Managments

Question 1

When attending an elderly fall - what are the assessments required

Answer 1

Fast
12 lead ECG
Postral drop
Head to toe ( trauma )
Mobility test

Question 2

When attending an elderly fall what history questions are important

Answer 2

• mechanism of injury ( intrinsic/ extrinsic
• duration on floor ( long lie)
• LOC
• Prior, during the fall, after fall
• what’s happened, when did you fall + what were you doing
• can you remember falling (how did you fall)
  + get a timeline + - any symptom prior to the fall.
• ( notice the location + surface + furniture involvement)
• what position (standing/sitting)
• have you been in the same position since
• how did you land

Whilst completely H2T
Ask ** any new pain if so where**
- NEURO - bang your head + headache + dizzyness + blurred vision + any loc

• chest pain + sob + palpations
• abdo pain + eating and drinking + vomiting or disheroioa + ask about urine ( frequency+ volume + colour + pain or blood
• pain in hips or legs

Question 3

What are the symptoms of symptomatic bradycardia
2) treatment plan

Answer 3

1) bradycardia causing poor precision - (HR 40-), BP(less 90), confusion, HF

2) O2 (94%+), pads, cannulate, atropine (600mcg -5 mins), fluids (100mmgh maintain)

3) if unrespetive to treatment plan = prealert

Question 4

How would you manage a fracture

Answer 4

• Early pain relief ( enternox)
• Assess neurovascular compromise
• Longer lasting analgesia ( parcemol/ morphine
• Vacuum splint

Question 5

What is the assessment pathway patient with asthma

• 1) primary action ( what do you need for your primary action)
• 2)classification/ treatment plan
• 3) what else action are required
• 4) aree you going to convey - if so when and why

Answer 5

Rapid primary survey ( Determine LT features)

2) - RR + HR + ISIFS ( give nebs + hydrocortisone)

• if GHOST is present ( Adrenaline 1:1000 + 02 then nebs + hydrocortisone)

3) Full set of OBS + 12 lead ECG

• 4) if pt not receptive to treatment 2+ nebs as there unlikely to get better = pre alert

Question 6

What is the basic management plan for an arrythmia ( Brady / svt)

Answer 6

S - support abc
T- 12 lead
O - oxygen ( if needed)
P - pads
P - pre alert
I- IV + fluid( if needed)
*“T**- tamper ( atropine / vagas monover)

Question 7

How would you manage a adult cardiac arrest

Answer 7

Confirm cardiac arrest via ( ABC Approach
- confirm absence of ADRT, LPA, DNAR, RESPECT forms or irreversible conditions
- put on pads ( respond to rhythm)
- 30:2 - 5 rounds

Question 8

How do you manage an active seizure ( A-E approach)

Answer 8

Protect head

A - airway (look + clear - suction + secure (OPA/ npa) + cyanosis check + remember mouth open/close

B- rr ( 15L 02 ) - sat not reliable when active seizures - prolonged + tolerating OPA = ? pop in igel ( ETCO2) + auscultate(?stridor= airway is shit = reassess)

C - pulse and cap refill ( BP+ 12 lead when possible)

D- head injury assess + pupils + temp + rashes + arms symmetrically shaking + GCS ( give time for them to respond + BM

T- time seizure = drugs

Question 9

How do you manage a patient post seizure ( postictal states)

Answer 9

-Manage ABC
- Placement in recovery position
- History ( DDEMSIPL)
-

Question 10

What is the management for patient with an active seizure basics

Answer 10

• Managed ABC
• protect the head, and airway from aspirations
• ask about DEMSIPL
• look for signs ( ? Epilepsy / ? PNES)
• 5 minutes + give benzo
• iv access
• 10 minutes in = if still seizuring ( move to ambo
• at 15 mins in/ 10 mins after first dosage = give second benzo

Question 11

How do you manage a patient in status epilepticus ( seizures)

Answer 11

Status = 5 minutes + seizure/ 3+ seizures with an hour
- address ABC concerns
- protect head
- history = DDEMSIPL
- follow care plan or ( give first benzo ( midazolam buccal)
- 10 mins after give second bezo ( IV diazapam)
- 3rd benzo only 25 mins after 2nd dosage

Move to hospital 5 mins after first benzo = pre - alert. === Get ready with BVM ( Respiratory depression)

