SBA Revise 4

The following patients have diagnosed or suspected aortic dissection. You’d like to control their blood pressure. But what agent do you use and why?

Benjamin has pain radiating to his back. You suspect he has aortic dissection. His observations show SpO2 99%, RR 28, HR 80, BP 190/120.

What medication do you give?

A patient that you have assessed has suicidal thoughts and intent. You find that they do not have mental capacity.

Whilst awaiting assessment from the mental health team, they abscond from your Emergency Department (ED).

You check the waiting room where another patient informs you that your patient was last seen walking towards the bus stop near the main hospital entrance and smoking a cigarette.

Your patient does not answer their mobile phone when you call. The security team have checked the hospital perimeters and are monitoring the hospital surveillance cameras.

Before calling the police, which of the following is an appropriate action to consider?

Hayder is a nine month old who fell from his high chair. You go to do your primary survey. He’s currently wriggling around, staring intently at you as you walk around the room. A is fine – so you move on to consider his c-spine.
What is the most appropriate way of managing his c-spine?

Aimen seems increasingly distracted at work, and has started turning up very late. There have been a few informal complaints from patients saying he is abrupt and unsympathetic. You’re worried.
Which of the following features would suggest he is suffering from burnout, rather than other possible causes of disengagement with work?

A 68-year-old lady was working outdoors, gardening during a hot summers’ day. She started having leg cramps and felt light-headed with a headache.

Later that afternoon, when her family visited for an outdoor picnic, she started hallucinating, becoming confused and disorientated.

She arrives by ambulance to your Emergency Department with fluctuating levels of consciousness. Despite having paracetamol, her temperature persists at 42.3oC.

On arrival, she is hyperventilating. Oxygen saturations are 97% in room air, respiratory rate 26 breaths per minute, heart rate 110 beats per minute and blood pressure 86/42 mmHg. Glucose level is 4.2 mmol/L.

There are no features of infection. No known trauma.

Her family report that she takes a diuretic and Bisoprolol for hypertension. She was previously well and lives independently.

You instigate immediate rapid cooling measures for this patient.

Which of the following measures would be the most effective initial management?

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

A 22-year-old female is brought to the ED by a concerned friend who states that she is “covering the furniture with aluminium foil to protect it from aliens.”

The patient is eager to leave and does not think she needs to be in the ED.

According to RCEM guidance, which of the following is most appropriate immediate action?

A 3-day-old boy is brought in by his parents with increased work of breathing, increased lethargy and a blue tinge around his lips after short feeds. He was born at 39 weeks by planned c-section, to a well mother and had been well the previous day.

On examination the neonate appears ill, is generally mottled but not cyanotic, has very faint femoral pulses, bibasal crepitations, and a systolic murmur.

Hr 130
BP 150/70
Temp 36.8

What is the most likely cause of his collapse?

Olu attends your Emergency department with a likely sickle cell crisis. What do you know about sickle cell?

Olu rates the pain as a 9/10. When you’re not in the room, he’s sat there texting his friends.

What is the best initial analgesia to give?

A 26-year-old estate agent goes running after work on a hot summer afternoon. He is training for a running a marathon.

He develops leg cramps, nausea and vomiting. He feels dizzy and light-headed. His running partner calls an ambulance when he has a seizure.

On arrival to your Emergency Department, his temperature is significantly raised and he is drowsy. His skin is dry and hot to touch. His past medical history is unknown.

He occasionally uses cocaine and drinks alcohol, although he has stopped since commencing his marathon training.
Based on this patient’s clinical features, which is the most likely diagnosis?

A 4-year-old boy is brought with a cough he has had for 4 weeks. He had URTI symptoms for 2 weeks prior to that. You suspect whooping cough.
Whooping cough vaccine is part of the Childhood immunisation programme and is given at which ages in the UK?