To lyse or not to lyse OSCE by Naanu Neenu

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


60 yrs old John Snow presented with Syncopal episode and RT sided Chest pain.he has been having on and off chest pain and Rt calf pain for 1 week.He also has been feeeling short of breath on exertion.
His Past medical history includes Pulmonary embolism 15 years ago, post spinal surgery after he had a motor vehicle accident.
He is on Tritace for BP and is not on any other medication.
he was hypotensive enroute to hospital which improved with 250 mls IV Normal saline.

Instructions for the candidate

He was seen in ED by your registrar Rob Stark ,who wants to discuss further management with you.

Domains being examined

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

For the actor

You are Dr Rob Stark ( no relation to the stark family or winterfell).
You have seen Mr Jon Snow and suspect Pulmonary embolism.
Mr Snow's ECG shows Sinus tachycardia and nil else.
If asked about CXR Mr Snow went to CXR and stood up for CXR and collapsed again.
Now he is increasingly SOB,Sweaty and Clammy.
His examination findings

HR 120
SaO2 96% on 6 l HM O2.
Temp 36.4.
still alert and talking.
Chest clear.
mild tenderness over RT calf nil swelling/redness.

you have organised a CTPA but radiology wants to wait for renal function tests to be back which will take another 30 min.

you want to discuss further management with the consultant.

if not mentioned
ask about
Bedside echo,
if suggesting Thrombolysis : Do we do it straight away or shall we wait for CTPA?
If wait for CTPA ask about transferring hypotensive patient to CT? should we take some drugs/equipment?
further plans after CT.

For the examiner

When Bedside Echo is mentioned inform candidate that it shows Dilated Right Ventricle with akinesia of the mid free wall but normal motion at the apex.

Domains Assessment Objectives

Medical Expertise
Criteria for Thrombolysis in PE.
Plan for thrombolysis
No right or wrong answer in this patient as long as candidate can justify why they want to do it.

Prioritisation And Decision Making
Transferring hypotensive patient to CT or thrombolysis with nil confirmation of PE

clear explanation to the registrar regarding the plan

Other Assessment Notes

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