The University of Sydney

Residency Report.

Dominique Abela. SID:200027582

Log
No.
Triage
No.
Reason for
presentation
Signs and Symptoms Tests carried out Diagnosis Treatment
1 2 BIB-self

Unpalpable Blood
pressure
Dyspnoea 2/52
Feeling unwell 2/52
Vitals (High HR, low BP)
Puplis-Normal
GCS-Normal (15)
FBC-Normal
LFT- ALT, ALP, GGT.
Cardiac enzymes troponin
Blood chemistry anion gap, PO
4
Urea.
Haematology-Normal
CXr- Small to moderate left-sided pleural effusion
associated with collapse/consolidation of the left lung
base. Small right-sided pleural effusion.
Acute heart
failure
O
2
Therapy:5L/m
Hudson mask for
2h, then room air.

Tritace, Lasix
2 3 BIB-police.

Drunk & disorderly
behaviour
Dizziness
Vomiting.

Vitals-Normal.
O
2
therapy- room air.

Acute
alcohol
intoxication

Metoclopramide.
Electrolytes.

3 3 Coughing up blood
1/24
Haemoptysis Vitals- normal
Puplis-Normal
GCS-15
FBC-Normal
LFT- ALP
Cardiac enzymes Normal
Blood chemistry
Anion gap, Total globin.
Haematology-Normal
Bedside tests - Normal
CXr- In progress
Micro-organisms investigations- Sputum culture
preliminary report: nil epithelial cells, moderate
PMNs, moderate normal respitatory flora. Plates to
be re-incubated.
Not available Not available
4 2 BIB-self.

Self-harm.

Ingestion of
approximately 15
panadol tablets.
Anxious Vitals- Normal
Puplis-Normal
GCS-15
FBC-Normal
LFT-Normal
Blood chemistry Normal
Haematology-Normal
Psychiatric assessment- result not available


Self-harm. Kept in for
observation
overnight.
Referred to
psychiatric
management unit.
5 5 Cut lip due to fall. Upper lip laceration. Physical exam.
Radiographs (lateral ceph).

Lip laceration. Lignocaine.
Suturing.
Tetanus booster.
Paracetamol.
Amoxicillin.


6 2 Chest pain Sudden onset of
Palpitations
With chest pains 90/60.
Pain described as
heaviness
SOB,
Diaphoresis,
Nausea.
At triage palpitations
have stopped but
chest pain continues.
Vitals- Normal
Puplis-Normal
GCS-Normal (15)
ECG-ST elevation on serial ECG.
FBC-Normal
LFT-Normal.
Cardiac enzymes 1
st
Normal, 2
nd
raised.
Blood chemistry Normal.
Haematology-Normal
Coagulation-Normal
Endocronology-Normal
Angiography-in progress



Myocardial
infarction.

Acute: Oxygen,
clopidogrel, GTN,
morphine.


7 5 Headache 2/7 Hx of headache.
Taken panadol &
ibuprofen. Resolved
but then returned last
night.
Patient describes it as
right-sided frontal
headache near eye.
Night sweats.
Chills
Nausea.
Methadone therapy




Vitals-Normal
O
2
therapy- room air
Puplis-Normal
GCS-Normal (15)
FBC-Normal
LFT- Normal.
Blood chemistry Normal.
Bedside tests- Normal
Haematology-Normal
CT Brain- Normal.


Cluster
headache
Panadine Forte
8 3 Tachycardia post
sedation.
Midazolam taken in
morning for anxiety.
Mild diaphoresis.
NIDDM
Vitals-Normal except HR 130bpm, then 2h later
123bpm, then 4h later 82bpm.
O
2
therapy- room air.
ECG-Normal.
Puplis-Normal.
GCS-Normal (15).
FBC-Normal.
LFT- ALT, AST.
Blood chemistry Normal.
Bedside tests- Normal.
Haematology-Normal.
Coagulation- Normal.




