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Summary University of Leeds 4th Year Acute & Critical Care Revision Notes (ACC)
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  • Course
  • Common Acute Emergency Management And Interpretation OSCE
  • Institution
  • University Of Leeds (UoL)

117 Pages Topics Covered: Acute Medicine 4 Important Areas 4 Clinical Presentations - Essential 5 Chest Pain 5 Shortness of Breath 11 Limb Pain/Swelling 12 Blood Glucose Disturbances 14 Substance Misuse 16 Serious Infections 20 Acute Kidney Injury 21 Confusion & Delirium 24 Clinica...

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Document information

  • June 13, 2023
  • 202
  • 2018/2019
  • Summary

Subjects

  • acute medicine
  • osce
  • medicine
  • anaesthesia
  • critical care
  • emergency medicine

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  • University of Leeds (UoL)
  • Unknown
  • Common Acute Emergency Management And Interpretation OSCE
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ACUTE &
CRITICAL
CARE



4TH YEAR MEDICINE
Indeera Shankla

, Table of Contents
Aims & Learning Objectives .................................................................................................................................. 3
Acute Medicine.................................................................................................................................................... 4
Important Areas............................................................................................................................................... 4
Clinical Presentations - Essential ....................................................................................................................... 5
Chest Pain ................................................................................................................................................................. 5
Shortness of Breath ................................................................................................................................................ 11
Limb Pain/Swelling ................................................................................................................................................. 12
Blood Glucose Disturbances ................................................................................................................................... 14
Substance Misuse ................................................................................................................................................... 16
Serious Infections ................................................................................................................................................... 20
Acute Kidney Injury ................................................................................................................................................ 21
Confusion & Delirium ............................................................................................................................................. 24
Clinical Presentations - Desirable .................................................................................................................... 25
Anaphylaxis ............................................................................................................................................................ 25
Unconscious Patient ............................................................................................................................................... 27
Acute Coronary Syndrome ..................................................................................................................................... 28
COPD - Acute Exacerbation .................................................................................................................................... 29
Subarachnoid Haemorrhage .................................................................................................................................. 30
Syncope .................................................................................................................................................................. 31
Electrolyte Disturbances ........................................................................................................................................ 32
Clinical Presentations - Enhanced Learning ..................................................................................................... 34
Chest Pain ............................................................................................................................................................... 34
Overdose ................................................................................................................................................................ 36
Acute Weakness ..................................................................................................................................................... 38
Asthma - Acute Exacerbation ................................................................................................................................. 41
Seizures .................................................................................................................................................................. 42
Skills - Essential .............................................................................................................................................. 44
ECG ......................................................................................................................................................................... 44
CXR ......................................................................................................................................................................... 46
ABG ......................................................................................................................................................................... 49
NEWS Score ............................................................................................................................................................ 50
IV Cannulation ........................................................................................................................................................ 51
Venepuncture ......................................................................................................................................................... 52
Oxygen Devices ...................................................................................................................................................... 53
Capillary Blood Glucose Sampling .......................................................................................................................... 54
Skills - Desirable ............................................................................................................................................. 55
Oxygen Prescribing ................................................................................................................................................. 55
Fluids ...................................................................................................................................................................... 56
Antibiotic Therapy .................................................................................................................................................. 58
Analgesia ................................................................................................................................................................ 61
ABG Sampling ......................................................................................................................................................... 62
Inhaler Technique................................................................................................................................................... 63
Nebuliser use .......................................................................................................................................................... 64
Skills - Enhanced Learning .............................................................................................................................. 65
Insulin Prescribing .................................................................................................................................................. 65
Alcohol Withdrawal ................................................................................................................................................ 66
Paracetamol Poisoning ........................................................................................................................................... 67
Anaesthesia ....................................................................................................................................................... 68
Learning Objectives........................................................................................................................................ 68
Curriculum ..................................................................................................................................................... 68
Knowledge .............................................................................................................................................................. 68
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, Skills ...................................................................................................................................................................... 68
Attitude .................................................................................................................................................................. 68
Behaviour ............................................................................................................................................................... 68
Anaesthetic and Airway Equipment ................................................................................................................ 69
Airway Equipment .................................................................................................................................................. 69
Monitoring.............................................................................................................................................................. 71
Anaesthetic Drugs .......................................................................................................................................... 72
IV Induction Agents ................................................................................................................................................ 72
Inhalation Anaesthetics .......................................................................................................................................... 73
Neuromuscular blockers ........................................................................................................................................ 74
Inotropic Agents ..................................................................................................................................................... 75
Local Anaesthetics .................................................................................................................................................. 76
Antiemetics and antacids ....................................................................................................................................... 78
Analgesic Agents .................................................................................................................................................... 79
Anaesthetic Management .............................................................................................................................. 83
Pre-operative Assessment...................................................................................................................................... 83
Preoperative management .................................................................................................................................... 87
Postoperative management ................................................................................................................................... 89
Other Related Topics...................................................................................................................................... 91
Regional Anaesthesia ............................................................................................................................................. 91
CEPOD classification ............................................................................................................................................... 93
Critical Care ....................................................................................................................................................... 94
Core Knowledge............................................................................................................................................. 94
General Principles of Critical Care .......................................................................................................................... 94
Shock, Cardiovascular Failure and Resuscitation ................................................................................................... 99
Respiratory Failure and Oxygen Therapy ............................................................................................................. 101
Renal Failure ......................................................................................................................................................... 104
Neurological Injuries & Trauma ........................................................................................................................... 105
Infection Control .................................................................................................................................................. 107
Post-critical Care .................................................................................................................................................. 107
Ethics, Law, Death & Donation ............................................................................................................................. 108
Practical Procedures..................................................................................................................................... 114
To Perform............................................................................................................................................................ 114
To Observe ........................................................................................................................................................... 114
Emergency Medicine ........................................................................................................................................ 115
Curriculum ................................................................................................................................................... 115
Presenting Complaints & Core Conditions ..................................................................................................... 116
Abdominal Pain .................................................................................................................................................... 116
Atraumatic Leg Pain ............................................................................................................................................. 131
Breathlessness...................................................................................................................................................... 136
Chest Pain ............................................................................................................................................................. 144
Collapse ................................................................................................................................................................ 149
Deliberate Self Harm ............................................................................................................................................ 164
Headache.............................................................................................................................................................. 168
Infection ............................................................................................................................................................... 173
MSK Problems ...................................................................................................................................................... 179
Palpitations/ Dysrhythmia.................................................................................................................................... 183
Shock .................................................................................................................................................................... 188
Trauma ................................................................................................................................................................. 193
Urinary Problems.................................................................................................................................................. 194
Acute Breathlessness ........................................................................................................................................... 199
OSCE................................................................................................................................................................ 200
OSCE Stations .............................................................................................................................................. 200
Pre-Op Assessment ...................................................................................................................................... 201

