SBA Revise 3

A patient presents with a facial wound and head injury sustained as a result of domestic violence.

According to the Department of Health, which statement best defines domestic violence:

Nadia arrives in the emergency department with her mum. She is 11 years old. She is not feeling very well, her abdomen hurts and she has some new self-harm wounds to her left wrist.
Which of these is the correct way to start the consultation?

A 62-year-old with prostatic cancer attends the Emergency Department with constipation, unremitting nocturnal back pain, and weakness of his hip flexors. He is in severe pain. Your ivory tower has all forms of imaging modality available immediately.

You provide opiate analgesia and his pain improves significantly.

What further management will you offer?

Cases of domestic abuse make up approximately 12% of attendances in your ED.

You decide to look at ways to identify and improve the care of these patients in your ED.

An Emergency Medicine trainee is interested in undertaking a quality improvement project (QIP) to improve the care of patients experiencing domestic violence.

Which of the following interventions is recommended by RCEM to increase recognition of domestic abuse?

You’re asked to deliver some teaching for the FY2s, and start to think about some of the relevant literature and techniques.

What is the most important characteristic of a positive teaching environment?

You review several case notes of patients who have presented to your Emergency Department (ED) as a result of domestic abuse. Approximately 12% of ED attendances are of patients suffering domestic abuse.1

You want to improve the care of these patients and decide to attend the Multi Agency Risk Assessment Conferences (MARACS), as a senior representative of your ED.

What can you expect and how will attending the MARAC improve their care?

Your senior ED consultant colleague is due to take maternity leave next month. You volunteer to attend the Multi Agency Risk Assessment Conferences (MARACS) on your colleague’s behalf whilst she is away.

What is the purpose of this conference?

Thana has complained via PALS that she attended ED with non-specific symptoms, and a hair sample was not sent for analysis for thalium poisoning. She feels that staff were rude and her concerns were not taken seriously.

When answering this formal complaint, what is the best way to apologise?

During a busy night shift in your full Emergency Department (ED), the triage nurse informs you of an agitated and distressed patient they have identified with a high risk of absconding.

Patients at risk of absconding should be…

On a hot summer’s day, a 28-year-old runner is brought by ambulance to your Emergency Department, following a collapse soon after completing a marathon.

She felt unwell during the marathon and struggled to complete it. Paramedics report a high temperature. She has no other features of infection and is pain-free, without any injuries.

She has no other medical problems and was previously fit and well. Following your assessment, you suspect a heat-related illness.

Which one of the following clinical features would indicate that your patient has heat exhaustion?

Jeremy is a patient who has been admitted with shortness of breath. He currently has RR32, SpO2 78% RA, HR 120, BP 120/80, Temp 38.2.

His ABG on room air shows pH 7.25, pO2 7.1 pCO2 7.4.

His chest sounds bilaterally wheezy. He has already been treated with salbutamol, ipratropium, steroids, antibiotics and fluids. Jeremy has been medically optimised and you wish to start him on NIV. The ultrasound scanner and chest x-ray are currently unavailable.

What is the best next management step?