Drug-induced
tachycardia and
associated
anxiety.
Patient kept under
observation and
HR monitoring
continued.

Patient was
discharged and
letter to G.P. given
for patient
management.
9 2 SOB


SOB 3/24
Flu-like symptoms for
2/52.
Previous Hx of Asthma

Vitals-Normal except RR 22.
O
2
therapy- 4L/m nasal prongs.
Puplis-Normal.
GCS-Normal (15).
FBC- WCC.
LFT- Normal.
Blood chemistry C-reactive protein.
Bedside tests- Normal.
Haematology-Normal.
Coagulation- Normal.

Acute
Bronchitis
Salbutamol
nebiliser.

Rulide
(roxithromycin)
antibiotic.

Salbutamol
inhaler. Serotide
inhaler.
10 1 BIBA Sudden onset of upper
limb numbness.
Slightly slurred
speech.
Right-sided facial
weakness.

Vitals- Normal
Puplis-Normal
GCS-Normal (12)
ECG-Normal.
FBC-Normal
LFT-Normal.
Cardiac enzymes Normal
Blood chemistry Normal.
Haematology-Normal
Coagulation-Normal
Endocronology-Normal
CT and MRI in progress.
Neurological exam: result not detailed.

Preliminary
diagnosis:
Transient
ischaemic
attack.
Further
tests &
monitoring.

Symptoms
resolved in 2/24

Clopidogrel
therapy.
11 5 Painful right eye Painful red eye 2/24.
Crusting around right
eye especially upon
waking.
Slight periorbial
inflammation

Vitals-Normal.
O
2
therapy- room air.
Puplis-Normal.
GCS-Normal (15).
Visual field & acuity testing-Normal.
Neurological exam-Normal.

Conjunctivitis Dorxy & Chlorsig.
12 2 BIBA Chest pain while at
home.
Previous Hx of Angina
NIDDM
Interpreter required.

Vitals-Normal.
O
2
therapy- 4L/m nasal prongs.
ECG-Normal.
Puplis-Normal.
GCS-Normal (15).
FBC-Normal.
LFT- AST.
Blood chemistry Normal.
Bedside tests- Normal.
Haematology-Normal.



Unstable angina GTN, referral to
cardiologist for
further testing.
13 5 Cut to finger Pain.
Laceration to left
index finger.
Occurred during meal
preparation


Examination
Vitals-Normal.
Superficial
lactertion to
tip of left
index finger.
Morphine.
Lignocaine.
Irrigation.
Suturing.
Amoxicillin

14 3 BIBA

Dizzy
Brought in from aged
care facility.
Dizzy.
Lethargic.
Diaphoresis

Vitals-Normal.
O
2
therapy- 4L/m nasal prongs.
ECG-Normal.
Puplis-Normal.
GCS-Normal (15).
FBC-Normal.
LFT- ALT, ALP.
Blood chemistry Normal.
Bedside tests-BSL 1.2
Haematology-Normal.


Hypoglycaemic
Episode.
Glucagon & glucose
drinks.
15 4 BIB-self & 2
female friends

Under the
influence of
ecstacy
Anxious.
In fear of life.
Swallowed 2 ecstacy
tablets 2/24 ago.
Never had ecstacy
before.
Vitals-Normal except HR 100bpm
Puplis-Normal
GCS-Normal (15)


Amphetamine
induced
psychosis
Patient kept for
observation and
psychological
assessment/
management.
16 4 Cut foot Pain.
Right foot laceration
(plantar surface).
Stepped on broken
glass.
Vitals-Normal.


Superficial
laceration.
Irrigation.
Tetanus booster.
Sutures &
dressing.
Paracetamol.
Amoxycillin.
17 5 BIB-Mother.

Collapsed 1/24
ago.
Light-headed.
Dizzy.
Nausea.
Hasnt eaten for 2/24.
Sun-exposure 4/24.

