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Cases 1 to 7

Cases 1 to 7. REACT Course. Clinical cases. Breathless Hypotensive Oliguric Generally unwell High or low glucose Low oxygen saturations High / low heart rate. Breathless. ABCDE Observe Listen Question Examine Investigate Treatment Do you need to call for HELP ?.

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Cases 1 to 7

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  1. Cases 1 to 7 REACT Course

  2. Clinical cases • Breathless • Hypotensive • Oliguric • Generally unwell • High or low glucose • Low oxygen saturations • High / low heart rate

  3. Breathless • ABCDE • Observe • Listen • Question • Examine • Investigate • Treatment • Do you need to call for HELP ?

  4. Differentials of Breathlessness • Sudden onset • MI, PE, Valve dysfunction, Pneumothorax, Acute tamponade, Lobar collapse, arrhythmia • Slower onset • Post cardiac Surgery • Fluid overload / LVF / CCF • Pneumothorax • Pleural effusion • Pneumonia • Post thoracic surgery • Sputum retention • Pneumothorax • Pleural effusion • Pneumonia • Post oesophageal surgery • Pneumothorax • Pneumonia • Pleural effusion (? Chylothorax)

  5. ABCDE • Do you need to call for HELP?

  6. Observe • Respiratory rate • Laboured • Use of Accessory muscles • Symmetrical chest expansion • Colour – cyanosis • Surgical emphysema • O2 Sats • Do you need to call for HELP ?

  7. Listen • Was it sudden onset ? • Any pain ? • Palpitations ? • What where they doing when it came on ? • Do you need to call for HELP ?

  8. Questions • Was it sudden onset ? • What were they previously like ? • What operation have they had ? • Have they been breathless before ? • Productive of sputum ? • Do you need to call for HELP ?

  9. Examine • Wheeze • Pulse character • Basal crepitations • Dull bases • Hyper resonant • Tracheal shift • Oedema • Do you need to call for HELP ?

  10. Investigate • Peripheral Saturations • ABG • ECG • CXR • Routine bloods • Do you need to call for HELP ?

  11. Treatment • Supportive eg Oxygen • Definitive – Directed at diagnosis, eg • Nebs for asthma • Diuretics for heart failure • Chest drain for an effusion / pneumothorax • Remember to Communicate and Document • Do you need to call for HELP ?

  12. Hypotensive • ABCDE • Observe • Listen • Question • Examine • Investigate • Treatment • Do you need to call for HELP ?

  13. Differentials of Hypotension • Preload • Hypovolaemic • Bleed - Chest, GUT • Cardiac • MI, arrhythmia, LVF/CCF, Beta blocker, valve dysfunction • Afterload • Sepsis • ACEI • Always think TAMPONADE

  14. ABCDE • Do you need to call for HELP ?

  15. Observe • Haematemasis • Melaena • Abdominal distension • Do you need to call for HELP ?

  16. Listen • What were they doing when it came on ? • Do you need to call for HELP ?

  17. Questions • What were they doing ? • What operation have they had ? • When were the drains removed ? • When were the pacing leads removed ? • What was the INR ? • What drugs have they been given ? • Did it start suddenly ? • What was their admission blood pressure ? • Do you need to call for HELP ?

  18. Examine • JVP • Heart sounds • Abdominal Pain • Dull hemi thorax • Do you need to call for HELP ?

  19. Investigate CXR ECG ABG FBC Lactate Do you need to call for HELP ?

  20. Treatment • Supportive • Lie flat • Volume • Adrenaline • Definitive – Directed at diagnosis • Stop ACEI, Beta blocker • Relieve Tamponade • Remember to Communicate and Document • Do you need to call for HELP ?

  21. Oliguric • ABCDE • Observe • Listen • Question • Examine • Investigate • Treatment • Do you need to call for HELP ?

  22. Differentials of Oliguria • Retention • Hypovolaemia • Renal failure • ACEI, NSAIDs • Diuretic dependent • Always think TAMPONADE

  23. ABCDE • Do you need to call for HELP ?

  24. Observe • Have they got an indwelling catheter ? • Is the catheter patent ? • Do you need to call for HELP ?

  25. Listen • Any pain in abdomen ? • Have they had retention in past ? • Do you need to call for HELP ?

  26. Questions • Any pain in abdomen ? • What operation have they had, and when ? • What is the creatinine, when was it measured ? • What drugs have they been given eg ACEI, NSAID • Kidney problems in past ? • Are they diabetic ? • Do you need to call for HELP ?

  27. Examine • Mass in lower abdomen • Raised CVP • Cool and clammy • Do you need to call for HELP ?

  28. Investigate • Catheterise if not already • U&E’s • Lactate • Do you need to call for HELP ?

  29. Treatment • Supportive • Definitive – Directed at diagnosis • Remember to Communicate and Document • Do you need to call for HELP ?

  30. Generally unwell • ABCDE • Observe • Listen • Question • Examine • Investigate • Treatment • Do you need to call for HELP ?

  31. Differentials of Generally Unwell • Sepsis • Wound • UTI • Pneumonia • Bacteraemia, Septicaemia • Endocarditis • GI ischaemia

  32. ABCDE • Do you need to call for HELP ?

  33. Observe • Flushed • Rigors • Obvious respiratory distress • Wound infection • Do you need to call for HELP ?

  34. Listen • Productive cough ? • Wound problem ? • Stinging urine ? • Do you need to call for HELP ?

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