What Would Doctor Do?

WhatWould Doctor Do?

START

Please choose from one of the cases below

Case 1

Case 3

Case 2

Case 4

Case 1

You are an FY1 doctor on-call and you have been bleeped to see a 53 year old gentleman on the Acute Medical Unit with increasing shortness in breath. Please review and proceed as appropriate.

Begin >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

0900 AMU F1 Dr. R/V

You have taken a history and examined the patient. These were your findings

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline SHx Smoker - 1 pack a day for past 25 years Alcohol - few cans of beer at the weekend Lives alone after wife died last year Nil recent travel

History

52M 3/7 ↑SOB 5/10 Chest pain, 2/7 onset, localising around right lower rib border, associated with coughing and resolving after few minutes. Productive cough in last 24 hours of pale grey sputum with occasional specks of blood. SOB at rest PMHx Hypertension STEMI 18 months ago Depression

Next >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

0900 AMU F1 Dr. R/V

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline SHx Smoker - 1 pack a day for past 25 years Alcohol - few cans of beer at the weekend Lives alone after wife died last year Nil recent travel

History

53M 3/7 ↑SOB 5/10 Chest pain, 2/7 onset, localising around right lower rib border, associated with coughing and resolving after few minutes. Productive cough in last 24 hours of pale grey sputum with occasional specks of blood. SOB at rest PMHx Hypertension STEMI 18 months ago Depression

Next Page >

Name: John Dolan DOB: 01/01/1970

0900 AMU F1 Dr. R/V

Examination

Resp Crackles + ↓ Air entry on right lower zone

CVS HR - 110 bpm HS - I+II+0 Calves SNT with mild pitting oedema at the ankles

GI Abdo SNT

< Previous Page

Patient Notes

Welcome to the patient bedside

Around the bay you will find a variety of interactable areas. Hover your mouse around to explore.

Patient Notes

Consultant Helpline

"Have you considered any differentials for what seems to be going on? Do some intial investigations to get a better picture - these can be found in the trolley by the bedside "

Initial Investigations

COVID Test

Peak Flow

NEWS Chart

Capillary Glucose

Urine Dip

ECG

Initial Investigations

COVID Test

Peak Flow

NEWS Chart

Capillary Glucose

Urine Dip

ECG

Initial Investigations

COVID Test

Peak Flow

NEWS Chart

Capillary Glucose

Urine Dip

ECG

Initial Investigations

COVID Test

Peak Flow

NEWS Chart

Capillary Glucose

Urine Dip

ECG

Initial Investigations

COVID Test

Peak Flow

NEWS Chart

Capillary Glucose

Urine Dip

ECG

Initial Investigations

COVID Test

Peak Flow

NEWS Chart

Capillary Glucose

Urine Dip

ECG

Initial Investigations

COVID Test

Peak Flow

NEWS Chart

Capillary Glucose

Urine Dip

ECG

Initial Investigations

COVID Test

Peak Flow

NEWS Chart

Capillary Glucose

Urine Dip

ECG

Continue →

Patient Notes

The Notes have been updated →

Computer unlocked

Patient Notes

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

0900 AMU F1 Dr. R/V

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline SHx Smoker - 1 pack a day for past 25 years Alcohol - few cans of beer at the weekend Lives alone after wife died last year Nil recent travel

History

53M 3/7 ↑SOB 5/10 Chest pain, 2/7 onset, localising around right lower rib border, associated with coughing and resolving after few minutes. Productive cough in last 24 hours of pale grey/yellow sputum with occasional specks of blood. SOB at rest PMHx Hypertension STEMI 18 months ago Depression

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Investigation Summary

0900 AMU F1 Dr. R/V

Examination

NEWS - 9 RR - 32 SATS 92% RA SBP 107 HR 115 Temp 38.9°C BM 7.4mmol/L ECG

Peak Flow 500L/min (expected 610L/min) Urine Dip Leuk - negative Nitrate - negative Blood - negative Covid Test - negative

Resp Crackles + ↓ Air entry on right lower zone

CVS HR - 110 bpm HS - I+II+0 Calves SNT with mild pitting oedema at the ankles

GI Abdo SNT

< Previous Page

Welcome to the Investigations Portal

Welcome to the Investigations Portal

Begin >

What investigations would you like to order?

