You’ve been bleeped: symptom control in the unwell patient

As a junior doctor you need to know how to recognise a deteriorating patient and to initially manage symptoms that the patient may be experiencing, such as pain, breathlessness, and nausea. This article shows you how to work out the causes of pain in a patient who has gastric cancer and who is deteriorating, so that you can formulate an appropriate management plan. #### Scenario You are a foundation year one doctor (FY1) working a weekend on-call rota that covers the oncology and haematology wards at a teaching hospital. It is 14:30 on Saturday and you have just reviewed a patient on oncology ward A who has hyperglycaemia. You are about to chase up some blood test results that were handed to you before the weekend when you receive a bleep. #### Bleep “Hi doctor, it’s Rob, charge nurse on oncology ward C. I’m ringing you about Mr Lewis, a 65 year old man with metastatic gastric cancer. He came into hospital with haematemesis, although this settled after he received palliative radiotherapy to the stomach. More recently, he has been treated for a chest infection, but over the past few days he has been deteriorating, and now he has worsening abdominal pain. He has vomited once, although I don’t think there was any blood. He is very uncomfortable and looks distressed. Could you come to review him please?” ### How would you react to this bleep on the phone? In this case you need to consider two main points. The first is the symptoms that Mr Lewis is experiencing: abdominal pain and vomiting. You need to work out the cause of both of these symptoms and develop a management plan. The second point you need to deal with is what is causing the patient to deteriorate. Abdominal pain can have many causes, so you should carry out a thorough history and physical examination. In patients …