Summary of common acute emergency management and interpretation
1. A to E assessment
Brief history if patient can speak
Ask for SAMPLE -Symptoms (Is there any sob? Is there pain?), Allergies, Medication, Past
medical history, Last eaten, Event
If patient is unable to speak, ask nurses for information
Example: What happened to this patient?
Use look, listen, feel structure
A
Look-Chest movements mnemonic (C-PUT)
Paradoxical see-saw pattern
Usage of accessory muscles
Tracheal Tug
Listen- Abnormal sound – snoring, choking, gurgling, stridor
Feel- Airflow through mouth and nose
Management- spine injury? If not then head tilt chin lift, if yes, jaw thrust
Remove obvious obstruction and suction of then secretions
Airway adjuncts-oropharyngeal airway (with reduced consciousness to
overcome soft palate obstruction) nasopharyngeal for conscious patient
If not breathing, ventilate with mask and bag
B
Look- Respiratory rate mnemonic (RECCS)
Effort of breathing
Cyanosis
Cough
Sweating
Listen-Auscultation-air entry, vesicular breath sound, crepitation, wheeze ,vocal resonance
Feel- Chest expansion mnemonic (CPT)
Percussion notes
Tracheal deviation
Investigation: Oximeter (SpO2)
Peak flow
ABG
Chest x ray
C
Look- Peripheries
Capillary refill
Pulse rate
Blood pressure
JVP
Skin turgor over clavicle
Urine output
Pedal oedema
, Listen-heart sound
Investigation- ECG,2 large bore cannula, FBC, blood culture, LFT, U&E, Clotting factors, CRP,
D-dimer, troponin, fluid challenge, fluid balance chart
D
AVPU or GCS
Blood glucose
Pupils
Focused neurological exam
Signs of traumatic brain injury (back of the head, haematoma, CSF leakage through the
nose)
Management- if GCS <8, consider intubation
Treat reversible causes of reduced consciousness (Low glucose, opioid
overdose and seizure)
Consider further investigation: CT scan, urine toxicology, TFT, LP after excluding increased
ICP mnemonic (CULT)
E
Abdominal examination-inspection mnemonic (ATTE)
Palpation
Percussion
Auscultation
(SHRUG) - Stools, Hernia, Rectal examination, Urine dipstick, Genital examination
Top to toe: swelling ,rashes, redness, bleeding, gross lesions , scars, wound
Temperature
Environment (bedside)
Reassess the patient
Document the findings
Chart review-
Observation chart
Fluid chart
Drug Chart
If patient not improving, consider sbarr to senior
2. SBARR
SITUATIONAL
Hi, I am, a FYI calling from ---, may I know who am I speaking to?
I have a acutely unwell patient named ---, date of birth--- and NHS no --- from ---(timing)
who is suspected to have a --- and I would like you to review this patient
BACKGROUND
Mr--- presented with (chief complaint and relevant presenting symptoms) with a past
medical history of --------. She is on ---------- with strong family history of -----. A (investigation
1. A to E assessment
Brief history if patient can speak
Ask for SAMPLE -Symptoms (Is there any sob? Is there pain?), Allergies, Medication, Past
medical history, Last eaten, Event
If patient is unable to speak, ask nurses for information
Example: What happened to this patient?
Use look, listen, feel structure
A
Look-Chest movements mnemonic (C-PUT)
Paradoxical see-saw pattern
Usage of accessory muscles
Tracheal Tug
Listen- Abnormal sound – snoring, choking, gurgling, stridor
Feel- Airflow through mouth and nose
Management- spine injury? If not then head tilt chin lift, if yes, jaw thrust
Remove obvious obstruction and suction of then secretions
Airway adjuncts-oropharyngeal airway (with reduced consciousness to
overcome soft palate obstruction) nasopharyngeal for conscious patient
If not breathing, ventilate with mask and bag
B
Look- Respiratory rate mnemonic (RECCS)
Effort of breathing
Cyanosis
Cough
Sweating
Listen-Auscultation-air entry, vesicular breath sound, crepitation, wheeze ,vocal resonance
Feel- Chest expansion mnemonic (CPT)
Percussion notes
Tracheal deviation
Investigation: Oximeter (SpO2)
Peak flow
ABG
Chest x ray
C
Look- Peripheries
Capillary refill
Pulse rate
Blood pressure
JVP
Skin turgor over clavicle
Urine output
Pedal oedema
, Listen-heart sound
Investigation- ECG,2 large bore cannula, FBC, blood culture, LFT, U&E, Clotting factors, CRP,
D-dimer, troponin, fluid challenge, fluid balance chart
D
AVPU or GCS
Blood glucose
Pupils
Focused neurological exam
Signs of traumatic brain injury (back of the head, haematoma, CSF leakage through the
nose)
Management- if GCS <8, consider intubation
Treat reversible causes of reduced consciousness (Low glucose, opioid
overdose and seizure)
Consider further investigation: CT scan, urine toxicology, TFT, LP after excluding increased
ICP mnemonic (CULT)
E
Abdominal examination-inspection mnemonic (ATTE)
Palpation
Percussion
Auscultation
(SHRUG) - Stools, Hernia, Rectal examination, Urine dipstick, Genital examination
Top to toe: swelling ,rashes, redness, bleeding, gross lesions , scars, wound
Temperature
Environment (bedside)
Reassess the patient
Document the findings
Chart review-
Observation chart
Fluid chart
Drug Chart
If patient not improving, consider sbarr to senior
2. SBARR
SITUATIONAL
Hi, I am, a FYI calling from ---, may I know who am I speaking to?
I have a acutely unwell patient named ---, date of birth--- and NHS no --- from ---(timing)
who is suspected to have a --- and I would like you to review this patient
BACKGROUND
Mr--- presented with (chief complaint and relevant presenting symptoms) with a past
medical history of --------. She is on ---------- with strong family history of -----. A (investigation
