Pre hospital management
How do we assess a patient? (Please refer to Appendix -1)
Consent?
Primary survey-ABCDE negative or positive?
Secondary survey – SOAP (subjective data, objective data, assessment, Plan) Why SOAP is important? (Appendix -2)
Data gathering tools. SAMPLER, SOCRATES
How effective are these tools? Does taking history only rule in/out a diagnosis? (Evidence research please for peer reviewed journal or book)
Consultation models and why they are useful?
(Such as; Cambridge model- structured well- how effective are they -in brief)
What are the tools with which we make decisions? How useful are these?
Are there any limitation in diagnostic tools in pre-hospital setting?
Diagnosis and Management: (650 words)
What mechanisms or diagnostic tools do we have to help? (Such as; News score 2/sepsis screening tool- relevant to a case study)
What are our choices of treatment?
Do they follow guidance, and is that local or national?
What is the evidence base behind our choices?
Referral of patients to an appropriate health care setting, medical practitioner or to other agencies.
Appendix 1:
Case study of 68-year-old female (Mrs X)- presenting with pyrexia and abdominal pain.
On the arrival on the scene, Mrs X answered a door for an ambulance crew, she said she has woken this morning with a high temperature and complains having a low abdominal pain and back pain since last 24 hours. She said she has been sitting on her armchair with a hot water bag placing on her abdomen and reported having a frequent small urination and discomfort whilst urinating. Mrs X lives alone, found to be alert with GCS 15.
Appendix 2:
Primary Survey
Airway: Patent and clear
Breathing: RR 22, Spo2 99% on air, equal chest rise
Circulation: HR 103, BP 110/60, Strong regular pulse
Disability: Temperature 39, GCS 15, Normal BM
Examine: Suprapubic abdominal tenderness and lower back tenderness
Appendix 3:
Secondary Survey (SOAP)
S= Subjective Data:
Patient complaining of her low abdominal pain and discomfort while micturating.
Patient states having a burning sensation when urinating & increased frequency to urinate with reduced output
Patient states her urine slightly cloudy but denies haematuria
Patients states normal bowel, denies any dizziness or confusion and denies vomiting & nausea
Denies shortness of breath
O= Objective Date:
Vital signs
Well hydrate
No history of UTI and no other past medical history
Suprapubic abdominal tenderness, lower back tenderness.
bowel sound normal
A= Assessment
Based on history and examination
Likely- UTI
Unlikely – pyelonephritis
Rare: Appendicitis
P=Plan
Impression?
ASHICE (enroute handover to hospital)
Iv paracetamol administered? (follow JRCALC for drug management)
Preparation of Morphine if patient still have constant pain following the paracetamol administration.
Fluid if BP drops and Ondansetron for nausea/vomiting.