Question 12

What is classified as SEVERE hypoglycemia
- what is the management plan for such PTS

Answer 12

1) PT with a reduced GCS - 8 OR LESS

• correct ABCS
• Give IV glucose / if not possible then Glucagon.
• reassess after 10 mins
• sugars still low = IV glucose or if no access = IO
• Recheck after 15 mins - no change = convay with PRE-ALERT = CONSIDER 3RD DOSAGE

Question 13

What is classified as a PT with mild - moderate hypoglycemic attack
2) treatment plan
3) backup treatment plan
4) backup backup treatment plan

Answer 13

• PT with suger below 4.0/3.0 who is conscious and can swallow
• give fast acting glucose = glucose 40% or 2 biscuits or pure fruit juice ( this can be given up to 3 times)
• not effictive giv GLUCAGON ( consider PT tho - poor stores)
• after 30 minutes give iv glucose
• once above 4.0 give long acting carbs ( bread or meal)
• make sure to replenish store if giving glucagon = more toast or more food

Question 14

What is the management plan for PT with sepsis

Answer 14

Early NEWS2 score
- cannulate
- O2 ( if signs of shock or below normal)
- benzopencillin + paracetamol(reduced temp/pain)if needed
- provide fluids ( dilute acidic products, increase volume)
** Pre alert**

Question 15

What is the management plan for hyperventilation
- who should be convayed

Answer 15

Confirm it is hyperventilation not respiratory, metabolic or cardiac in origin

Management = reassurance, breathing and or distraction technique, in nose out mouth

**Transfer if **under 16 or first episode, known hyperventlator and non resolved or reaccuring,

Question 16

What is the management for a patient with a suspected stroke

Answer 16

• general history + ONSET TIME
• complete full set of OBS including BM + °C
• complete a FAST TEST
  -if FAST+ call stroke nurse regardless of onset time
• complete 12 interracial nerves

Question 17

How do you complete a neuro assessment for patient suspects of a stroke

Answer 17

Face - eyebrows, close eyes then do trigeminal, puff up cheeks, big smile
Arms - squeeze, pull push, hold up, push on them, ?rebound + legs
Speech - hippopotamus, memory recollection

Eyes - vision peripheral, read something, accdomidate, pupils, pearl, big h

Dyscolkinesia, f2n, rebound, Romberg’s, tandom gate

Question 18

What is the history you should take for someone with a headache - use the socrate nmeonic (tailored to headaches)

Answer 18

S - what’s happened ( general build up)

O - when did it start/ gradual or sudden onset and progression (sub arrach), build up to the headache (aura - flashing light zigzag,weakness).

S - where does it hurt ( sides, front, top)

C - feel (pulsating, sharp, constricting, throbbing)
Is it constant or come and go

R - move anywhere neck shoulder pain, eye pain

A -, vision deficit, loc, trauma, nausea/vomiting or weaknesses or stiffneck(rashes) ,

T -do you often get headaches(often?), - any different, how long do they last? certain times, seen anyone - what they said ? ( Family history)

E - changes from lying down to standing, wake you up at all(ICT). photophobia or phonophobia

S- pain score, any pain relief take, any general pain relief ( check for paracetamol or NSAID, how often - medication overuse)

any recent stress, alcohol, sleeping okay, eating/drinking, caffeine
Does rest make any difference

• wake up from sleep (ICT)
• sudden onset thunderclap headache (subarrach)
• orthostatic (changes on positions)

Question 19

What is the management for someone with a headache

Answer 19

• History - Socrates + pertinent question
• Trauma assessment of the head + scalp tenderness
• Fast test + 12 intercranial nerve test to include (pupils + finger to nose and hand flip test)
• appropriate analgesia

Question 20

What is the history you should gain for a patient who had had a seizure

Answer 20

What’s happened - when did it start - what were they doing

Duration
Describe
Epilepsy history of
Medication administered or self resolving
Signs/symptoms
Isolated
Last seizure

HBEDTTTIMESS

Question 21

What is the history you should gain for a patient with a suspected stroke

Answer 21

Onset time - gradual or sudden onset - what were they doing
- feel any weakness/numbness + where + progressivion over time
- headaches + trauma + confusion + LOC + AVVV

Question 22

What is the history you should gain for a patient complaining of chest pain in the Socrates framework

Answer 22

Onset : when did it start, what were you doing when it started, sudden or gradual, had anything like this before,

Site: where about is the pain
Character: what does the pain feel like
Radiation: pain move anywhere
Associated symptoms : sob, sweating, abdo pain ( heart burn, bitter taste), muscular pain, pin point, palpation, legs ( swelling, redness or pain), pain worse on exhaustion, coughs, vomiting/ nausea,

Time: constant/ intermittent + progression.

