Emergencies

ABG Interpretation

In this article, we will look at more practical aspects of how to read an ABG and treatment following your interpretation. If you’re looking on...

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Acute Asthma

1. You are unlikely to be expected to make decisions about long term asthma management, therefore, focus your efforts on learning how to deal with...

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Acute COPD exacerbation

As an FY1, you are unlikely to be expected to make decisions about long term COPD management therefore focus your efforts on learning how to...

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Acute Stroke

Whilst on call or in A&E you may be asked to assess somebody who is suspected to have had a stroke. This is a very...

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Alcohol Withdrawal

Suddenly stopping alcohol intake in patients who have been drinking heavily for prolonged periods is dangerous and can lead to severe withdrawal. Delirium tremens can...

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Anaphylaxis

Anaphylaxis is a serious, life-threatening allergic reaction. Features include airway compromise, breathing or circulation difficulties and skin changes. Skin changes alone are not a sign...

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Atrial Fibrillation

AF is the most common sustained cardiac arrhythmia you will encounter. In this article, we focus on the management of it. Identification of atrial fibrillation...

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Chest Pain

As a junior doctor, you will also often assess patients complaining of chest pain in the acute admissions setting and on the wards. Reviewing a...

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CNS Infections

A CNS infection is one that involves the central nervous system in some way. This includes the meninges, cerebellum, ventricular system and spinal cord, among...

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Compartment Syndrome

Acute Compartment Syndrome is one of the few orthopaedic emergencies. If missed, it can lead to severe and life-changing consequences for the patient. This article...

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Delirium

Acute confusion, otherwise known as delirium, is very common in hospitals – 20-30% on medical wards and between 10% and 50% of those that have...

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Deteriorating Patient

The deteriorating patient is often the worst nightmare for new FY1s.  I remember when I started FY1, I was terrified of coming across a deteriorating...

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Difficult Airway Patients

As a doctor, you may come across patients with complex airways. They should be found on dedicated wards such as respiratory, ENT, ITU or HDU...

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DKA and HHS

You’ve found a patient is hyperglycaemic & either they are ketotic or have significant hyperglycaemia (>30mmol/L) and so you suspect DKA or HHS respectively. Diabetic Ketoacidosis (DKA)...

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ENT

In this article, we cover the main ENT situations you are likely to encounter either in A&E, during an ENT on call job or occasionally...

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Femoral Stab

Femoral puncture is typically used to acquire blood from a patient in an emergency setting as both the veins and arteries are large vessels. In...

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Fluid Balance

Almost every patient admitted to hospital receives IV fluids at some point in their journey. However, the body manages this, without the need for careful...

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Haematuria

You will regularly see patients with blood in their urine, most often picked up incidentally on a urine drip. Your initial assessment should aim to...

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Heart Failure

Heart Failure is not a diagnosis in itself, rather a collection of symptoms that require investigation to find the underlying cause. Heart failure syndrome is...

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Hyperglycaemia

Hyperglycaemia is something you will encounter frequently. In this article, we focus on how to approach hyperglycaemia and identify diabetic emergencies. If your patient is...

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Hyperkalaemia

Hyperkalaemia can cause life-threatening emergencies particularly cardiac arrhythmias. A widely used definition is extracellular [K+] ion concentration ≥ 5.5 mmol/L. Complications increase with severity and...

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Hypoglycaemia

In this article, we provide a quick overview of how to treat and investigate the cause of patients with hypoglycaemia. Definition In diabetics, <4 mmol/L...

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Hyponatraemia

Hyponatraemia (serum Sodium <135 mmol/L) is one of the most common electrolyte abnormalities you will see and so a systematic approach to identifying the underlying...

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Hypotension

Expect many bleeps about hypotension from concerned nursing staff. It is a useful way to flag up which patients might be unwell. Although defined as...

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Hypothermia

Hypothermia, whilst an infrequently encountered issue during foundation, is a high-risk condition with a need for investigation and often rapid intervention. It is defined as...

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Hypoxia

As an FY1, you will be called to review hypoxic ward patients. Here we discuss common causes of generalised hypoxia and not focal hypoxia/ischaemia such...

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Neutropenic Sepsis

Please read an overview of the management of sepsis before reading this article. ContentsDefinitionHigh-risk patientsSigns and symptomsInvestigations and ManagementConfirming the diagnosisScoring systemsFollow upReferences Definition Neutropenic...

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Non-Invasive Ventilation

Non-invasive ventilation is a way of providing ventilatory support to patients in respiratory failure without using an invasive airway device (e.g. ET tube or tracheostomy...

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Opiate overdose & toxicity

You will likely encounter an opiate overdose due to the prevalence of opiates for recreational use, in those who have chronic pain or mental health...

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Opiate Withdrawal

As doctors, you will frequently see patients with opiate dependence. It isn’t uncommon for these patients to be admitted due to withdrawal or due to...

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Parkinson’s Disease

In this article, we will present several common scenarios involving Parkinson’s disease (PD) that F1 doctors might face on the ward or on call. We...

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Pneumothorax

A pneumothorax is defined as the abnormal collection of air between the visceral and parietal space of the lung i.e. the pleural space. It typically...

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PR Bleeding

The first thing when called is to identify whether the bleeding is truly a lower GI bleed or whether it is an Upper GI Bleed as...

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Prescribing IV Fluids

There are certain situations where you need to prescribe IV fluids which vary from fluid resuscitation to maintenance fluids if a patient is nil-by-mouth (NBM)...

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Pulmonary embolism

A pulmonary embolism (PE) is a blocked blood vessel in your lungs, most often due to a blood clot. It is common and can be...

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Pulmonary Oedema

RCEM has published some clear and comprehensive information which is well worth a read. Below we include a very quick summary as a refresher. Causes: Impaired...

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Red Eye

Red eye is one of the most common eye presentations you will encounter. Whilst many will likely be referred to an opthalmologist or senior clinician,...

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Reduced GCS

As a doctor, you will frequently be called for a drowsy patient. They can vary from confused to completely unconscious. The Glasgow Coma Scale can...

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Seizures

Scenario: You are bleeped by one of the staff nurses to review a patient on the orthopaedic ward who is “jerking in her bed”. She...

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Sepsis

Sepsis is an infection with evidence of organ dysfunction. Septic shock is when a patient with sepsis is hypotensive despite appropriate fluid resuscitation. ContentsIntroductionHigh-risk criteriaSepsis...

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Sharps Injuries

Sharps injuries happen when you least expect them. You can’t always prevent them but you can do a lot to reduce the risk. It might...

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Sickle Cell Disease

Sickle cell diseases are a disorder of haemoglobin affecting red blood cells. This autosomal recessive, single gene defect results in the formation of HbS (sickle...

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Upper GI bleed

These patients have the potential to become haemodynamically unstable extremely quickly; try to avoid delays in reviewing them. In-hospital mortality is around 10%. If they...

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