Radiology

Bloods

Name: John Dolan DOB: 01/01/1970

Examination

GI Abdo SNT

0900 AMU F1 Dr. R/V

Resp Crackles + ↓ Air entry on right lower zone

CVS HR - 110 bpm HS - I+II+0 Calves SNT with mild pitting oedema at the ankles

Investigation Summary

Name: John Dolan DOB: 01/01/1970

NEWS - 9 RR - 32 SATS 92% RA SBP 107 HR 115 Temp 38.9°C BM 7.4mmol/L Covid Test Negative ECG

Peak Flow 500L/min (expected 610L/min) Urine Dip Leuk - negative Nitrate - negative Blood - negative

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

0900 AMU F1 Dr. R/V

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline SHx Smoker - 1 pack a day for past 25 years Alcohol - few cans of beer at the weekend Lives alone after wife died last year Nil recent travel

History

53M 3/7 ↑SOB 5/10 Chest pain, 2/7 onset, localising around right lower rib border, associated with coughing and resolving after few minutes. Productive cough in last 24 hours of pale grey/yellow sputum with occasional specks of blood. SOB at rest PMHx Hypertension STEMI 18 months ago Depression

Next Page >

Bloods Request Form

CRP

TFTs

FBC

LFTs

Blood Gas

D-Dimer

Blood Cultures

Troponins

Coagulation Screen

U&Es

Autoantibody Screen

Patient Notes

Blood Gas Analysis

Which of the following best describe the results shown.

NAME: John Dolan DOB: 01/01/1970

Arterial Sample

PaO2 12.3 (11-13 kPa) pH 7.23 (7.35 - 7.45) PaCO2 4.9 (4.5 - 6.0 kPa) SpO2 90% (95-100%)HCO3 20.2 (22-28 mmol/L) ———————————————————- Na+ 140 (135-145mmol/L) K+ 4.5 (3.5-5 mmol/L) Cl- 100 (94-107 mmol/L) Lac 5 (<2 mmol/L)

Metabolic acidosis without compensation

CORRECT!!

Click to continue →

For more information regarding ABGs check out the help icon at the top of the page.

INCORRECT Please try again.

For help with analysing ABGs, check out the help icon at the top of the page.

Respiratory acidosis with partial metabolic compensation

Respiratory alkalosis without compensation

Metabolic acidosis with partial respiratory compensation

Bloods Request Form

CRP

TFTs

FBC

LFTs

Blood Gas

D-Dimer

Blood Cultures

Troponins

Coagulation Screen

U&Es

Autoantibody Screen

Patient Notes

Continue →

Radiology Request Form

MRI

High Resolution CT

Echo- cardiography

CTPA

USS Doppler

PET Scan

CT - CAP

Chest X-Ray

Patient Notes

Chest X- Ray Interpretation

Which of the following best describe the scan shown.

NAME: John Dolan DOB: 01/01/1970

Bilateral hilar opacification

CORRECT!!

Click to continue →

For more information regarding CXRs check out the help icon at the top of the page.

INCORRECT Please try again.

For help with analysing CXRs, check out the help icon at the top of the page.

Hyperinflated lungs + flattened left diaphragm

Dense opacificaton in the right lower lobe

Alveolar oedema + upper lobe diversion

Radiology Request Form

MRI

High Resolution CT

Echo- cardiography

CTPA

USS Doppler

PET Scan

CT - CAP

Chest X-Ray

Patient Notes

Finish →

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

0900 AMU F1 Dr. R/V

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline SHx Smoker - 1 pack a day for past 25 years Alcohol - few cans of beer at the weekend Lives alone after wife died last year Nil recent travel

History

53M 3/7 ↑SOB 5/10 Chest pain, 2/7 onset, localising around right lower rib border, associated with coughing and resolving after few minutes. Productive cough in last 24 hours of pale grey/yellow sputum with occasional specks of blood. SOB at rest PMHx Hypertension STEMI 18 months ago Depression

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Investigation Summary

0900 AMU F1 Dr. R/V

Examination

NEWS - 9 RR - 32 SATS 92% RA SBP 107 HR 115 Temp 38.9°C BM 7.4mmol/L ECG

Peak Flow 500L/min (expected 610L/min) Urine Dip Leuk - negative Nitrate - negative Blood - negative Covid Test - negative

Resp Crackles + ↓ Air entry on right lower zone

CVS HR - 110 bpm HS - I+II+0 Calves SNT with mild pitting oedema at the ankles

GI Abdo SNT

< Previous Page

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Investigation Summary cont.

