerking, you should also take, considering other risk factors that could increase their risk of, um, complications from it. So, if they have a learning disability, if they're isolated, et cetera, um, you wanna examine them, you know, get their observations. Um, if you can not always, not always possible, you wanna get a peak flow and make sure that you know what their usual peak flow is. Um, obviously after hypoxic, you wanna get an ABG. Um, and then if they have any viral symptoms or anything like that, you might wanna do some swabs as well, um, to find them effective. Of course, um, we've talked a bit about the severities in the previous sections as well. So, um, you get moderate severe life threatening and neo ftal asthma. So, um, life threatening and neo Fattal are the ones where you get, um, hypoxia. So, um, in life threatening you would have, um, sort of, um, a low oxygen drive with some other signs as well in the fatal you get, um, a raised, um, um, carbon dioxide which, because it shows that your body is getting exhausted and you're not able to breathe it out. Um, in moderate and severe, you should have a decreased CT in your gas. Um, and then to differentiate between modern and severe, it's just, you need to know, unfortunately, some of these things. Um, so any of the severe ones will put them into the category of the severe. Ok. So in this case, um we obviously don't know the peak flow. So we can't really comment on that. Um But if you have a look at his um sort of respirator and um heart rate, um you can see that his breast rate is 22 and his heart rate is 98 and he's also able to speak. So it doesn't quite qualify for severe. So we're gonna be in moderate. Um So when it comes to moderate, oh, just hear it bigger in case you wanted it bigger. So, yeah, if you wanted moderate, um, what you do is, um, you generally give oxygen if you need it, it shouldn't be needed. Um, and um, you give us salbutamol. Um So Albuterol, we give to buy a spacer initially and you can use prednisoLONE if there's no improvement of the spacer you can use.