Find examples of the specifics to assessing common acute presentations here .
Introduction
W ash hands
I ntroduce self
Ask P atientโs name and DOB
E xplain you want to ask them some questions and examine them
If they are critically ill, use an ABCDE approach
Give oxygen, fluids, analgesia as soon as you realise the patient needs them (โask a nurseโ to do it while you continue assessing)
Focussed history
Presenting complaint
History of presenting complaint
Explore symptoms, e.g. SOCRATES for pain (see history notes on exploring symptoms )
Important parts of relevant systems reviews to include or exclude differential diagnoses (see history notes on systems review )
PMHx (focus on PMHx relevant to problem)
DHx + allergies
FHx: if relevant to PC (e.g. family cardiovascular history if patient presents with chest pain)
SHx: smoking and alcohol
Check observations
Determine the patientโs observations :
HR and BP
Respiratory rate and O2 saturations
Temperature
A patient presents to ED with chest pain and this trace. What would you do?
Interpretation management
Covered in OSCE Stations
Focussed examination
Quickย general exam
Surroundings: drips, medications, catheters, monitoring
General inspection: well/unwell, breathing pattern, in pain, pale, sweaty/clammy
Hands: shut down, tremor, capillary refill
Pulse: rate, rhythm, volume (central and peripheral)
Eyes: pallor, jaundice
Mouth: dry mucus membranes, cyanosis
Perform the appropriate focussed system examination โ see examples here
Investigations
BOXES โ choose relevant ones to include or exclude differentials
B loods + cannulate (mark as urgent): e.g. VBG and venous bloods (FBC, CRP, U&Es, LFTs ยฑ amylase, G&S, INR), blood culture, ABG, capillary glucose
O rifice tests: e.g. urine dip, urine ฮฒHCG, sputum culture, stool culture
X -rays/imaging: e.g. CXR, abdominal X-ray
E CG
S pecial tests: depending on likely cause (see here )
Management
Acute management tetrad:
Oxygen – if low sats (e.g. 15L via non-rebreather mask if not at risk of hypercapnic respiratory failure )
Fluids – if hypotensive or dehydrated (e.g. bolus 500ml 0.9% saline / Hartmann’s solution if no heart failure )
Analgesia – e.g. 10mg morphine IV titrated slowly to pain if severe ยฑ antiemetic ยฑ antipyretic
Disease-specific treatments – depends on cause (see here )
NB: use ABCDE approach if critically unwell.
Finally
Check for patient concerns and explain whatโs going on
Document in notes
Chase investigation results (and change plan as necessary)
Discuss with seniors if required and refer to relevant team if necessary
Want to find out how 99% of people passed their exams?
Test yourself
You undertake an assessment on a 34 year old female with right iliac fossa pain. Which investigations would you request?
Oops! This section is restricted to members. Click here to signup!
You suspect a patient has appendicitis. What is your initial management?
Oops! This section is restricted to members. Click here to signup!
You assess a patient with breathlessness and pleuritic chest pain. You suspect a pulmonary embolism. Which initial investigations would you request? What is your initial management?
Oops! This section is restricted to members. Click here to signup!
Try some acute assessment OSCE stations
Headache
Chest pain
Shortness of breath
Shortness of breath II
Abdominal pain
Abdominal pain II
Find more stations here