USS doppler Findings → Bilateral mild diffuse subcutaneous oedema. → Vessels appear patent with minimal signs of narrowing or occlusion identified. CTPA Findings → Focal lucencies measuring between 0.5-1 cm in diameter located in the upper zones of the apical and posterior segment in the upper lobe of the right lung. → Dense ground-glass opacification of majority of the right lower lobe CXR Findings Dense consolidation of the right lower lobe

Admission Bloods WCC 25.2 Na+ 140 K+ 4.3 Urea 7.5 Creat. 115

D-Dimer 647 CRP 30 INR 2 Trop. I 0.25

PaO2 12.3 (11-13 kPa) pH 7.23 (7.35 - 7.45) PaCO2 4.9 (4.5 - 6.0 kPa) SpO2 90% (95-100%)HCO3 20.2 (22-28 mmol/L) Lac 5 (<2 mmol/L)

< Previous Page

Patient Notes

The Notes have been updated →

Management Trolley unlocked

Name: John Dolan DOB: 01/01/1970

Plan

How would you like to proceed?

Refer for spirometry testing

Begin antibiotic treatment

Discharge home with safety netting

Refer to Oncology

Organise transfer to Cath Lab

Before you begin antibiotic treatment what score would you use to decide the severity of his condition?

CORRECT!!

Click to continue →

INCORRECT Please try again.

CHADSVASC

Wells Score

GRACE Score

CURB-65

AMT-4

PHQ-9 Score

APGAR Score

QRISK Score

Calculate the CURB Score

INCORRECT Please try again.

For help with remembering CURB-65, check out the help icon at the top of the page.

CORRECT!!

Click to continue →

For more information regarding CURB-65 check out the help icon at the top of the page.

Patient Notes

You have calculated that the CURB score is 2. What next?

Admit to the wards

Discharge home with safety netting

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

0900 AMU F1 Dr. R/V

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline SHx Smoker - 1 pack a day for past 25 years Alcohol - few cans of beer at the weekend Lives alone after wife died last year Nil recent travel

History

53M 3/7 ↑SOB 5/10 Chest pain, 2/7 onset, localising around right lower rib border, associated with coughing and resolving after few minutes. Productive cough in last 24 hours of pale grey/yellow sputum with occasional specks of blood. SOB at rest PMHx Hypertension STEMI 18 months ago Depression

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Investigation Summary

0900 AMU F1 Dr. R/V

Examination

NEWS - 9 RR - 32 SATS 92% RA SBP 107 HR 115 Temp 38.9°C BM 7.4mmol/L ECG

Peak Flow 500L/min (expected 610L/min) Urine Dip Leuk - negative Nitrate - negative Blood - negative Covid Test - negative

Resp Crackles + ↓ Air entry on right lower zone

CVS HR - 110 bpm HS - I+II+0 Calves SNT with mild pitting oedema at the ankles

GI Abdo SNT

< Previous Page

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Investigation Summary cont.

USS doppler Findings → Bilateral mild diffuse subcutaneous oedema. → Vessels appear patent with minimal signs of narrowing or occlusion identified. CTPA Findings → Focal lucencies measuring between 0.5-1 cm in diameter located in the upper zones of the apical and posterior segment in the upper lobe of the right lung. → Dense ground-glass opacification of majority of the right lower lobe CXR Findings Dense consolidation of the right lower lobe

Admission Bloods WCC 25.2 Na+ 140 K+ 4.3 Urea 7.5 Creat. 115

D-Dimer 647 CRP 30 INR 2 Trop. I 0.25

PaO2 12.3 (11-13 kPa) pH 7.23 (7.35 - 7.45) PaCO2 4.9 (4.5 - 6.0 kPa) SpO2 90% (95-100%)HCO3 20.2 (22-28 mmol/L) Lac 5 (<2 mmol/L)

< Previous Page

You start planning to move the patient up to ward, when you get a call from AMU...

Continue →

"Hiya, this is Terry the nurse-in-charge on AMU. I am calling because I am worried about one of your patients, John Dolan, please can you review them."

