Category: Emergencies

Acute Stroke

Whilst on call or in A&E you may be asked to assess somebody who is suspected to have had a stroke. This is a very brief overview that gives you an approach to managing a patient in this setting. Before considering treatment options, it is important to remember that there are two causes of stroke:

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Deteriorating Patient

The deteriorating patient is often the worst nightmare for new FY1s.  I remember when I started FY1, I was terrified of coming across a deteriorating patient whilst on call and having to manage them all alone. However, it is important to remember that although you will definitely come across deteriorating patients, help will always be

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Delirium

Acute confusion, otherwise known as delirium, is very common in hospitals: 20-30% on medical wards, and between 10-50% of those that have surgery develop delirium. Types of Delirium Hyperactive – agitated, delusions, hallucinations, aggression Hypoactive – harder to spot – lethargy, psychomotor retardation, excessive sleeping, inattention – often misdiagnosed as depression Mixed Predisposing factors Previous

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Pulmonary Oedema

RCEM has published some clear and comprehensive information which is well worth a read. Below we include a very quick summary as a refresher. Causes Impaired cardiac function e.g., MI, arrhythmia and sepsis. Beware particularly cardiac patients who have recently been given IV fluids. Fluid overload- this can occur even in patients with a normal heart

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Prescribing IV Fluids

There are certain situations where you need to prescribe IV fluids which vary from fluid resuscitation to maintenance fluids if a patient is nil-by-mouth (NBM) (e.g. pre-operatively, ‘drip & suck’ for bowel obstruction, acute pancreatitis, recent stroke with unsafe swallow). The NICE Guidance CG174 Intravenous fluid therapy in adults in hospital contains an excellent PDF

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Sepsis

Sepsis is an infection with evidence of organ dysfunction. Septic shock is when a patient with sepsis is hypotensive despite appropriate fluid resuscitation. Introduction One study has shown that for every hour delay in receiving treatment mortality increases by 7.4%. There is NO diagnostic test for sepsis. Your Trust will likely have a Sepsis Screening

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Acute Asthma

You are unlikely to be expected to make decisions about long term asthma management, therefore focus your efforts on learning how to deal with acute exacerbations. Brief history If a patient reports having a diagnosis of asthma, it is worth asking a few questions to clarify the accuracy of the statement. It isn’t uncommon for

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