Vitals- Normal
Puplis-Normal
GCS-Normal (15)
FBC-Normal
LFT-Normal.
Blood chemistry-Na
+
, K
+
, Anion gap.
Haematology-Normal
Endocronology-Normal
Bedside tests: BSL 2.4
Neurological exam-Normal
Dehydration
and
hypoglycaemic.
I.V. fluid
replacement.

Glucagon and
glucose drinks.


18 3 BIB-police

Assult.
Assult 1.5/24 ago.
Pain in jaw.
Trismus
Bruising overlying
left face-eye and
lower jaw.


Vitals- Normal
Puplis-Normal
GCS-Normal (15)
Blood alcohol-3.2
FBC-Normal
LFT-Normal.
Blood chemistry-Normal.
Haematology-Normal
Neurological exam-Normal
Radiographs (PA: no evidence of fracture)
Facial trauma
to soft tissues
Paracetamol.
Ibuprofen. Or

19 4 BIB-partner

Abdominal pain.
Nausesa & vomiting
for 6/24.
Diarrhoea without
blood.
Onset 1.5/24 after
last meal (fried rice).
Abdominal pain 6/24.
Chills.

Vitals- Normal except temperature 38

C
Puplis-Normal
GCS-Normal (15)
FBC-Normal
LFT-Normal.
Blood chemistry-Na
+
, K
+
, Mg
+
, Anion gap.
Haematology-Normal
Tenderness in epigastric quadrant.

Food poisoning. I.V. fluid
replacement.

Stamatil
20 3 BIB Auburn
community health
team
For medical &
pshchological
review.

Seen in blacktown
yesterday re: post
incidence of
domestic violence.



23kg weight loss in
3/12.
Aggressive
outbursts.
Threatening to kill
family.
Emotionally labile.
Sucidal thoughts.
Has never had
suicidal thoughts or
violent outbursts
previously.
Vitals-Normal.
O
2
therapy- room air.
Puplis-Normal.
GCS-Normal (15).
FBC-Normal.
LFT- ALT, AST, GGT, ALP.
Blood chemistry Normal.
Bedside tests- Normal.
Haematology-Hb, RCC, Ht.
Coagulation- Normal.
Hepatitis C positive, viral load positive, Type 1a
genotype. Interferon therapy for the past 8/12.
Depression
(most likely
associated with
interferon
therapy)
Interferon
therapy to be
reviewed.

Patient referred
for psychological
assessment.
21 1 BIBA

Patient presents
with cardio/
respiratory arrest
Cardiac arrest
Down for 30 mins
Tip of the nasogastric
tube is coiled in a
retrocardiac location
suggesting of hiatus
hernia
Vital signs-Normal.
Blood chemistries-Normal.
Coagulation studies-Normal.
Hematology-Normal.
CT chest (multiple bilateral anterior rib fractures no
displacement), pelvis, abdomen (primary tumor in liver,
atrophic kidney), brain.


Anterior rib
fractures,
primary liver
tumor, atrophic
kidney

Discharged to the
care of local
medical officer
22 2 Referred by local
medical officer
for X-ray of facial
bones post alleged
assault.

Presents with
head injury.

LOC post incident ~ 1
min.
Laceration to right
zygomatic arch and
right eyebrow and
tenderness and bumps
to back of head.
Abrasions and swelling
to right cheek with
swelling to left cheek
Moderate amount of
subcutaneous
emphysema overlying
the malar region
Vital signs -Normal.
Glasgow coma scale-Normal.
CT facial bones (Undisplaced fracture through the
anterior maxillary sinus floor extending superiorly
into the orbital floor. Minimally displaced, slightly
depressed fracture through the left zygomatic arch).
Blood chemistry-Normal.
Haematology-Normal.
Coagulation studies-Normal.
Pupil size and reaction to light-Normal.
Assessed by maxillofacial surgeon
Multiple
uncomplicated
facial
fractures.
Discharged from
ED. Outpatient at
maxillofacial clinic
Outpatient at eye
clinic

Oral antibiotic for
1 week and avoid
nose blowing
23 2 BIB-self
Chest pain and
vomiting
Vomiting since last
night, then develops
chest pain
Central chest pain
radiates to shoulder
and neck
No relief with GTN
Vital signs-Normal.
Glasgow coma scale-Normal.
Blood chemistry-Normal.
Haematology-Normal.
Coagulation studies-Normal.
Chest X-ray-Normal.
Blood culture-Normal.