Continue →

Patient Notes

"Hi, thanks for coming down. I understand that you are already aware of the patient so I will keep it brief. Over the last hour, he has been getting more and more confused. One of your collegues have already re-examined him, they wrote their findings in the patients notes. They have asked that you chase the new bloods and scan results and proceed as required."

Begin

You discharge the patient home with advice to return if his condition deteriorates.

Continue →

The Next Day: AM Handover

"Hiya, this is Sarah the F1 on AMU overnight, I am just calling to handover a patient 53M John Dolan..."

Continue →

Patient Notes

"Hi, thanks for coming down. I understand that you are already aware of the patient so I will keep it brief. He was brought in by ambulance around 3 hours ago. Paramedics found him delirious and confused. You can read my findings in the notes, but I have sent off the bloods and ordered all the investigations, can you chase them please?"

Begin

Patient Notes

The notes have been updated →

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

0900 AMU F1 Dr. R/V

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline SHx Smoker - 1 pack a day for past 25 years Alcohol - few cans of beer at the weekend Lives alone after wife died last year Nil recent travel

History

53M 3/7 ↑SOB 5/10 Chest pain, 2/7 onset, localising around right lower rib border, associated with coughing and resolving after few minutes. Productive cough in last 24 hours of pale grey/yellow sputum with occasional specks of blood. SOB at rest PMHx Hypertension STEMI 18 months ago Depression

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Investigation Summary

0900 AMU F1 Dr. R/V

Examination

NEWS - 9 RR - 32 SATS 92% RA SBP 107 HR 115 Temp 38.9°C BM 7.4mmol/L ECG

Peak Flow 500L/min (expected 610L/min) Urine Dip Leuk - negative Nitrate - negative Blood - negative Covid Test - negative

Resp Crackles + ↓ Air entry on right lower zone

CVS HR - 110 bpm HS - I+II+0 Calves SNT with mild pitting oedema at the ankles

GI Abdo SNT

< Previous Page

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Investigation Summary cont.

USS doppler Findings → Bilateral mild diffuse subcutaneous oedema. → Vessels appear patent with minimal signs of narrowing or occlusion identified. CTPA Findings → Focal lucencies measuring between 0.5-1 cm in diameter located in the upper zones of the apical and posterior segment in the upper lobe of the right lung. → Dense ground-glass opacification of majority of the right lower lobe CXR Findings Dense consolidation of the right lower lobe

Last Admission Bloods WCC 25.2 Na+ 140 K+ 4.3 Urea 7.5 Creat. 115

D-Dimer 647 CRP 30 INR 2 Trop. I 0.25

PaO2 12.3 (11-13 kPa) pH 7.23 (7.35 - 7.45) PaCO2 4.9 (4.5 - 6.0 kPa) SpO2 90% (95-100%)HCO3 20.2 (22-28 mmol/L) Lac 5 (<2 mmol/L)

< Previous Page

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Examination A - Airway intact B - Crepitus + ↓ air entry throughout RHS RR 38 SATS 90% RAC - CRT >2 sec, HR 127, BP 105/58, HS I+II+0, dry mucous membranesD - BM 6.3, PEARL, GCS 13/15, ↓urine output, Temp 39.7°C AMT 2/4E - NAD Plan ○ Chase bloods and cultures ○ Chase radiographs

AMU F1 Dr. R/V

History 53M c/o ↑SOB, RHS CP on inspiration, high fever + new onset consfusion.

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline

PMHx Hypertension STEMI 18 months ago Depression

< Previous Page

Patient Notes

The investigation results have been updated on the computer system ↓

Welcome to the Investigations Portal

Welcome to the Investigations Portal

Begin >

What investigations would you like to see?

