ouch! my neck hurts! OSCE added anonymously 

You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.


You are the ED consultant working in a rural hospital. The nearest Trauma center is 6 hrs drive away. It is a busy night, the department is full. A 50yr old male has been BIBA with complained of neck pain and slightly intoxicated, breatherlyser 0.09. He has been involved in a high speed accident. Your junior resident has requested you to assist her in clearing his neck.He has had a cervical spine Xray.

View attached:  Attachment 1

Instructions for the candidate

There are radiology service in the hospital. CT is available during office hours only. Radiology reg needs to be called in after hours.

Your task:
1) Assist the resident in deciding if the neck can be 'cleared'
2) Management of the patient subsequently

Domains being examined

  • Medical Expertise
  • Prioritisation And Decision Making
  • Communication
  • Teamwork and Collaboration
  • Leadership and Management
  • Professionalism
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

Have not cleared neck before
Patient complains of midline neck pain around C5-7 area.
No focal neurological signs grossly but patient uncomfortable in hard collar., maybe some tingling in the right fingers at first.
Has had oral analgesia
Mechanism of injury: 100km/h, one death at scene . Helped out of car by witness.
Patient no other obvious injury except for neck pain, normal vitals, GCS14 eyes closed but smelled of alcohol eFAST negative.

Radiology reg:
Unhelpful. Have not been woken up before in the past to do scans.
Suggest putting the pt in a soft collar then scan in the morning.
Ask candidate to justify why scans need to be done urgently.
Insist it's not standard practise here and especially in a stable pt, that it can wait till the morning to have it done.
At this point candidate should escalate to calling radiologist oncall: or something along that line, then said ok fine....I'll come in but only just for this time!
or alteranatively candidate may come up with a shared time to have scans done say within next 4 hours/ first thing in am like 6am. or if another CT scans is also required for another patient to have this done all at once. While pt is put in a philidelphia collar, but will need urgent scans if condition deteriorates.

For the examiner

No focal neurology, pt otherwise well
Candidate: to acknowledge inadequate views of Xray.
Recognise high risk mechanism, unable to clinically clear C-spine
Will need CT scan

Justifiable points:
Patient factor: intoxicated, neck pain, inadequate Xray views, pain despite analgesia
increase pressure area and stiffness of neck for pt in prolonged spinal precaution
Departmental factor: Busy, full shift, early imaging will assist with pt flow. will require transfer out to trauma center if significant injury.
Candidate need to demonstrate professionalism, firm but polite manner when dealing with difficult colleague
To escalate plan accordingly when not getting through to registrar.

Domains Assessment Objectives

Medical Expertise

Prioritisation And Decision Making


Teamwork and Collaboration

Leadership and Management


Other Assessment Notes

You must be logged in to add a comment


There are no comments on this OSCE