MY REVISION - OSCE > A-E ASSESSMENT > Flashcards

A-E ASSESSMENT Flashcards

(47 cards)

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1
Q

AIRWAY
what are the steps?

A

can the patient talk?
- if yes, then move onto breathing

  • if no, look for signs of compromise
  • open mouth
  • listen for abnormal breathing noises
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2
Q

AIRWAY
what are the possible causes of airway compromise?

A
  • inhaled foreign body
  • blood in airway
  • vomit/secretions in airway
  • soft tissue swelling (anaphylaxis, infection)
  • local mass effect (tumours)
  • laryngospasm (asthma, GORD, intubation)
  • depressed level of consciousness
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3
Q

AIRWAY
what are the interventions?

A

SEEK IMMEDIATE SUPPORT (CRASH CALL)
- head tilt/jaw thrust
- oropharyngeal/nasopharyngeal airway
- anaphylaxis (IM adrenaline)
- blood, vomit or secretions (suction)
- stridor (sit upright, urgent anaesthetic input)

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4
Q

AIRWAYS
how would you manage stridor?

A

sit upright
urgent anaesthetist input

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5
Q

BREATHING
what are the steps for assessing breathing?

A
  • respiratory rate
  • oxygen saturation
  • general inspection
  • tracheal position
  • chest expansion
  • percussion
  • auscultation
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6
Q

BREATHING
what does dullness on percussion mean?

A
  • increased tissue density
  • cardiac dullness
  • consolidation
  • tumour
  • lobar collapse
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7
Q

BREATHING
what causes stony dullness on percussion?

A

pleural effusion

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8
Q

BREATHING
what causes hyper-resonance on percussion?

A

decreased tissue density
- pneumothorax

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9
Q

BREATHING
what are the investigations?

A
  • ABG (if indicated)
  • portable CXR = if suspected pneumonia, pneumothorax or pulmonary oedema
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10
Q

BREATHING
what are the interventions?

A
  • sit patient upright
  • oxygen = 15L non-rebreather mask
  • if COPD = 4L on 24% or 28% venturi mask
  • antibiotics if pneumonia
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11
Q

BREATHING
what are the specific interventions for asthma?

A
  • nebulised salbutamol
  • nebulised ipratropium bromide
  • corticosteroids
  • magnesium sulfate
  • aminophylline
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12
Q

BREATHING
what are the specific interventions for exacerbation of COPD?

A
  • bronchodilators (salbutamol and ipratropium bromide)
  • corticosteroids
  • antibiotics (if evidence of infection)
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13
Q

CIRCULATION
what are the steps?

A
  • heart rate
  • blood pressure
  • fluid balance
  • general inspection
  • feel peripheral temperature
  • measure CRT
  • radial pulse
  • brachial pulse
  • inspect JVP
  • auscultation
  • inspect sacrum for oedema
  • inspect ankles for oedema
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14
Q

CIRCULATION
what are the investigations/procedures?

A
  • wide bore cannula (14G or 16G)
  • FBC, U&Es, LFTs
  • 12 lead ECG (if chest pain, arrhythmia, murmur or electrolyte imbalance)
  • bladder scan (if suspected retention/obstruction)
  • urine pregnancy test
  • cultures/swabs
  • fluid output/catheterisation
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15
Q

CIRCULATION
what are the bloods required for sepsis?

A

FBC
U&Es
LFT
CRP
Lactate
Blood cultures

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16
Q

CIRCULATION
what are the blood required for haemorrhage or surgical emergency?

A

(FBC, U&Es, LFTs)
coagulation
cross-match

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17
Q

CIRCULATION
what are the bloods required for ACS?

A

(FBC, U&Es, LFTs)
troponin
CRP
serum glucose
coagulation screen

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18
Q

CIRCULATION
what are the bloods required for arrhythmias?

A

(FBC, U&Es, LFTs)
calcium
magnesium
phosphate
TFTs
coagulation

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19
Q

CIRCULATION
what are the bloods required for a PE?