Morphine 2.5 mg.
Maxalon 10 mg.
Vitals monitored
Discharge to the
care of local
medical officer.
24 3 BIB-self
Presents with limb
pain
Swelling and bruising
to right elbow and
hand after altercation
with another resident
yesterday.
Patient denies pain
Vital signs-Normal.
Blood chemistry-Normal.
Hematology-Normal.
Coagulation studies-Normal.
Blood sugar level-6.2
Capillary refill time-Normal.
Antibody screen-Normal.
Radiography to the right elbow, foream, wrist, hand,
pelvis, hip. All clear.
Neurovascular observation of right arm. All clear

Discharge into
care of LMO.
25 3 Presents with
confusion
Becoming forgetful over
past few days, yawning a
lot
Vitals-Normal.
Blood chemistry-Normal.
Hematology-Normal.
Chest X ray-Normal.
Blood culture-Normal.
CT brain- all clear
Discharged to the
care of LMO.
26 3 Pain in left hip
after trip and fall.
Pain in left hip.
cellulitis in both
ankles.
ulcers on both hells
Glasgow comma scale (15)
Limb response-Normal.
Neurovascular exam-Normal.
Chest CT-Normal.
Discharged to the
care of LMO.
27 4 Pain to right side
of head
3 weeks history of
right pulsating
sensation to head.
Feeling hot

Vitals-Normal. Chronic
anxiety.
Intermittent
hypertension.
Headache.
Panadine forte.

Starting dose of
irbesartan 150 g
28 3 Lethargy.
SOB.
Unwell for last 2 day.
Productive cough with
white sputum.
SOB.
Intermittent
palpitations

Blood glucose level. 5.5
Vital signs-Normal.
CHX (moderate interstitial thickening particularly in
right lung, with nodular appearance suggesting
lymphangitis carcinoma. Moderate left pleural
effusion).
Limb response-Normal.
Glasgow coma scale score (15)
Lymphangitis
carcinoma. Left
pleural
effusion.


Discharged to the
care of LMO.
29 5 Sore eye. Patient is alert, normal
vision, non-distressed
Non-taken viral
conjunctivitis

Outpatient at Eye
clinic without
prior medical
30 5 Burn to left foot
two days ago
Red, inflamed area,
blistered.
Cellulitis on dorsum of
foot.
Afebrile
Vital signs-Normal.
Blood chemistry-Normal.
Hematology-Normal.
Antibody screen
Neurovascular test
Partial
thickness burn
to dorsum of
left foot
IV 1 g Ceftriaxone
for 3d.
Bactrgras
dressing


ABBREVIATIONS:
BIB= brought in by.
BIBA= brought in by ambulance.
SOB= Shortness of breath.
BP= Blood Pressure.
Vitals= Temperature (tympanic), Heart rate (HR),
Pulse Rate (PR), Respiratory rate (RR), Mean
Arterial Pressure (MAP), Oxygen saturation (SO2).
Pupils= react to light, size.
GCS= Glasgow coma scale. Eyes open, best verbal
response, best motor response.
Limb Assessment= Normal Power both right and left
arms and legs.
FBC= Full blood count.
LFT= Liver function tests.
ALT= Alanine aminotransferase.
AST=Aspartate aminotransferase.
ALP= Alkaline Phosphotase.
GGT= Gamma-glutamyltranspeptidase.
Cardiac Enzymes= Troponin.
Bedside tests= Uralysis with dip stick. Blood
glucose.
CXr= Chest x-ray.
PMN= polymorphonuclear granulocytes.
NIDDM= non-insulin dependent diabetes mellitus.

