4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is...
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Transcript of 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is...
![Page 1: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/1.jpg)
4 collapsed patients
![Page 2: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/2.jpg)
Case 1
• A teenager aged 18 is found at home• Febrile and appears confused and is irritable
![Page 3: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/3.jpg)
Examination
• Temperature 39.7• P 120• BP 90/50• Noted to have a faint
rash on skin
![Page 4: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/4.jpg)
Questions
• Which illnesses you consider?• What actions need to be undertaken• How quickly should any intervention be
made?• What are the potential risks ?• Should any action be undertaken relating to
friends or family?
![Page 5: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/5.jpg)
Case 2
• A 62 year old man is found at home• He is collapsed • He is confused but rousable• He is pale and noted to be sweating
![Page 6: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/6.jpg)
Examination
• BP 60 • Unable to palpate wrist pulse• P 40 • HS audible
![Page 7: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/7.jpg)
Questions
• What are the possible causes of this picture?• What actions would you take when this man
arrives in A/E?• What tests are available?• Which organs might be particularly at risk?• Actions?
![Page 8: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/8.jpg)
Case 3
• A 22 year old student is our with friends for a curry
• He suddenly collapses• He is noted to be pale and cold
![Page 9: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/9.jpg)
Examination
• BP 70/50• P 100• Raised rash on trunk and legs• Swelling of lips• Audible wheeze
![Page 10: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/10.jpg)
Questions
• What is the likely cause of this collapse?• What are the possible precipitants of the
condition?• Why has this mans BP dropped?• What actions need to be taken?
![Page 11: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/11.jpg)
Case 4
• A jockey is thrown from his horse on the racecourse at Newmarket
• When the doctor arrives he is responding to pain
• His radial pulse cannot be felt
![Page 12: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/12.jpg)
Examination
• Noisy respiration• Responding to pain• P 120 carotid but not palpable at wrist• Sweating
![Page 13: 4 collapsed patients. Case 1 A teenager aged 18 is found at home Febrile and appears confused and is irritable.](https://reader035.fdocuments.us/reader035/viewer/2022072005/56649cee5503460f949bc795/html5/thumbnails/13.jpg)
Questions
• What will kill this man first?• What does the doctor need to do first ?• What is the AVPU score?• What is the most likely reason for the
tachycardia and the low BP?• Where in the body might he be loosing blood
and how much?• What actions are required?