Category: Emergencies

Anaphylaxis

Anaphylaxis is a serious, life-threatening allergic reaction. Features include airway compromise, breathing or circulation difficulties and skin changes. Skin changes alone are not a sign of anaphylaxis but are present in 80% of patients with anaphylaxis. Signs & Symptoms Airway – feeling their throast closing up, stridor (inspiratory sound) & hoarse voice Breathing – shortness

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Opiate overdose & toxicity

You will likely encounter an opiate overdose due to the prevalence of opiates for recreational use, in those who have chronic pain or mental health issues & those who may accumulate opiates due to liver or renal impairment. No matter the type of opiate, treatment is broadly the same, although some opiates may require higher

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Seizures

Scenario: You are bleeped by one of the staff nurses to review a patient on the orthopaedic ward who is “jerking in her bed”. She tells you the patient is a 74-year-old female who is 2 days post knee replacement. She is a known epileptic who takes sodium valproate daily but has not taken any

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Hyperkalaemia

Hyperkalaemia can cause life-threatening emergencies particularly cardiac arrhythmias. A widely used definition is extracellular [K+] ion concentration ≥ 5.5 mmol/L. Complications increase with severity and hyperkalaemia may be classified as: Mild 5.5-5.9 mmol/l Moderate 6.0-6.4 mmol/l Severe ≥ 6.5 mmol/l Causes Always consider the cause of hyperkalaemia. Emergency treatments only temporarily lower potassium levels to

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Heart Failure

Heart Failure is not a diagnosis in itself, rather a collection of symptoms that require investigation to find the underlying cause. Heart failure syndrome is the term used to describe the collection of symptoms such as; breathlessness and fatigue, and signs such as fluid retention. As an FY1 you will likely encounter patients with heart

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PR Bleeding

The first thing when called is to identify whether the bleeding is truly a lower GI bleed or whether it is an Upper GI Bleed as the management differs. Both can quickly become emergencies so seek senior advice. When the nurse first calls you Check the observations & their trend (urgent review for haemodynamic instability) If

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Difficult Airway Patients

As a doctor, you may come across patients with complex airways. They should be found on dedicated wards such as respiratory, ENT, ITU or HDU – however, bed pressures might lead to patients being on wards with staff who are not used to looking after them. Usually, the patients are visited daily by specialist nurses/critical

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Reduced GCS

As a doctor, you will frequently be called for a drowsy patient. They can vary from confused to completely unconscious. The Glasgow Coma Scale can help reliably quantify and track the level of consciousness over time – however, during the initial assessment, it takes too long unless you use it regularly. You can use AVPU

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Metastatic Spinal Cord Compression

Spinal cord compression occurs when there is compression of the spinal cord or cauda equina at any level secondary to the effects of a malignancy. This can include metastatic infiltration to the vertebral column causing instability or pathological fractures as well as direct pressure from malignancy to the spinal cord. This condition affects around 5-10%

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Opiate Withdrawal

As doctors, you will frequently see patients with opiate dependence. It isn’t uncommon for these patients to be admitted due to withdrawal or due to consequences of their drug use such as a groin abscess or overdose. It is difficult to differentiate symptoms of withdrawal from other conditions & the symptoms can be horrible leading

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