INTERESTING CASE:
Presenting Complaint: Collapse
History of presenting condition: Syncope whilst exercising on treadmill in the rehabilitation gym. Patient was unresponsive
for <1 minute, apnoes to staff. Given 2 rescue breaths then regained consciousness.
Summary of key events: Syncope. Patient was placed on oxycontin over 1 year ago for back pain. Dose has been decreased
over the past 7 months due to patient complaint of dizziness and recurrent presyncope episodes (light headedness lasting 5-
10seconds, settles with sitting down, onset occurs with exertion or posture). It is thought that these symptoms are related
to the oxycontin the patient is taking.
Past medical History: Chronic lumbar back pain. Physio regimen 3X/week. Laminectomy lumbar spine. Oxycontin for back
pain.
On Examination: BP 124/84 (nil postural drop), PR 72 regular, GCS14 appeared confused, secondary survey diffusely tender
over lower lumbar spine L3-5, chest clear.
Investigations: ECG-sinus rhythm, 80/min, nil ST-T wave changes, Bloods NAD, CT-C spine NAD, limb assessment NAD,
Pupils NAD.
Treatment: Patient observed and re-evaluated. GCS score 15. Patient discharged to home.
Follow-up appointments: LMO (Local medical officer) to follow up: 1. CT head (out patient) if persistant dizziness; 2.
Cardiology; 3. Continue weaning oxycontin.

REFLECTIONS:
1. PRIMARY CARE OF THE ACUTELY ILL AND TRAUMA PATIENT:
Principles involved in the initial assessment of a patient with major trauma/illness are those outlined by the AmericanCollege
of Surgeons (ACS) in their Advanced Trauma Life Support (ATLS) guidelines or those of the Australasian College of
Surgeons in the Early Management of Severe Trauma guidelines.
The principles involved consist of (1) preparation and transport; (2) primary survey and resuscitation, including monitoring,
urinary and nasogastric tube insertion, and radiography; (3) secondary survey, including special investigations, such as CT
scanning or angiography; (4) ongoing reevaluation; and (5) definitive care.
The primary survey aims to identify and treat immediately life-threatening injuries relying on the ABCDE system.
This system comprises airway control with stabilization of the cervical spine, breathing (work and efficacy),
circulation including the control of external hemorrhage, disability or neurologic status, and exposure or undressing
of the patient while also protecting the patient from hypothermia.
A = Airway should be check whilst spine in a neurtal position. When the airway is in jeopardy, or when the GCS score is
less than 8, an artificial airway is essential. Airway control is commonly achieved by means of rapid-sequence orotracheal
intubation.
B = Breathing. Assessment is by visual inspection of thoracic cage movement, palpation of the thoracic cage movement,
and auscultation of gas entry. One is assessing for inequalities from one side to the other, crepitus, and local movement
asymmetry as in paradoxic thoracic cage movement in flail chest. One is also evaluating for signs of impending
respiratory failure, such as uncoordinated thoracic cage and abdominal wall movement, accessory muscle use, and stridor.
C = Circulation. This assessment includes identifying and managing rapid external hemorrhage. This can often be achieved
with a simple pressure dressing, but surgical intervention may be required.
D = Disability. Brief assessment of neurologic status should be performed. This assessment should include the patient's
posture, pupil asymmetry, pupillary response to light, and a global assessment of patient responsiveness (A recommended
system is the AVPU method, as follows: A = Patient is awake, alert, and appropriate; V = Patient responds to voice; P =
Patient responds to pain; U = Patient is unresponsive). GCS should also be carried out at this stage.
E = Exposure. Disrobe Patient during the initial assessment and the subsequent secondary survey. This helps ensure that
significant injuries are not missed. Effort must be made to prevent significant hypothermia, using a warm ambient room
(28-30C), overhead heating, and warmed IV fluids, should be instituted. Temperature should be continually monitored.
Other monitors: catheters to monitor genitourinary system haemorrhage and urinary flow. Gastric drainage tubes should
be inserted in all major trauma patients.
Radiology: Basic radiographs such as portable AP chest and pelvis images. Cervical CT, Brain CT.
Secondary Survey: The secondary survey follows in the wake of correction of immediately life-threatening injury and
completion of the primary survey so it may not occur until after an emergency operation has been completed. The
secondary survey includes a detailed history, complete physical examination, additional radiologic examinations, and
special diagnostic studies.