Radiology

Bloods

Bloods Request Form

CRP

TFTs

FBC

LFTs

Blood Gas

D-Dimer

Blood Cultures

Troponins

Coagulation Screen

U&Es

Autoantibody Screen

Radiology →

Radiology Request Form

MRI

High Resolution CT

Echo- cardiography

CTPA

USS Doppler

PET Scan

CT - CAP

Chest X-Ray

Finish →

Patient Notes

The notes have been updated →

local guidelines →

Management Trolley unlocked ↓

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

0900 AMU F1 Dr. R/V

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline SHx Smoker - 1 pack a day for past 25 years Alcohol - few cans of beer at the weekend Lives alone after wife died last year Nil recent travel

History

53M 3/7 ↑SOB 5/10 Chest pain, 2/7 onset, localising around right lower rib border, associated with coughing and resolving after few minutes. Productive cough in last 24 hours of pale grey/yellow sputum with occasional specks of blood. SOB at rest PMHx Hypertension STEMI 18 months ago Depression

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Investigation Summary

0900 AMU F1 Dr. R/V

Examination

NEWS - 9 RR - 32 SATS 92% RA SBP 107 HR 115 Temp 38.9°C BM 7.4mmol/L ECG

Peak Flow 500L/min (expected 610L/min) Urine Dip Leuk - negative Nitrate - negative Blood - negative Covid Test - negative

Resp Crackles + ↓ Air entry on right lower zone

CVS HR - 110 bpm HS - I+II+0 Calves SNT with mild pitting oedema at the ankles

GI Abdo SNT

< Previous Page

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Investigation Summary cont.

USS doppler Findings → Bilateral mild diffuse subcutaneous oedema. → Vessels appear patent with minimal signs of narrowing or occlusion identified. CTPA Findings → Focal lucencies measuring between 0.5-1 cm in diameter located in the upper zones of the apical and posterior segment in the upper lobe of the right lung. → Dense ground-glass opacification of majority of the right lower lobe CXR Findings Dense consolidation of the right lower lobe

Last Admission Bloods WCC 25.2 Na+ 140 K+ 4.3 Urea 7.5 Creat. 115

D-Dimer 647 CRP 30 INR 2 Trop. I 0.25

PaO2 12.3 (11-13 kPa) pH 7.23 (7.35 - 7.45) PaCO2 4.9 (4.5 - 6.0 kPa) SpO2 90% (95-100%)HCO3 20.2 (22-28 mmol/L) Lac 5 (<2 mmol/L)

< Previous Page

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Examination A - Airway intact B - Crepitus + ↓ air entry throughout RHS RR 38 SATS 90% RAC - CRT >2 sec, HR 127, BP 105/58, HS I+II+0, dry mucous membranesD - BM 6.3, PEARL, GCS 13/15, ↓urine output, Temp 39.7°C AMT 2/4E - NAD Plan ● Chase bloods and cultures ● Chase radiographs

AMU F1 Dr. R/V

History 53M c/o ↑SOB, RHS CP on inspiration, high fever + new onset consfusion.

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline

PMHx Hypertension STEMI 18 months ago Depression

< Previous Page

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Latest Investigations

CXR Findings

Bloods WCC 36.3 (25.2) Na+ 135 (140) K+ 4.9 (4.3) Urea 12.9 (7.5) Creat. 198 (115)

CRP 45 (30)

Previous CXR

Recent CXR

PaO2 10.2 (12.3) (11-13 kPa) pH 7.13 (7.23) (7.35 - 7.45) PaCO2 4.6 (4.9) (4.5 - 6.0 kPa) HCO3 18.7 (20.2) (22-28 mmol/L) Lac 9.7 (5) (<2 mmol/L)

Plan ○ Start treatment

< Previous Page

Patient Notes

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Examination A - Airway intact B - Crepitus + ↓ air entry throughout RHS RR 38 SATS 90% RAC - CRT >2 sec, HR 127, BP 105/58, HS I+II+0, dry mucous membranesD - BM 6.3, PEARL, GCS 13/15, ↓urine output, Temp 39.7°C AMT 2/4E - NAD Plan ● Chase bloods and cultures ● Chase radiographs

AMU F1 Dr. R/V

History 53M c/o ↑SOB, RHS CP on inspiration, high fever + new onset consfusion.

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline

PMHx Hypertension STEMI 18 months ago Depression

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Latest Investigations

CXR Findings

Bloods WCC 36.3 (25.2) Na+ 135 (140) K+ 4.9 (4.3) Urea 12.9 (7.5) Creat. 198 (115)

CRP 45 (30)

Previous CXR

Recent CXR

PaO2 10.2 (12.3) (11-13 kPa) pH 7.13 (7.23) (7.35 - 7.45) PaCO2 4.6 (4.9) (4.5 - 6.0 kPa) HCO3 18.7 (20.2) (22-28 mmol/L) Lac 9.7 (5) (<2 mmol/L)

Plan ○ Start treatment

< Previous Page

Patient Notes

Which of the following is the most important task to tackle first?