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, Aims & Learning Objectives
 Apply legal and ethical principles in the care of acutely ill/unconscious patients with (temporary) lack of
capacity
 Appreciate (and have developed) a structured approach to the acutely ill or injured patient.
 Appreciate the multi-faceted approach to recognizing an acutely unwell patient (clinical assessment,
deranged physiology and/or MEWS and use of nearside investigations)
 Appreciate the patho-physiological changes that occur in acutely unwell or deteriorating patients and
recognise the importance of applying acute changes in a patient’s physiological status to their immediate
medical management.
 Assess acutely ill patients, incorporating communication with patients, relatives and other clinical staff
 Demonstrate competence in the simple interpretation of: blood gases, ECGs, CXRs, urinanalysis.
 Demonstrate competence in: obtaining blood gases (arterial and venous), using cannula packs, obtaining
blood samples, basic airway management, checking baseline observations , calculating the MEWS score,
emergency use of oxygen, setting up intravenous fluid and resuscitation.
 Demonstrate safe medicines management including decision making and supervised prescribing according to
the student formulary
 Have reflected on the acute assessment and further management of patients with common acute
presentations such as: chest pain, breathlessness, collapse, reduced consciousness, sepsis, confusion,
abdominal pain, head injury, overdose and haemorrhage.
 Understand basic principles of airway management, preoperative evaluation, peri- operative investigations,
fluid management, anaesthetic drugs, acute pain management and peri-operative oxygen delivery
 Understand the need for early escalation of care to appropriate seniors/specialties, good communication
(including SBARR) and sound teamwork in the management of acutely unwell patients.
 Understand the paramount importance of the placement is to recognise acutely ill or deteriorating patients
to ensure patient safety and reduce professional vulnerability in the clinical environment.
 Understand the peri-operative anaesthetic care of the surgical patient.
 Understand the principles of managing respiratory failure, shock and sepsis and VTE prophylaxis.
 Understand the usefulness and limitations of “near-side” investigations, in guiding clinical decisions in the
resuscitation of acutely unwell patients.




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