Burns, burns, and more burns OSCE by Gabriel Lau

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

Scenario:

The paramedics have brought in an 85 year old female with burns. Her retirement unit is in a building that had caught fire and she was unable to escape until after firefighters arrived.

You have already examined the patient and determined that there are partial thickness burns on the entire left arm, both legs, the lower abdomen, upper and lower back, with sparing of the head and upper chest. There are no facial burns/edema and the patient is able to vocalize that she is in a lot of pain.

Patient vital signs:
T 34 BP 170/110 P 100 RR 12 O2 sat RA 89%

The patient’s (son/daughter) has arrived and you are asked to speak with (him/her) to get any additional history, discuss treatment, and provide an update on the patient’s condition.

Instructions for the candidate

Domains being examined

  • Medical Expertise
  • Communication
  • Health Advocacy
 
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 (son/daughter) of a 85 year old female. You’ve already been told that she has been brought to the hospital after a fire in her unit. You don’t know any other information about her current condition.

Regarding your mother’s health, she has been generally pretty healthy and has been living alone since your father died a few years ago.

She doesn’t have any medical problems besides having a “mini-stroke” a few years ago and generally gets around well enough to do her daily errands.

You don’t know her medications or any other info about her past medical history.

If asked, you are not aware that she has an advanced directive, but mention that you’ve talked with her a lot about what to do if she got really ill, and she has told you that she’s a fighter, but wouldn’t want to be kept alive if there was no hope. You can mention that your father suffered when he passed away, and your mom often mention that she would never want to go “like that.”

Questions to ask if not already covered:

“Is she suffering?”

“Is she going to die?”

“what treatments are you going to give her?”

For the examiner

No special instructions

Domains Assessment Objectives

Medical Expertise
-Adequate history
-Explanation of burns treatment – dressings, fluids (general), transfer to burns center
-Explanation of prognosis (very poor, likely will die in hospital)
-Recognition of need for intubation if transferring to tertiary/burns facility

Communication
-Introduction to family member
-Verbal clarity, conciseness, specificity – at level for family member to understand
-Explanation of findings, further treatment, and prognosis

Health Advocacy
-identification of implied advanced directive
-provision of comfort care

Other Assessment Notes


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