Scenario | Description | Worsening (See GP) | Red flags (111 or 999) | Lifestyle |
---|---|---|---|---|
Infection | Bacterial infection of area | Symptoms not resolving in 2-3 days | Sepsis- temp > 38, increased SOB, fever, rigors, confusion, unable to pass urine, | ?Practice good hygiene |
Anticoagulation | Blood thinning in response to AF/DVT/PE/Valve | SOB Limb pain, swelling, reddening Minor bleeds increased bruising |
Stroke Face Arm Speech Time Major Bleeding - urine, bowels, vomit, cough, nose not resolved in 10 mins Head injury Accident |
Hydration Mobility - no prolonged sitting/crossing legs Travel advice Healthy weight Reduce alcohol Stop smoking |
Hypertension | Raised blood pressure | Headache BP >150/95 |
BP > 180/120 Visual disturbance Nausea and Vomiting Chest pain Stroke FAST |
Reduce salt intake Balanced low-fat diet Exercise Drink less EToH and Caffeine Stop smoking |
Diabetes | Reduced response to insulin, so high blood sugar concentration, this can cause complications/damage to organs | Tingling or numbness in limbs Eyes blurred vision, floaters Hypoglycaemia - drowsy, irritable If unwell sick day rules for in event of poor eating and drinking > Gliclazide risk of Hypos/Metformin Lactic Acidosis |
Hypoglycaemia - loss of conciousness, aggressive, seizures | Balanced diet, less sugar, fat, salt Regular meals - don't skip 2-3 hours of activity per week Lose weight BMI |
Condition | Description | Inspection | Trachea | Palpation | Percussion | Auscultation | Tactile vocal fremitus, bronchophony, egophony and whispered pectoriloquy |
---|---|---|---|---|---|---|---|
Consolidation | Likely infection within the lung. It is due to material, usually purulent, filling the alveoli | Increased SOB and resp rate | Central | Decreased expansion | Dull | Crackles/Rhonchi | Increased |
Pneumothorax | Air in the pleural cavity. This occurs when there is a breach of the lung surface or chest wall which allows air to enter the pleural cavity and consequently cause the lung to collapse. | Increased SOB and resp rate | Shifts away from affected side | Decreased expansion | Hyper resonant | Reduced/Absent breath sounds | Decreased/Absent |
Pulmonary Oedema | Abnormal accumulation of fluid in the extravascular compartments of the lung parenchyma | Increased SOB and resp rate | Central | Equal expansion/may be reduced | Resonant | ?Fine Crackles | Decreased |
Acute Asthma | Inflammatory disease of the airways of the lungs. Reversible airflow obstruction, and easily triggered bronchospasms | Increased SOB and resp rate | Central | Decreased expansion symmetrically | Hyper resonant | Red Flag - Silent Chest Reduced Vesicular breath sounds Expiratory Wheeze |
Decreased/Absent |
Drug/Class | C/Is/Cautions | Preg | Likely interactions |
---|---|---|---|
Metformin | Acute metabolic acidosis | No issues | |
Gliclazide | Ketoacidosis Risk of Hypos |
Risk of neonatal hypos | |
Sitagliptin | Ketoacidosis | Avoid | |
Pioglitazone | Bladder Cancer Heart failure Macroscopic Haematuria |
Avoid |
Drug/Class | C/Is | Preg | Likely interactions |
---|---|---|---|
ACEi/ARBS Ramipril |
Age Afro-caribbean Angioedema |
Avoid unless essential | |
Calcium channel blocker Amlodipine |
Unstable angina Aortic Stenosis Cardiogenic Shock |
Manf says avoid - unless critical to managing HTN | |
Beta-blocker Bisoprolol |
Asthma Peripheral Arterial Disease Uncontrolled heart failure AV blocks |
Can cause growth restriction Labetalol usually used |
?Digoxin |
Diuretic - Thiazide like Indapamide |
Addisons ?Gout |
Avoid |
Drug/Class | C/I | Preg | Likely interactions |
---|---|---|---|
LMWH | ?Needlephobia | Preferred option | |
DOAC | Pregnancy | Avoid | Most things |
Warfarin + LMWH bridge | Pregnancy | No Avoid in first and third trimesters |
Might be able to manage |