Reevaluation. During the secondary survey, the ABCDE system should be used to constantly reevaluate the patient,
and an ongoing diagnostic and therapeutic plan should be revised, as indicated, by the patient's response to
intervention and diagnostic test results.

2. MANAGEMENT OF RESPIRATORY, CARDIOVASCULAR AND NEUROLOGICAL EMERGENCIES:
RESPIRATORY EMERGENCIES:
Acute severe asthma
Acute exacerbations of COPD
Pneumothorax
Tension pneumothorax
Massive pulmonary embolism
ACUTE SEVERE ASTHMA EMERGENCY MANAGEMENT: History > Differential diagnosis > Investigations > Assessment of
severity of acute asthma attack > Treatment > Discharge.
ACUTE EXACERBATIONS OF COPD EMERGENCY MANAGEMENT: Controlled oxygen therapy > Nebulized bronchodilators >
Steriods > Antibiotics > Physiotherapy > If no response repeat and consider I.V. aminophyline. > If no response consider 1.
Nasal intermittent pressure ventilation, 2. Intubation & ventilation, 3. Respiratory stimulant drug eg. Doxapram.
PNEUMOTHORAX EMERGENCY MANAGEMENT:
1

Pneumothorax:
SOB > Aspiration; Aspiration successful then consider discharge; Aspiration not successful > repeat aspiration, if this is not
successful then place chest drain.
No SOB > Consider discharge.
2

Pneumothorax:
SOB + >50yr + rim of >2cm on CXR > if yes then place Chest drain, if no then aspirate. If aspirations successful then
discharge if not successful then place chest drain.
MASSIVE PULMONARY EMBOLISM EMERGENCY MANAGEMENT: Oxygen 100% > Morphine 10mg iv + antiemetic if
patient in pain or distressed > if critically ill consider immediate surgery > IV access & start heparin > Systolic BP <90mmHg
start rapid colloid infusion, if still low BP dobutamine and aim for BP of 90mmHg. If BP still low consider noradrenaline. If
Still <90mmHg after 30-60min of standard treatment & clinically definite PE + no contraindications then give thrombolysis.
CARDIOVASCULAR EMERGENCIES:
Acute myocardial infarction.
Acute coronary syndrome.
Severe pulmonary oedema
Cardiogenic shock
Broad complex tachycardia
Narrow complex tachycardia
ACUTE MYOCARDIAL INFARCTION EMERGENCY MANAGEMENT: Attch & record a 12 lead ECG > High flow oxygen by
face mask, but caution in COPD patients. > IV access- FBC, U&E, Glucose, Lipids, Cardiac enzymes. > Brief assessment of
History of CV disease, risk factors of IHD, Contraindications for thrombolysis, Examination of BP, JVP, cardiac murmurs,
signs of heart failure, periperial pulses, scars from previous cardiac surgery. > Aspirin + morphine + GTN > Thrombolysis > B-
blocker . > CXR > Consider glucose, insulin, potassium for diabetes mellitus > Consider DVT prophylaxis > continue medication
except calcium channel antagonists.
NEUROLOGICAL EMERGENCIES:
Menigitis
Status epilepticus
Cerebral abscess
Head injury
Raised intracranial pressure
STATUS EPILEPTICUS EMERGENCY MANAGEMENT: Open and Maintain airway, lay in recovery position, Remove false
teeth, insert oral/nasal airway, intubate if necessary. > Oxygen + suction. > IV access and take blood, U&E, LFT, FBC,
glucose, calcium. Toxicology screen. > Thiamine if alcoholism or malnurishment suspected. > Correct hypotension with
fluids. > Slow iv bolus phase to stop seizures eg. Lorazepam. > if seizures continue start phenytoin or diazepam. > general
anaesthesia phase for continuing seizures.
3. PRIMARY CARE OF ORAL AND MAXILLOFACIAL EMERGENCIES:
Trauma to the maxillofacial anatomy requires special attention. Contained within the face are systems that control
specialized functions including seeing, hearing, smelling, breathing, eating, and talking. Also, the vital structures in the head
and neck region are intimately associated. Lastly, the psychological impact of disfigurement can be devastating.
The maxillofacial region is divided into 3 parts. The first part is the upper face, where fractures involve the frontal bone
and sinus. The second part is the midface. The midface is divided into upper and lower parts. The upper midface is where
maxillary Le Fort II and Le Fort III fractures occur and/or where fractures of the nasal bones, nasoethmoidal or
zygomaticomaxillary complex, and the orbital floor occur. Le Fort I fractures are in the lower part of the midface. The
third part of the maxillofacial region is the lower face, where fractures are isolated to the mandible.

