Acute and Emergency Medicine –
Comprehensive Final Year Medical Notes with
System-Based Management Protocols and
Guidelines (ABCDE, ACS, Heart Failure, COPD,
Pneumonia, Pneumothorax, GI Bleed & More)
CHAPTER 1: EMERGENCY MEDICINE PRINCIPLES
1.1 The Emergency Department Approach
Philosophy of Emergency Medicine: Emergency medicine is fundamentally different from other
medical specialties. The focus is on rapid assessment, stabilization, and disposition of patients
with undifferentiated presentations. The emergency physician must make critical decisions with
limited information and time constraints.
Key Principles:
• Time-critical decision making: Decisions must be made rapidly, often with incomplete
information
• Pattern recognition: Recognizing life-threatening conditions early
• Risk stratification: Identifying high-risk patients who need immediate intervention
• Safety netting: Ensuring appropriate follow-up for discharged patients
• Resource management: Efficient use of investigations and treatments
1.2 Triage Systems
Manchester Triage System (MTS): Used widely in UK emergency departments to prioritize
patients based on clinical need rather than order of arrival.
Priority Levels:
• Red (1): Immediate - Life-threatening conditions requiring immediate intervention
• Orange (2): Very urgent - 10 minutes maximum wait
• Yellow (3): Urgent - 60 minutes maximum wait
, • Green (4): Standard - 120 minutes maximum wait
• Blue (5): Non-urgent - 240 minutes maximum wait
Triage Discriminators: Key clinical features that determine priority level including vital signs,
pain scores, mechanism of injury, and specific symptoms. Triage nurses use flowcharts to assign
appropriate priority levels.
1.3 The ABCDE Approach
Primary Survey (ABCDE): Systematic approach to life-threatening emergencies, treating
problems as they are identified.
A - Airway (with C-spine control):
• Assessment: Look for obstruction, listen for stridor, feel for air movement
• Signs of obstruction: Inability to speak, stridor, use of accessory muscles
• Management:
o Simple measures: Head tilt-chin lift, jaw thrust
o Adjuncts: Oropharyngeal (Guedel) airway, nasopharyngeal airway
o Advanced: Laryngeal mask airway, endotracheal intubation
o Surgical: Cricothyroidotomy in "can't intubate, can't ventilate" scenarios
B - Breathing:
• Assessment: Look (chest movement, cyanosis), listen (breath sounds), feel (chest
expansion)
• Investigations: Oxygen saturations, ABG, chest X-ray
• Management: High-flow oxygen initially, specific interventions based on cause
• Life-threatening conditions: Tension pneumothorax, massive hemothorax, flail chest
C - Circulation (with haemorrhage control):
• Assessment: Pulse rate and quality, blood pressure, capillary refill time, skin perfusion
• Investigations: ECG, blood tests (FBC, U&E, glucose, lactate)
• Management: IV access, fluid resuscitation, blood products, vasopressors
• Haemorrhage control: Direct pressure, tourniquets, surgery
, D - Disability (neurological assessment):
• Assessment: AVPU scale (Alert, Voice, Pain, Unresponsive) or Glasgow Coma Scale
• Pupils: Size, equality, reaction to light
• Blood glucose: Exclude hypoglycemia as a cause of altered consciousness
• Spinal assessment: Log roll, palpation, neurological examination
E - Exposure (with environmental control):
• Complete examination: Remove all clothing to identify injuries
• Temperature control: Prevent hypothermia with blankets, warming devices
• Documentation: Record all findings and interventions
CHAPTER 2: CARDIAC EMERGENCIES
2.1 Acute Coronary Syndromes (ACS)
Definition and Classification: Acute coronary syndromes represent a spectrum of conditions
caused by acute myocardial ischemia due to reduced coronary blood flow.
Classification:
1. ST-Elevation Myocardial Infarction (STEMI)
2. Non-ST-Elevation Myocardial Infarction (NSTEMI)
3. Unstable Angina (UA)
Clinical Presentation:
• Chest pain: Typically central, crushing, radiating to the left arm, jaw, or back
• Associated symptoms: Shortness of breath, nausea, vomiting, sweating, syncope
• Atypical presentations: More common in the elderly, diabetics, women
o Epigastric pain, isolated dyspnoea, fatigue, syncope
Risk Factors:
• Non-modifiable: Age, male sex, family history
• Modifiable: Smoking, hypertension, diabetes, hyperlipidemia, obesity
Comprehensive Final Year Medical Notes with
System-Based Management Protocols and
Guidelines (ABCDE, ACS, Heart Failure, COPD,
Pneumonia, Pneumothorax, GI Bleed & More)
CHAPTER 1: EMERGENCY MEDICINE PRINCIPLES
1.1 The Emergency Department Approach
Philosophy of Emergency Medicine: Emergency medicine is fundamentally different from other
medical specialties. The focus is on rapid assessment, stabilization, and disposition of patients
with undifferentiated presentations. The emergency physician must make critical decisions with
limited information and time constraints.