INCORRECT

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Begin fluid resusicitation

CORRECT!!

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For more information check out the help icon at the top of the page.

Begin antibiotic treatment

Begin O2 supplementation

Prescribe an antipyretic

Patient Notes

Which of the following is the most important task to tackle first?

INCORRECT

For help with task prioritisation, check out the help icon at the top of the page.

Click to try again →

Begin fluid resusicitation

CORRECT!!

Click to continue →

For more information check out the help icon at the top of the page.

Begin antibiotic treatment

Begin O2 supplementation

Prescribe an antipyretic

The patient is requiring additional oxygen. Which O2 regimen would be most appropriate?

Intubate the patient

CORRECT!!

Click to continue →

For more information check out the help icon at the top of the page.

INCORRECT

For help with airway management , check out the help icon at the top of the page.

Click to try again →

15L via NRB

10L va CPAP

15L via Venturi

The patient is requiring additional oxygen. Which O2 regimen would be most appropriate?

Intubate the patient

CORRECT!!

Click to continue →

For more information check out the help icon at the top of the page.

INCORRECT

For help with airway management , check out the help icon at the top of the page.

Click to try again →

15L via NRB

10L va CPAP

15L via Venturi

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Examination A - Airway intact B - Crepitus + ↓ air entry throughout RHS RR 38 SATS 90% RAC - CRT >2 sec, HR 127, BP 105/58, HS I+II+0, dry mucous membranesD - BM 6.3, PEARL, GCS 13/15, ↓urine output, Temp 39.7°C AMT 2/4E - NAD Plan ● Chase bloods and cultures ● Chase radiographs

AMU F1 Dr. R/V

History 53M c/o ↑SOB, RHS CP on inspiration, high fever + new onset consfusion.

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline

PMHx Hypertension STEMI 18 months ago Depression

Next Page >

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Latest Investigations

CXR Findings

Bloods WCC 36.3 (25.2) Na+ 135 (140) K+ 4.9 (4.3) Urea 12.9 (7.5) Creat. 198 (115)

CRP 45 (30)

Previous CXR

Recent CXR

PaO2 10.2 (12.3) (11-13 kPa) pH 7.13 (7.23) (7.35 - 7.45) PaCO2 4.6 (4.9) (4.5 - 6.0 kPa) HCO3 18.7 (20.2) (22-28 mmol/L) Lac 9.7 (5) (<2 mmol/L)

Plan ○ Start treatment

< Previous Page

Patient Notes

Local Guidelines

Which antibiotic is the most appropriate in this case?

CORRECT!!

Click to continue →

Meropenam - given in sepsis of unknown origin - here we know there is a respiratory origin Metronidazole - targets anaerobic bacteria and so is not appropriate in this situation Diclofenac - is an NSAID not an antibiotic Check out the local guidelines below for further information

Co-Amoxiclav

INCORRECT

Meropenam - given in sepsis of unknown origin - here we know there is a respiratory origin Metronidazole - targets anaerobic bacteria and so is not appropriate in this situation Diclofenac - is an NSAID not an antibiotic Check out the local guidelines below for further information

Click to continue →

Meropenam

Metronidazole

Diclofenac

Name: John Dolan DOB: 01/01/1970

Plan

Tasks:

● Chase bloods and cultures

● Chase radiographs

● Start oxygen + titrate down as needed

● Start antibiotics → Co-Amoxiclav

● Organise transfer to the ward

Continue →

The patient was successfully transferred to the respiratory ward where they will recieve a full course of IV antibiotics.

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Case 1

COMPLETE ✓

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Achieved Objectives: ✓ Reading hospital notes ✓ Interpreting bedside and lab based Ix ✓ Blood gas analysis ✓ CXR analysis ✓ Prioritising mangement options ✓ Calculating and interpreting scores ✓ Managing deteriorating patients

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Management Options

An oncology referral has been sent and will be reviewed in due time.

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Review Although ruling out a potential malignancy is very impotant, it should not delay treatment for the patient's current presentation. It is important to prioritise your management. In this case, sending an oncology referral as the first line would not be the wisest use of your time. For further information on task prioritisation check out the info button above.

