Our notes are now found under OSCE Learning! Click here
image

Acute presentation assessment

Introduction

  • Wash hands; Introduce self; ask Patient’s name and DOB; Explain 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 (‘ask a nurse’ to do it while you continue assessing)

Focussed history

  • Presenting complaint
  • History of presenting complaint
  • 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 patient’s observations:

  • HR and BP
  • Respiratory rate and O2 saturations
  • Temperature

Focussed examination

  • Quick 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 – see examples here

Investigations

  • BOXES – choose relevant ones to include or exclude differentials
    • Bloods + cannulate (mark as urgent): e.g. VBG and venous bloods (FBC, CRP, U&Es, LFTs ± amylase, G&S, INR), blood culture, ABG, capillary glucose 
    • Orifice tests: e.g. urine dip, urine βHCG, sputum culture, stool culture
    • X-rays/imaging: e.g. CXR, abdominal X-ray
    • ECG
    • Special 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 ± antiemetic ± antipyretic
  • Disease-specific treatments – depends on cause (see here)

NB: use ABCDE approach if critically unwell.

Finally

  • Check for patient concerns and explain what’s 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 
image