Key Principles:
• Time-critical decision making: Decisions must be made rapidly, often with incomplete
information
• Pattern recognition: Recognizing life-threatening conditions early
• Risk stratification: Identifying high-risk patients who need immediate intervention
• Safety netting: Ensuring appropriate follow-up for discharged patients
• Resource management: Efficient use of investigations and treatments
1.2 Triage Systems
Manchester Triage System (MTS): Used widely in UK emergency departments to prioritize
patients based on clinical need rather than order of arrival.
Priority Levels:
• Red (1): Immediate - Life-threatening conditions requiring immediate intervention
• Orange (2): Very urgent - 10 minutes maximum wait
• Yellow (3): Urgent - 60 minutes maximum wait
, • Green (4): Standard - 120 minutes maximum wait
• Blue (5): Non-urgent - 240 minutes maximum wait
Triage Discriminators: Key clinical features that determine priority level including vital signs,
pain scores, mechanism of injury, and specific symptoms. Triage nurses use flowcharts to assign
appropriate priority levels.
1.3 The ABCDE Approach
Primary Survey (ABCDE): Systematic approach to life-threatening emergencies, treating
problems as they are identified.
A - Airway (with C-spine control):
• Assessment: Look for obstruction, listen for stridor, feel for air movement
• Signs of obstruction: Inability to speak, stridor, use of accessory muscles
• Management:
o Simple measures: Head tilt-chin lift, jaw thrust
o Adjuncts: Oropharyngeal (Guedel) airway, nasopharyngeal airway
o Advanced: Laryngeal mask airway, endotracheal intubation
o Surgical: Cricothyroidotomy in "can't intubate, can't ventilate" scenarios
B - Breathing:
• Assessment: Look (chest movement, cyanosis), listen (breath sounds), feel (chest
expansion)
• Investigations: Oxygen saturations, ABG, chest X-ray
• Management: High-flow oxygen initially, specific interventions based on cause
• Life-threatening conditions: Tension pneumothorax, massive hemothorax, flail chest
C - Circulation (with haemorrhage control):
• Assessment: Pulse rate and quality, blood pressure, capillary refill time, skin perfusion
• Investigations: ECG, blood tests (FBC, U&E, glucose, lactate)
• Management: IV access, fluid resuscitation, blood products, vasopressors
• Haemorrhage control: Direct pressure, tourniquets, surgery
, D - Disability (neurological assessment):
• Assessment: AVPU scale (Alert, Voice, Pain, Unresponsive) or Glasgow Coma Scale
• Pupils: Size, equality, reaction to light
• Blood glucose: Exclude hypoglycemia as a cause of altered consciousness
• Spinal assessment: Log roll, palpation, neurological examination
E - Exposure (with environmental control):
• Complete examination: Remove all clothing to identify injuries
• Temperature control: Prevent hypothermia with blankets, warming devices
• Documentation: Record all findings and interventions
CHAPTER 2: CARDIAC EMERGENCIES
2.1 Acute Coronary Syndromes (ACS)
Definition and Classification: Acute coronary syndromes represent a spectrum of conditions
caused by acute myocardial ischemia due to reduced coronary blood flow.
Classification:
1. ST-Elevation Myocardial Infarction (STEMI)
2. Non-ST-Elevation Myocardial Infarction (NSTEMI)
3. Unstable Angina (UA)
Clinical Presentation:
• Chest pain: Typically central, crushing, radiating to the left arm, jaw, or back
• Associated symptoms: Shortness of breath, nausea, vomiting, sweating, syncope
• Atypical presentations: More common in the elderly, diabetics, women
o Epigastric pain, isolated dyspnoea, fatigue, syncope
Risk Factors:
• Non-modifiable: Age, male sex, family history
• Modifiable: Smoking, hypertension, diabetes, hyperlipidemia, obesity
