Meeting with doctor in CUH

We met with Deborah Ryan in CUH on Monday 29th January and she outlined a typical case of a patient entering A&E. Here is a rough transcript of what she said:

Case #1

A 36 year old male, one week post-op, driven in by a member of his family.

The nurse takes the info from the patient and passes it on to the doctor.

Info :
Lower abdominal pain
One week post appendicectomi
Epigastric
Some distension
Feeling nauseous
Feeling unwell
Mild tachycardia
Heart Rate : 105
Blood Pressure, stable, 135/85
No temperature

Blood is taken by the nurse in A&E
Doctor should cross check whether the patient was in before.
Doctor comes to patient who is lying on bed in a cubicle.
The patient hasn’t vomited
Mild pain
Mild constipation
Epigastric pain
Right lower quadrant pain
Blood pressure is a little bit high.

Past Medical History:
High cholesterol – on a high dose of medication for it (14mgs)
Past history of alcohol abuse
On a binge the night before
Was on a binge the night before the operation
Put some of the pain down to the drink
Smokes 10 – 15 cigarettes a day
Married, one child

Family History:
No major diseases
Uncle died suddenly in his 40s (maybe heart related)

Review Symptoms:
No headache
Some dizziness
On Tranadol (painkillers)
No urinary symptoms
Tachycardic

On examination (takes about 15 minutes):
Pale
Unwell
Sweating
Abdomen mildly distended
Bowel signs are present
Respiratory system is clear
Chest is clear
Cardiovascular heart sounds 1 & 2, no murmurs

Neuro examination:
Grossly normal

Repeated checking of vital signs:
Still tachycardic
Blood pressure 150/85

After examination:
Doctor looks for an ECG (nurse places order)
Orders bloods (fills out forms)
Orders chest X-rays

Checks last weeks blood results:
High cholesterol (increase risk)

Run cardiac enzymes
Labs have problems running bloods because there are too many liquids in them
ECG shows SVT

If the patient becomes unstable:
Shock him using Defibrillator

If the patient is stable:
Give medication
Painkillers
IV access
Oxygen

Later, the patient is experiencing no pain:
Add on cardiac enzymes
Look for a repeat ECG and cardiac monitoring

At this point, the doctor would start looking for help from the senior doctors