You cracked the chest? Crucify! OSCE by Michael

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

Scenario:

You have just pronounced life extinct on a 28yo male who presented to the ED via ambulance following single stab wound to left clavicle region. He was conscious and talking on arrival in the ED, with no recordable blood pressure but a faint carotid pulse. He arrested within 2 minutes of arrival in your outer metropolitan emergency department.

During the resuscitation you performed a thoracotomy.

The family of the patient have just left the department after you talked to them. Your staff have asked for a hot debrief of the case.

Instructions for the candidate

You will be expected to conduct the debrief with your staff to ensure you allay any of their concerns and questions.

Domains being examined

  • Medical Expertise
  • Communication
  • Leadership and Management
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

You are the resuscitation team in an outer metropolitan emergency department. You are not used to majo ;trauma, let alone penetrating trauma. You are not used to giving blood transfusions or dealing with traumatic cardiac arrest.

Case details – 28yo male, single small stab wound to left clavicular region, talking on arrival in ED. Rapid deterioration to cardiac arrest. Thoracotomy performed without tamponade. Significant bleeding from subclavian vessels. Unable to control bleeding. Died from haemorrhage.

Reasons for distress
- Why do a thoracotomy in the first place?
- Not used to so much bleeding
- Not used to blood transfusions
- Too many instructions from team to cope with at once
- Talking on arrival – why did he die?
- Any other questions you may have related to a difficult resuscitation

If questions aren’t adequately answered, can become increasingly distressed and upset. Towards end, ask – so where do we go from here? How do we learn more about this? What happens if this happens again?

For the examiner

Domains Assessment Objectives

Medical Expertise
- Trauma resuscitation
- Role of thoracotomy in penetrating trauma
- Massive transfusion protocols

Communication
Non-judgemental debriefing approach

Leadership and Management
Team leadership systems and communication within resus setting

Other Assessment Notes

Worth watching: http://intensivecarenetwork.com/hinds-crack-the-chest-get-crucified/


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