Prepare for RSI OSCE by Michael

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

Scenario:

You are asked by your registrar to assist with intubation of a 70-year-old lady who has presented with respiratory failure and altered mental state. She clinically has APO likely due to a cardiac event. ECG shows no acute changes.
She is afebrile, HR 124, BP 180/90, SaO2 92%, GCS 5 (E2 V2 M1)
She is requiring some jaw thrust and is having assisted ventilation with a BVM.

Instructions for the candidate

Assist your registrar to prepare for intubation and outline your post-intubation care plan.

Domains being examined

  • Medical Expertise
  • Communication
  • Teamwork and Collaboration
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

Nurse: Experienced ED nurse able to assist in intubation. Currently providing assisted ventilation with BMV.

Registrar: Junior ED registrar, limited experience with RSI, needs guidance.

Patient: Simple mannequin on bed.

For the examiner

Actual intubation is not required during this scenario. The focus is on preparing the patient and team for RSI intubation and post-intubation care.

Domains Assessment Objectives

Medical Expertise
Demonstrate clear knowledge and approach to RSI and intubation

Communication
Clearly explain RSI plan and approach

Teamwork and Collaboration
Manage staff around critical procedure (RSI)

Other Assessment Notes

1. Approach to RSI & intubation
- Outline a clear and sensible approach and plan with contingencies for failed airway, including explicit statement of surgical airway as option
- Adequately prepare patient nd equipment for RSI (preoxygenate, position, IV access, suction, monitoring)
- Safe plan including appropriate medications and doses
- Clear role allocation and team management

2. Plan for post-intubation care
- Confirm tube position
- Ongoing sedation
- Management of underlying condition (GTN, etc)
- Ventilator settings

3. Bonus points
- Ask about limitations of care and advanced directives


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