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Inpatient spirometry is not often done so this will be referred to the GP to action once the patient is discharged.

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Review In real life there is nothing stopping you from putting the referral back to the GP, hence we allow a similar experience here. However in this case, spirometry was not indicated. Remember tests ordered must be clinically relevant must affect your further decisions. Additionally it is also important to prioritise your management. Even if spirometry was indicated, putting in the referral as the first line treatment would not be the wisest use of your time. For more information on task prioritisation check out the info button.

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Referral

An inpatient referral has been requested. If it is an acute situation, please discuss with your consultant and then escalate through the ACS channel.

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Cancel Referral

Discuss with Consulatant

Review In real life there is nothing stopping you from putting the referral to the cath lab, hence we allow a similar experience here. However in this case, this was not indicated. Remember tests ordered must be clinically relevant must affect your further decisions. Additionally it is also important to prioritise your management. For more information on task prioritisation check out the info button.

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Consultant Line

"At the moment your patient's presentation is not suggestive of having an acute coronary event. Their ECG is showing sinus tachycardia, with no other investigation supporting a cardiac origin. Their current observations are suggesting a respiratory pathology. Go back to your differentials and try again. Remember to examine and treat deteriorating patients using an A-E manner "

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Local Guidelines

Adult Pneumonia Guidelines

NSTEMI Guidelines

Paediatric Safeguarding

DKA Guidelines

Acute Oncological Emergencies

COVID-19 Guidelines

Rib Fracture Guideline

Acute Asthma Guidelines

STEMI Guidelines

Sepsis Guidelines

Paed. Pneumonia Guidelines

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Name: John Dolan DOB: 01/01/1970

Plan

How would you like to proceed?

Refer for spirometry testing

Discharge home with safety netting

Begin treatment dose anticoagulation

Refer to Oncology

Organise transfer to Cath Lab

Refer to smoking cessation program

Begin antibiotic treatment

Optomise medication for heart failure

Patient Notes

You have reached the end of the case! Currently the rest is still under construction.

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Local Guidelines

Acute Oncological Emergencies

DKA Guidelines

Acute Oncological Emergencies

Acute Oncological Emergencies

Acute Oncological Emergencies

Acute Oncological Emergencies

How would you like to begin managing this patient

Complete Sepsis Bundle

Begin antibiotic treatment

Start O2

Start resusitation fluids

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Which abx would you perscribe Which of the following have been prescribed correctly in the drug chart

Start O2

Start resusitation fluids

Complete Sepsis Bundle

Begin antibiotic treatment

Continue →

YOU ESCALATED WAY TOO EARLY

Have you considered any differentials or investigations?

Apologies, this area is still under construction.

Name: John Dolan DOB: 01/01/1970

Name: John Dolan DOB: 01/01/1970

Case 1

0900 AMU F1 Dr. R/V

You have taken a history and examined the patient. These were your findings

DHx [NKDA] Amldoipine Bisoprolol Furosemide Aspirin Atorvastatin Lisinopril Sertraline SHx Smoker - 1 pack a day for past 25 years Alcohol - few cans of beer at the weekend Lives alone after wife died last year Nil recent travel

History

52M 3/7 ↑SOB 5/10 Chest pain, 2/7 onset, localising around right lower rib border, associated with coughing and resolving after few minutes. Productive cough in last 24 hours of pale grey sputum with occasional specks of blood. SOB at rest PMHx Hypertension STEMI 18 months ago Depression

You are an FY1 doctor on-call and you have been bleeped to see a 52y/o gentleman on the Acute Medical Unit with increasing shortness in breath. Please review and proceed as appropriate.

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COVID Test is NEGATIVE

Name: John Dolan DOB: 01/01/1970

Plan

How would you like to proceed?

Refer for spirometry testing

Discharge home with safety netting

Begin treatment dose anticoagulation

Refer to Oncology

Organise transfer to Cath Lab

Refer to smoking cessation program

Begin antibiotic treatment

Optomise medication for heart failure

YOU ESCALATED WAY TOO EARLY

Have you considered any differentials or investigations?

Initial Investigation

Peak Flow

COVID PCR Test

NEWS Chart

Urine Dip

ECG

Cappillary Glucose

Return

Return

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WhatWould Doctor Do?

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Patient Notes

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