ACEM example: Asthma Management OSCE added anonymously 

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

Scenario:

You are working in a rural district hospital. You have immediately available an experienced emergency department nurse and emergency department registrar.
A 26 year old man is brought into your emergency department having a severe asthma attack. Initial arterial gas on high flow oxygen is as follows:
pH 7.10
pO2 54
pCO2 120
HCO3 18
Base 21.0
Na 135
K 4.6
Cl 99
Gluc 6.4
Lactate 4

Instructions for the candidate

You are required to describe the blood gas result to the staff and commence therapy for this patient with severe asthma. You may assume that all drugs and equipment usually available in a Resuscitation Room are available. You will need to provide detailed instructions to the nurse and registrar including drug dose and administration route.

You will have a high fidelity resuscitation mannequin and two staff members; an emergency department registrar and an emergency department nurse who will assist by carrying out your instructions but will not initiate any treatment unless requested. They may alert you to major changes in the patient’s clinical status.

Domains being examined

  • Medical Expertise
  • 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

Role player – ED nurse:
You are an experienced ED nurse and will follow instructions as given by the candidate promptly and efficiently. You are able to note any significant changes to the clinical status of the patient. You are not to initiate therapy without being asked, nor prompt regarding patient management. You are able to seek clarification if any instruction is unclear. If asked to administer a drug you will need to be provided with the dose and route of administration. If asked to ventilate or connect to a ventilator you will expect to be provided with clear instruction, and can prompt the candidate if required.

Role player – ED registrar:
You will follow instructions as given by the candidate. You are able to note any significant changes to the clinical status of the patient. You are not to initiate therapy without being asked, nor prompt regarding management. You are able to seek clarification if any instruction is unclear. If asked to administer a drug you will need to be provided with the dose and route of administration. If asked to ventilate or connect to a ventilator you will expect to be provided with clear instruction, and can prompt the candidate if required.

For the examiner

The candidate should efficiently describe the blood gas result to the staff members and then immediately proceed with resuscitation.
The candidate should assume the team leader role, and communicate with and utilise team members appropriately.
The candidate should commence reasonable therapy for severe asthma including intravenous drugs with doses and prepare for immediate intubation and ventilation.
Once intubated, the candidate should aim for adequate oxygenation and accept hypercarbia, with prolonged expiratory time.

Domains Assessment Objectives

Medical Expertise

Leadership and Management

Other Assessment Notes

Accurately identify severe acute respiratory failure.
Manage drug therapy for severe asthma appropriately.
Identify need for intubation and proceed to intubation using appropriate drugs for RSI.
Intubation technique.
Appropriate post intubation checks and ventilation goals in a patient with severe asthma.


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