Hamish OSCE by bbwhiting

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

Scenario:

Clinical Scenario Stem:
PLEASE DO NOT DOWNLOAD THE ATTACHMENTS AS THE CANDIDATE - IT SHOULD BE HANDED TO YOU DURING THE OSCE BY THE ACTOR/CONFEDERATE

You are the duty consultant at a rural ED.
You are asked to assist your resus nurse in the care of an unwell 3 year old,
The child has been brought in by the ambulance from a GP clinic with dyspnoea and hypoxia, starting 2 days previously.
Your task is to assist your nurse in the management of the child.

People in the room will be: highly competent resus nurse, child’s parent, and child (sim)

View attached:  Attachment 1

Instructions for the candidate

If interested, the bulk of my practice OSCE are available freely at http://www.edcentral.com.au/education/fellowship-exam-resources/osce-administration

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

2 actors - nurse and parent

Parent: 3 yo boy Hamish, prev well, vaccinated, no allergies
specifically, never had asthma

SOB since 2 days ago. GP heard wheeze and started ventolin and prednisolone but got much worse since.
All started with a choking episode whilst eating chicken casserole 2 days ago - been coughing ever since. (no complete airway obstruction at the time if asked). nothing got coughed up so you tried not to worry about it.



nurse - initial exam child coughing and breathless
speaking full sentences, distressed,
SpO2 90% RA (later improves to 91% with high flow o2)
RR 34
HR 120
t 37,0

exam when asked - very poor air entry on left
maybe maybe some slight wheeze if suggested - say without certainty
normal air entry patient’s R side

airway patent, no drooling

prompt candidate for XR if not req by 5min

prompt for disposition plan

(if asked for blood gas - POC machine is under repair. can send results to lab but will be some delay to results

(if candidate tries to intubate, repeatedly suggest that child looks stable for time being and clarify plans for this ( may be reasonable for t/p if discussed with receiving team - but can try hfnp etc)

For the examiner

If the candidate is efficient and gets to the phone call within the allotted time, you may have to become the specialist receiving the referral for transfer/bronchoscopy.

Domains Assessment Objectives

Medical Expertise
recognise bronchodilators not working
sensible approach to hypoxia
ABX
recognise need for early bronchoscopy and thus transfer.

Prioritisation And Decision Making
structured approach

Communication
communicate with mother as approaching the situation.
elicit key parts of hx
inform of next steps

Other Assessment Notes

success in the station will depend on getting adequate hx from parent


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