Babe Ruth OSCE by Adam

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

Scenario:

24M intoxicated BIBA with facial trauma following an alleged assault with a baseball bat.
You are based in a Urban district hospital and it is 1130pm

View attached:  Attachment 1

Instructions for the candidate

Please perform a primary assessment, and safely manage any problems which might arise.

Domains being examined

  • Medical Expertise
  • Prioritisation And Decision Making
  • Communication
  • Teamwork and Collaboration
  • 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

Patient is lying flat, there is obvious extensive mid facial facial trauma with missing teeth and a mobile maxilla. There is no c-spine collar.
A- Patient is groaning and gurgling.
- Poor response to Jaw thrust and basic airway maneouvres.
- Anaesthetic unavailable due to Malignant hyperthermia in OT, and airway becomes increasingly compromised with a drop in sats to 90%
B- RR 30, no cyanosis, no obvious signs of external chest trauma, sats 94% RA
C- PR 110, BP 140 systolic. Moderate Epistaxis, warm to touch, peripheral pulses palpable
D- BSL 8.4, Temp 36.6, PEARLA
GCS- E3, M6, V4 (essentially unable to complete sentences)

For the examiner

1. Place trauma call

2. Candidate is expected to place a collar and manage the compromised airway.
- NRB 02, Jaw thrust, suction, NP contraindicated, OPA not tolerated. Airway remains compromised
- Expected to place rapid rhinos

3. Expected to call for anaesthetic assistance for an awake fibreoptic intubation, due to anticipated difficulties in BVM and negotiating the airway.
- Anaesthetics unavailable, malignant hyperthermia case in OT

3. Prepare for difficult RSI:
- Predicted problems: anatomically difficult airway, difficult BVM, blood in the field, aspirated teeth
- Patient: Wide bore access, xmatch, coag, Hand pump set.
High flow 02 via NRB. 0-ve blood available.
1g TXA. Rapid Rhinos, direct pressure to bleeding areas. Consider foley catheter to control bleeding.
identify and mark out CTM
- People: call the ENT, chase anaesthetics, ICU
- Paraphernalia: Direct laryngoscope (wide field of view), boogie, iLMA, dual set up, FONA equipment, Dual suction
- Position: reverse trendelenberg.
- Poisons: Ketamine and rocuronium.

4. Intubation successful.
- Expected post intubation actions (ETT confirmation, orogastric, catheter, ECG, VBG) and finish trauma assessment (look for missing teeth)/ investigations including log roll, CXR ( avulsed/aspirated teeth), Pelvic AP. CT Brain, facial bones and C- spine.
- ADT and cephazolin
- Disposition OT or ICU, under trauma and maxillo facial surgery.

5. Fluffy bunny. Inform NOK, Get a collateral History. Consider anonymising name

Domains Assessment Objectives

Medical Expertise

Prioritisation And Decision Making

Communication

Teamwork and Collaboration

Leadership and Management

Other Assessment Notes


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