Ischemic heart disease, pneumonia, cerebrovascular accidents and chronic obstructive pulmonary disease rank among the top 10 causes of hospitalisation in Singapore1. For optimum patient outcomes, acute presentations of each of these spectrum of diseases requires a continuum of care involving crucial steps at primary healthcare, pre-hospital transport, emergency care at the emergency department, hospitalisation and sometimes, rehabilitation at step-down facilities. For patients with suspected ACS, a resting 12-lead electrocardiogram (ECG) should be obtained as soon as possible: do not rule out acute coronary syndrome (ACS) because of a normal resting 12-lead ECG; administer a loading dose of 300mg aspirin, preferably chewed; do not offer other antiplatelet agents in primary care; and if aspirin is given before arrival at hospital, send a written record with the patient. For patients with suspected stroke, attempt to ascertain exact time of onset of stroke - when the patient was last seen at his or her neurologic baseline, rather than the time at which the symptoms were first noticed; immediate assessment using a standardised tool (CPSS, or FAST, or LAPSS) is indicated for patients with new or developing stroke-like symptoms. The therapeutic window for thrombolsis is 3 hours for intravenous tPA and 6 hours for intra-arterial tPA. For patients presenting with acute onset dyspnea, assess emergently for signs and symptoms suggestive of airway obstruction; administer high flow oxygen in sitting position/ position of comfort; without delaying transfer, obtain CXR, ECG, capillary blood glucose.

Ischemic heart disease, pneumonia, cerebrovascular accidents and chronic obstructive pulmonary disease rank among the top 10 causes of hospitalisation in Singapore1. For optimum patient outcomes, acute presentations of each of these spectrum of diseases requires a continuum of care involving crucial steps at primary healthcare, pre-hospital transport, emergency care at the emergency department, hospitalisation and sometimes, rehabilitation at step-down facilities. For patients with suspected ACS, a resting 12-lead electrocardiogram (ECG) should be obtained as soon as possible: do not rule out acute coronary syndrome (ACS) because of a normal resting 12-lead ECG; administer a loading dose of 300mg aspirin, preferably chewed; do not offer other antiplatelet agents in primary care; and if aspirin is given before arrival at hospital, send a written record with the patient. For patients with suspected stroke, attempt to ascertain exact time of onset of stroke - when the patient was last seen at his or her neurologic baseline, rather than the time at which the symptoms were first noticed; immediate assessment using a standardised tool (CPSS, or FAST, or LAPSS) is indicated for patients with new or developing stroke-like symptoms. The therapeutic window for thrombolsis is 3 hours for intravenous tPA and 6 hours for intra-arterial tPA. For patients presenting with acute onset dyspnea, assess emergently for signs and symptoms suggestive of airway obstruction; administer high flow oxygen in sitting position/ position of comfort; without delaying transfer, obtain CXR, ECG, capillary blood glucose.

Sprains, strains and minor fractures involving the upper and lower limbs are relatively common injuries presenting to primary care physicians and emergency departments. A significant number of these injuries are managed conservatively with appropriate splinting and gradual staged mobilisation therapy. Proficiency in the acute management of these injuries ensures pain relief, optimal siting of care, optimal healing and best patient outcomes.