Study These Flashcards
A

(FBC, U&Es, LFTs)
D-dimer (if appropriate based on Well’s score)

20
Q

CIRCULATION
what bloods are required for overdose?

Study These Flashcards
A

(FBC, U&Es, LFTs)
toxicology screen (e.g. paracetamol levels)
CRP
lactate
coagulation screen

21
Q

CIRCULATION
what bloods are required for anaphylaxis?

Study These Flashcards
A

(FBC, U&Es, LFTs)
mast cell tryptase

22
Q

CIRCULATION
what are the interventions if hypovolaemic?

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A
  • hypovolaemic = 500ml 0.9% sodium chloride over less than 15 mins (250ml if fluid overloaded)
  • significant haemorrhage = activate massive transfusion protocol (red cells, platelets + FFP)
23
Q

CIRCULATION
what are the interventions if ACS?

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A
  • morphine
  • nitrates
  • aspirin
  • clopidogrel
  • oxygen (if required)
24
Q

CIRCULATION
what are the interventions for sepsis?

Study These Flashcards
A
  • alert senior clinician

BUFFALO
- oxygen (if required)
- blood cultures
- lactate
- measure urine output
- IV antibiotics
- IV fluids

25
CIRCULATION what are the interventions for fluid overload?
- diuretics (IV furosemide) - close fluid balance monitoring
26
CIRCULATION what are the interventions for AF?
- treat underlying trigger - consider rate vs rhythm control
27
DISABILITY what are the steps for assessing disability?
- assess consciousness using ACVPU - assess pupil size - assess direct + consensual pupil response - neuro exam (move limbs) - review drug chart - test blood glucose - if glucose raised, test ketones
28
DISABILITY what are the investigations?
CT head
29
DISABILITY what are the interventions?
- maintain airway ( GCS <8 or P or U on ACVPU) + get urgent help from anaesthetist - correct hypoglycaemia
30
DISABILITY what are the interventions for opioid overdose?
- ventilation - naloxone
31
DISABILITY what is the management of DKA?
- IV fluids - insulin (fixed rate 0.1U/kg/hr)
32
DISABILITY what is the management of seizures?
- maintain airway - IV lorazepam
33
DISABILITY what are the components of ACVPU?
- Alert = patient is fully alert - Confusion = new onset or worsened confusion - Verbal = making some kind of voice when spoken to - Pain = responds to painful stimulus - Unresponsive
34
EXPOSURE what are the steps for assessing exposure?
INSPECTION - inspect skin for rashes, bruising + infection - review IV lines for signs of infection - expose + inspect abdomen - inspect calves for erythema/swelling - review surgical wounds - review output of catheter + any drains PALPATION - palpate abdomen - palpate calves for tenderness TEMPERATURE
35
EXPOSURE what are the investigations?
- cultures/swabs if signs of infection
36
EXPOSURE what are the interventions?
CONTROL BLEEDING - pressure if external bleeding WARM PATIENT - blankets - seek senior advice for warmed fluids + bair hugger TREAT INFECTION - if infection is suspected, reassess for sepsis - antibiotics
37
UPPER GI BLEED what specific steps should be included in A-E of upper GI bleed?
CIRCULATION - insert 2 wide bore cannulas - FBC, U&Es, LFTs, group + crossmatch, coagulation screen - strict fluid balance - reverse anticoagulation (discuss with senior) - terlipressin (consultant led) - prophylactic antibiotic - endoscopy (discussed with on-call endoscopist) EXPOSURE - rectal exam (for evidence of melaena)
38
ACUTE ASTHMA what specific steps are in A-E assessment of acute asthma?
BREATHING - ABG - Peak expiratory flow rate (PEFR) - nebulised salbutamol - nebulised ipratropium bromide - IV hydrocortisone - IV magnesium sulphate - IV aminophylline
39
