I've got the baby blues OSCE by Michael

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

Scenario:

You are the consultant working in ED in a tertiary hospital with obstetric services. You receive notification that an ambulance has just delivered a term baby en route, arriving in 1 minute. The baby is not making any respiratory effort. The mother is stable and will be cared for by another team on arrival.

The attached file is for use in debrief.

View attached:  Attachment 1

Instructions for the candidate

You have 1 minute to prepare for the arrival of the baby. You will receive a handover and must then manage the scenario as it unfolds. You are working with an experienced ED nurse and a junior registrar.

Domains being examined

  • Medical Expertise
  • Communication
  • 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

Paramedic: You were called to a labouring term pregnant lady who was G6P5 (now G6P6). The antenatal course was unremarkable with normal scans. Labour progression was precipitous and you ended up delivering the baby in the back of the ambulance. This is your first hands-on delivery, and you believe there were no complications (eg, no cord prolapse, strangulation, meconium or dystocia). The baby had some initial gasps, but on arrival has become floppy, blue and making no respiratory effort. The birth was 2 minutes ago.

Nurse: You are an experienced ED nurse with limited neonatal resuscitation experience. You will quickly follow instruction but not initiate treatment.

Registrar: You are a junior registrar with no neonatal experience. You are able to put in a drip or IO.

For the examiner

Baby's obs:
Blue, floppy, no respiratory effort
HR 50
Pulses unpalpable
SaO2 50%

During the resuscitation process, you enter as another doctor caring for the mother, enquiring about information for the mother.

Domains Assessment Objectives

Medical Expertise
Expert neonatal resuscitation.

Communication
Clear communication with team.
Clear information for mother

Leadership and Management
Good team management during resuscitation.

Other Assessment Notes

Call for help - obstetric hospital will have neonatal support of some time

Good knowledge and compliance with neonatal resuscitation algorithm (see attachment).
- correct use of IPPV, oxygen, adrenaline and dose
- IV access with IO or umbilical vein

Bonus points for:;
- Inviting mother to come into room during resus (if she is stable and wants to)
- Identifying poor outcome and when to cease efforts
- Debriefing staff if ends poorly


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