ACEM example: Paediatric status epilepticu OSCE added anonymously 

You have 3 minutes reading time. This OSCE will run for a maximum of 17 minutes. DOUBLE


5 year old child, coming in 2 minutes away, ongoing seizure. You will be required to assess the child and manage the clinical scenario.

Instructions for the candidate

You will have one minute to prepare your team which will consist of a junior doctor and a nurse.
On arrival of the patient you will receive handover from a paramedic.
You will then be required to manage the scenario as it unfolds

Domains being examined

  • Medical Expertise
  • Prioritisation And Decision Making
  • Communication
  • Teamwork and Collaboration
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 17 minutes. DOUBLE

For the actor

Nurse. You are a reasonably experienced ED nurse able to perform simple procedures, take obs and give medication as directed.

Doctor. You are a PGY 3 RMO interested in ED. You are able to put IVs in children on a good day. You have seen an IO but never done one and would jump at the opportunity to do one in a real patient.

Paramedic. You are a primary care paramedic. You were called to the child’s school where you found the child with an ongoing seizure. As the school was only 1 minute from the hospital you decided to scoop and run and came straight in.

There is no history available. The child was not known to fall or hit his head. There are no marks suggesting trauma.

For the examiner

The child arrives with an ongoing generilsed tonic-clonic seizure.

The candidate has one minute to prepare his team and make the appropriate calculations.

On arrival he will be given handover by the paramedic (Examiner 1)
He will then be required to delegate tasks and manage the scenario. Must check Glucose at this stage.

IV access X2 is unsuccessful, so the candidate should elect to proceed with IO or they can direct the RMO to do the IO< but the candidate will then carefully explain how to do it. An IO should be inserted into the prop, using the Ezy IO provided. Correct placement and technique should be demonstrated.

Once the IO has been inserted the candidate should take blood for VBG, GLC if not previously done and give intra-venous anticonvulsants.
Midazolam 0.1 mg/kg, no effect; second dose, no effect.
Second line treatment - Keppra, phenobard, thiopentone etc.
Should direct the staff with drug dosage and administration, e.g. phenobarb 20 mg/kg. IV Thiopentone 1-2 mg/kg titrated to effect.

After second line treatment the seizure stops.
At this stage the child remains unconscious (post-ictal). The candidate may elect to intubate or to wait and see.
It this stage the father or mother (gender of examiner 1) arrives and the candidate is required to explain to the parent what has happened, take a relevant focused history AMPLE and decide on further management.

Domains Assessment Objectives

Medical Expertise
Must demonstrate understanding of the managemnt of status epilepticus in a child, including knowledge of drugs/doses/routes. Must be able to either do or teach an IO.

Prioritisation And Decision Making
Must recognise that this is an emergency presentation

Must communicate clearly and calmly with the doctor, nurse and paramedic

Teamwork and Collaboration
Must demonstrate good teamwork, with clear delegation of tasks, clear communication and clear and logical decision making which should be communicated to the team as it proceeds.

Other Assessment Notes

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