ANAPHYLAXIS what are the specific steps for A-E assessment of anaphylaxis?
AIRWAY - listen for signs of airway compromise - open mouth to check for obstruction - IM adrenaline BREATHING - oxygen 15L via non-rebreather mask CIRCULATION - insert 2 wide bore cannulas - blood tests = FBC, U&Es, LFTs + mast cell tryptase EXPOSURE - remove causative agent (e.g. medication) - start non-sedating oral antihistamine (e.g. cetirizine)
40
STROKE what are the specific steps for A-E assessment for stroke?
CIRCULATION - wide bore cannula - bloods (FBC, U&Es, LFTs, coagulation, HbA1c, cholesterol) - 12-lead ECG (to check for AF) DISABILITY - calculate GCS score - National institute of health stroke scale (NIHSS) - blood glucose - immediate CT head - ischaemic = thrombolysis (within 4.5hrs) or thrombectomy or aspirin 300mg + clopidogrel 75mg - haemorrhagic = anticoagulant reversal, labetalol (to lower BP), refer to neurosurgery
41
BENZODIAZEPINE OVERDOSE what are the specific steps for A-E assessment for benzodiazepine overdose?
CIRCULATION - bloods (FBC, U&Es, LFTs, CRP, CK, Lactate, Coagulation, Toxicology) - 12-lead ECG - 3 lead continuous ECG monitoring DISABILITY - flumazenil (only if requiring ventilation + confident no other substances taken)
42
PULMONARY EMBOLISM what are the specific steps for A-E assessment of PE?
BREATHING - ABG (low PaO2, metabolic acidosis) - CXR (normal) - Well's score - CTPA or V/Q scan if indicated by Well's score - D-dimer if indicated by well's score - oxygen 15L via non-rebreather mask - commence treatment (DOAC e.g. apixaban) if there will be delay in scanning CIRCULATION - bloods (FBC, U&Es, LFTs, coagulation, CRP, troponin, d-dimer) - ECG (sinus tachycardia) EXPOSURE - inspect calves for signs of DVT
43
PULMONARY EMBOLISM what are the components of Well's score?
- clinical signs of DVT (leg swelling + pain on palpation of deep veins) = 3 - alternative diagnosis less likely = 3 - heart rate >100 = 1.5 - immobilisation for >3 days or surgery in last 4 weeks = 1.5 - previous DVT/PE = 1.5 - haemoptysis = 1 - malignancy (treatment in last 6m or palliative) = 1 score >4 = PE likely, CTPA or V/Q scan score <4 PE unlikely, do d-dimer
44
DKA what are the specific steps for A-E assessment of DKA?
BREATHING - VBG (only do ABG if hypoxaemia) - oxygen 15L non-rebreather CIRCULATION - wide bore cannula - bloods (FBC, U&Es, LFTs, CRP, blood cultures, serum glucose) - VBG - 12 lead ECG - urine pregnancy test - if hypotensive = 500ml 0.9% sodium chloride over less than 15 mins - if not hypotensive = 1000ml 0.9% sodium chloride over 1 hour DISABILITY - blood glucose (4 - 5.8 mmol/L) - capillary ketones - fixed rate insulin infusion (0.1U/kg/hr) EXPOSURE - IV antibiotics if infection is suspected
45
AF what are the specific steps for A-E assessment for AF?
CIRCULATION - bloods (FBC, U&Es, LFTs, CRP, troponin, coagulation, TFTs) - ECG (irregular, absence of P waves) - cardioversion (if unstable or <48hrs) - rate control (metoprolol, diltiazem/verapamil) - anticoagulation (CHA2DS2-VASc + ORBIT) - diuretics (furosemide if overloaded)
46
COPD what are the specific steps for A-E assessment of COPD?
BREATHING - ABG - CXR - sputum culture - oxygen via venturi mask - sit upright - nebulised salbutamol - nebulised ipratropium bromide - oral steroids - consider NIV CIRCULATION - bloods (FBC, U&Es, LFTs, CRP, blood cultures) - ECG - antibiotics
47
PULMONARY OEDEMA
BREATHING - ABG if low sats - CXR (blunting costophrenic angles, fluids in fissures) - oxygen 15L non-rebreather CIRCULATION - bloods (FBC, U&Es, LFTs, CRP, troponin, plasma BNP) - ECG - diuretics (IV furosemide)
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