Le Fort I Le Fort II Le Fort III (pictures courtesy of wikipedia)

The aetiology of facial trauma is varied. In an urban settings facial trauma is most often caused by assaults, followed by
motor vehicle and industrial accidents. The zygoma and mandible are the most commonly fractured bones during assaults. In
the community setting facial trauma is most often caused by motor vehicle accidents, assaults and recreational activities.
IMMEDIATE MAXILLOFACIAL TRAUMA MANAGEMENT: ABCDE (primary survey, radiology, secondary survey,
revaluation) > Oxygen > Treat for shock if required. > Treat seizures with diazepam. > Investigations: U&E, glucose, FBC,
blood alcohol, toxicology screen, Arterial blood gasses, clotting > Brief History: when? Where? How? Had fit? Lucid
interval? Alcohol?. > Evaluate lacerations of face and scalp. > Check for CSF leak, battle signs, racoon eyes. > Palapate the
neck posteriorly for tenderness and deformity.

4. SURGICAL TRIAGE AND ITS PRINCIPLES:

1. IMMEDIATELY LIFE THREATENING: Emergency (triage is bypassed and the patient is attended to immediately).
Those patients present with lifethreatening conditions and require attention and treatment within 2 minutes. Most
would have been brought in by ambulance and would be suffering from critical injuries such as cardiac arrest, life-
threatening trauma.

2. IMMINENTLY LIFE THREATENING: Patients present with critical illnesses or severe pain. Patient is attended to
within 10 minutes eg, burns, MVA, chest pain, and difficulty breathing.

3. POTENTIALLY LIFE THREATENING: Patient is attended to within 30 minutes. Patients present with serious
discomfort or distress such as severe illness, haemorrhage, major fractures, and severe dehydration.

4. POTENTIALLY SERIOUS: Patient is attended to within 1 hour. Patients present with illnesses of significant
complexity or severity, causing serious discomfort or distress. For instance, patients present with foreign body in the
eye, sprained ankle or migraine.

5. LESS URGENT conditions: Patient is attended to within 1.5 hours. Patients in this category have minor illnesses or
symptoms that may have been present for some time.

5. TYPES OF CONDITIONS PRESENTING IN THE EMERGENCY:
Preventable
I observed falls, MVAs, Self harm, ischaemic heart disease, trauma and chronic obstructive pulmonary disorders.

Emergencies Due to late presentation
Chronic back pain.
Related to sport/recreational activities, alcohol
I did not observe any sporting injuries in the time I was present in the department.































BIB=self Collapse
Syncope whilst exercising on treadmill in rehabilitation gym. Unresponsive for 1/60, Apnoec to staff, given 2 rescue
breaths and regained consciousness.