What is the acute abdomen?
Pain in abdomen coming on in the last 24 hours. There are other sx too - vom, diarrhoea, constipation
Causes of pathology of sudden onset
Vascular accident - dissection, bleeding, infarction or perforations.
Abdo pain that migrates/radiates
Migrates = appendicitis, para umbilical vague to RIF localised Radiates = pancreas or AAA radiates to back
Markers of local vs systemic illness
Local - haematemesis, dysuria, faeculent vom, absolute constipation
Systemic - anorexia, weight loss, vom
Differentials for acute abdo
- GORD, PUD, gastritis, perforated oesophagus
- HPB - hepatitis, cholecystitis, cholangitis, acute pancreatitis
- Bowel - appendicitis, diverticulitis, obstruction, IBD
- Vascular - AAA, mesenteric ischaemia, dissection, haemorrhage
- Male - torsion, renal colic
- Female - ovarian cyst rupture, ectopic pregnancy, PID, UTI
What are some specific signs on exam for acute abdomen?
- Anaemia/cachexia - acute on chronic
- Abdo distension
- Cullen’s/Grey Turners
- Rebound tenderness
- Peritonism
- Guarding
- McBurney’s sign
What can you test for on urine dip?
- UTI
- Pregnancy
- DKA
How do you assess a patient with chest pain?
Hx - SOCRATES, previous eps, MI? angina? CVS RF, ask about sx of none cardio causes eg. resp, GORD, MSK, trauma, anxiety and depression
O/E - CVS, chest wall, abdo, neck (tender and stif), legs (DVT), skin (shingles and bruises), temp
Ix - ECG, bloods, TFTs, LFTs, CRP, CXR
What are the cardiac causes of chest pain?
- ACS
- Stable angina
- Aneurysm
- Pericarditis/tamponade
- HF
- Arrhythmias
What are the resp causes of chest pain?
- PE
- Pneumothorax
- Pleural effusion
- Pneumonia
- Asthma
- Lung collapse
- Lung cancer
How do you assess a seriously unwell child?
- AtoE assessment and resus
- Secondary assessment and emergency treatment
- Stabilise and transfer
What is stridor?
Noisy breathing that occurs due to obstructed air flow through a narrowed airway.
A resus
Airways - naso pharyngeal airways, Guedel airways.
If stridor call senior immediately. Anaesthetic help may be needed.
What are some signs of resp distress in children?
- Grunting
- Flaring nostrils
- Tracheal tug
- Accessory muscle use
- Gasping = late severe hypoxia
- Silent chest
B resus in child
- High flow O2 through reservoir bag
- Coughing if chocking or 5 back blows then 5 chest thrusts
C resus in child
20 ml/kg bolus 0.9% NaCl then reassess. Get IV access ASAP.
D resus in child
- Intubation if poor conscious level or not conscious
- Hypoglycaemia = bolus 2ml/kg 10% glucose IV or IO then glucose infusion
- Suspect ICP = mannitol
What is AVPU?
Alert
Voice
Pain
Unresponsive
What is involved in the secondary assessment of the acutely unwell child?
- Reassess response to resus
- Focused Hx and systems based exams
- Ix
What are the causes and what is the emergency treatment of stridor?
- Harsh stridor and barking cough = croup = oral dex, NEB budesonide and adrenaline
- Soft and drooling = epiglottitis = intubation and then IV Abc
- Sudden and hx inhalation = foreign body = laryngoscopy
- Anaphylaxis = IM adrenaline
What does a bubbling sound in unwell child suggest? How do you treat?
Excessive secretions = suctioning
What needs to be monitored in an unwell child?
- O2 sats
- Pulse - rate and rhythm
- BP
- Urine output
- Core temp
How do you assess a patient w unilateral weakness, suspected stroke?
CF - headache, vom, reduced consciousness
Hx - onset, fluctuation, duration
RF - PMH, chronic conditions, cancer, recent trauma or surgery, FH, meds
O/E - GCS, AtoE, FAST, CVS
Ix - BM, ECG
What is Bells Palsy?
Acute, unilateral facial nerve weakness/paralysis of rapid onset of unknown cause.
- Dry eye, incomplete closure, numbness of mouth
- Hyperacusis
- Speech articulation problems