Exaccibating/ alleviating - leaning forward

Pain score: x/10

Question 23

What are the physical assessment you should conduct for any patient complaining of chest pain

Answer 23

• Bilateral radial pulse(primary survey)
• History + first set of OBS
• AMPLE
• 12 lead ECG + feel centrally skin (warmth + colour + CBR)
• take deep breaths(pluerretic) + lift arms to side then above head (muscular) + lean forward(pericarditis) + have a look at calfs (DVT+ HF)
• feel of the chest + auscultation
• decision + if conveying do a standing BP

Question 24

What history must you gain for a patient experience abdominal pain ( use Socrates phramwork + PPULIVE)

Answer 24

Site : where
Onset: when start + doing what + gradual sudden + had before = seen anyone= what they said
Character : feel ( burning, sharp, stabbing)
Radiating: move anywhere ( back, sides, chest)
Time : constant or intermittent + progression
Exaccibating ( leaning forwards/ deep breath)
Severity score + any NSAID USAGE

Associated symptoms
P: poo (frequent, consistency(diarrhoea/ hard to pass), colour (white?), any blood + passing wind.
Periods ( chance of pregnancy + last period, consistant (28 days?), heavy periods/ cyclic pain?)
U:ninary ( frequency, pain, smell, colour, blood)
L: lower back pain
I: indigestion/ bitter taste
V: vomiting, frequency, texture(food bole phelmgh) any blood
E:eating (last intake ?fatty + pain during or after

Question 25

What is the history you should gain from someone suffering from shortness of breath using the socate framework

Answer 25

S : what happened O : when start + what doing + sudden/gradual + had before C : what do you mean by breathless+ how does it feel A : "apart from breathlessness anything else + have you been feeling under the weather at all - colds or sore throat runny nose - coughs ( productive (green = infection) blood(pe) bubbly or pink (HF) - any chest pain (jaw arm back) - tingling in fingers - palpation - generalised weakness or dizziness - legs swelling ( pain +redness) - mobility ( how far) - sleep ( wake up + pillows) T : constant or intermittent + progression - better worse stayed same E : better or worse ( mobilising + sitting or standing or deep breath)

Question 26

What is the generalised history you should gain from a pediatric history to rule out serious illnesses (Use system base for structure)

Answer 26

**Disability** drowsiness/lethargic, floppy or difficult to rouse, LOC, photophobia +neck stiffness + rashe, inconsolably + seizures **Airway+ breathing** : drooling, runny nose + sore throat, sneezing, coughs(productive / sound= croup), breathing difficulties - @rest or feeding ?, noisy breathing ? Cardiac: (pale/ mottled/ cyanosis/ pink,) cold hands and feet Abdo: eating and drinking ? ( How much), vomiting = colour quantity frequency) diaheria, jellylike red poo, UTI symptoms, Limbs : weaknesses, gait, swelling redness, trauma

Question 27

What are the assessments you should conduct for a pediatric medical

Answer 27

**Airway** : patient + throat check (tonsillitis) + tongue (strawberry/ dehydration) **Breathing** : RR + SATS + TCRASHING + AUSCULTATE **cardiac** : HR + warmth + colour + CBR of skin central and peripherally Abdo : have a feel Neuro : PUPILS + fontanelle + bruvinski signs + rashes check + temp and BM

Question 28

What is the management/ procedure in confirming a role/ verifing death

Answer 28

1) confirm RESPECT forms/ ADRT/ LPA/ 15 mins rule / 30 minutes continuous and persistent aystole/ ROLE criteria met (9 ways) 2) obtain ECG print out of aystole for 30 seconds 3) listen for heart sounds + breath sounds 4) pupils = check they are fixed and dilated 5) turn the body - take a pic front and back ( hypostasis)

Question 29

How do you assess and manage a mild/moderate head injury