BEFORE STARTING - DO NOT OPEN THE ATTACHMENTS AS THE CANDIDATE - THEY SHOULD BE PASSED TO YOU BY THE CONFEDERATES?ACTORS RUNNING THE OSCE DURING THE STATION AT THE APPROPRIATE TIME.
Clinical Scenario Stem:
You are seeing Claire, a 25 yo female with palpitations, onset at the supermarket 30 mins prior. She had associated dizziness and nausea and felt tightness in the chest.
They spontaneously resolved just before the ambulance arrived but she has been transported in for your assessment
She had made a comment to the ambulance officer that she has had one or two of these episodes previously, but not been assessed in hospital for them.
Nursing staff have already inserted a IV cannula
Your task is to assess the patient and manage accordingly
You will have 1-2 nursing staff and an airway-competent ED registrar.
Medical Expertise 40%
Leadership and Management 40%
Prioritisation and Decision Making 20%
n.b. if you have found this OSCE useful there are quite a few more freely available at http://www.edcentral.com.au/education/fellowship-exam-resources/osce-administration
reg and nurse to comply with instructions but not initiate.
when candidate walks in have pt already on monitor, [IV is already in if asked]
Patient - hx as above. no regular meds, no recent changes , no allergies, usually fit and well.
no family hx
when they are recording the 12 lead - state “oh god it started again” -from then on you are very dizzy and nauseous with palpitation in your chest. (ECG attached next page)
if not treated within a minute your consciousness deteriorates .
progresses to VF arrest if not dc cardioversion in another 1-2 min
if given verapamil or beta blocker or adenosine - extreme tachycardia then VF. need prolonged CPR +/- ECMO to salvage.
If appropriately treated in the first instance with some DCR - return to sinus rhythm (ecg at bottom).
nb if shocked in 1st 1-3 mins but without sedation yell ‘ow’
at the end - looking at ECG - reg should ask questions about what the 12-lead shows / what to do next to propt fill out the 7min
may need to vary whether confederate or dummy serves as patient depending on numbers.