An ambitious mouthful OSCE by Michael

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

Scenario:

You are approached by a junior doctor who is new to emergency medicine to teach them how to manage a child who chokes on a foreign body.

Instructions for the candidate

You are an Emergency Consultant in a tertiary hospital with a mixed adult-paediatric ED. You are to teach the junior doctor how to manage such a scenario using the mannequin provided.

Domains being examined

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

For the actor

You are a PGY2 resident. You have never done a paediatric term nor paediatric emergency; you have not done PLS/APLS. You heard of a recent coroner's report where a young child (6-7yo) choked and was poorly managed, but don't know the details.

For the examiner

Requirements: paediatric mannequin.

Domains Assessment Objectives

Medical Expertise
Management of choking child and indication for intubation

Scholarship and Teaching
Good teaching technique

Other Assessment Notes

1. Management algorithm
Describe management for different eventualities:
*Awake, alert, breathing, effective cough - encourage coughing +/- O2
*Ineffective cough (indicates significant obstruction) but conscious
- Up to 5 Back blows, position dependent on size of child, ideally head down
- Alternate 5 back blows, 5 chest thrusts (sharper than CPR) assessing for relief each time
- Abdominal thrusts (Heimlich) not recommended d/t intra-abdo injury
- Attempt visualisation, removal with suction, Magill forceps. Advise against finger sweep d/t injury
- May be able to ventilate with BVM
*Obstruction, hypoxia or apnoea, unconscious
- Commence CPR 15:2, check for FB dislodgement prior to each breath
- High pressure BVM ventilation
- Proceed to RSI and intubation
- If able, remove under direct vision
- Else can push into right main bronchus for bronchoscopic retrieval
- Ventilation in this case of single lung - watch volumes/pressures

2. Teaching technique
- Clear and detailed explanations
- Explore experience and knowledge
- Demonstrate techniques and then critique student's performance of same
- Identify clear learning objectives
- Develop learning plan and actions for student
- Arrange follow up to ensure learning

Bonus:
- explore reasons for interest (eg traumatic case)


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Comments:

should the ratio not be 15:2 given that it would not be a lay person doing the CPR in the child

MaryAnne at 18:00 18 Sep 2015  

Yes, you're right. I've changed it in the assessment. Thanks.

Michael at 22:54 23 Sep 2015