And down I went OSCE by Michael

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


Your registrar comes to you to discuss the ECG of a 76yo lady who had an unconscious collapse, who they had seen on another shift.

They had felt out of their depth treating the patient and want some advice about the management.

View attached:  Attachment 1

Instructions for the candidate

You are the teaching consultant on and you are meeting the registrar in non-clinical time. You are to interpret the ECG and provide an approach to management.

Domains being examined

  • Medical Expertise
  • Prioritisation And Decision Making
  • 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 junior registrar, newly promoted to the position.

The patient presented with collapse, bradycardia and hypotension. You were not entirely confident interpreting the ECG, but thought there may be a 2nd degree block with 2:1AV conduction. You were told it was complete heart block but want help explaining why.

You called the senior reg for assistance and they lead the management and the patient went to coronary care. You are unsure exactly what treatment was given. Isoprenaline was mentioned and you are not sure what this is.

You want help with the ECG and an approach to managing Complete Heart Block. You are keen to learn how to do transcutaneous pacing.

If asked, you are happy to be a registrar and are enjoying the role. This was the first time you felt really overwhelmed.

For the examiner

Resources: defib capable of pacing

Domains Assessment Objectives

Medical Expertise
ECG interpretation
Management of complete heart block with haemodynamic compromise

Prioritisation And Decision Making
Appropriate stepwise management approach

Scholarship and Teaching
Approachable and appropriate teaching style

Other Assessment Notes

1. ECG
- Complete heart block
- Ventricular escape

2. Management
- Resus environment, ABCDE (high flow O2, IV access and fluids, connect defib, temperature)
- drugs (atropine, adrenaline, isoprenaline) - indications, limitations, doses, administration, end points
- transcutaneous vs transvenous pacing
- definitive: PPM insertion
- disposition - cath lab vs ICU vs CCU

3. Transcutaneous pacing
- indications, contraindications
- complications
- procedure (pad placement, rate, energy, titrating, monitoring)
- sedation, analgesia

4. Teaching
- clear and correct
- identify learning objectives and follow up

- Explore if registrar is comfortable in role or needs more support / mentoring

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