Sleepy time for Seb OSCE by Michael
You are on duty when Sebastian, a 3 year old boy is brought in by his mother. He hit his head on the edge of a low table when he tripped and fell about 45 minutes ago. Sebastian has sustained a 3-4cm deep laceration on the left forehead and through the eyebrow which will require suturing. He cried immediately after the fall and there is no concern of a more significant closed head injury. He has been moderately noncompliant with your assessment (as is typical of many 3 year old boys) and will require sedation to enable safe suturing of the wound.
Instructions for the candidate
1. Give instructions to the emergency nurse (who is outside the room), regarding medication and monitoring you would like prepared ready for this procedure. (approx time guide 1-2 minutes)
2. In the remaining time, proceed to discuss the situation with Sebastian’s mother Rebecca, paying particular attention to the planned management and gaining of consent. (approximate time guide 5-6 minutes)
Domains being examined
- Medical Expertise
For the actor
Instructions for emergency nurse:
You may prompt for either drugs or monitoring required but be no more specific.
Ie “ what drugs would you like drawn up?” “what monitoring would you like me to set up?”
Instructions for parent role player:
You are a reasonable but relatively anxious mother. Feel free to ask as many questions as you like to ensure any concerns you have regarding your sons management are allayed.
For the examiner
Domains Assessment Objectives
- Medical Expertise
- Safe completion of procedural sedation in a child
- Clear professional direction to assisting nurse
Open and clear discussion with parent
Other Assessment Notes
An excellent candidate will demonstrate/ cover most/all of the following:
Part 1. :
A clear specification of drug, dose and planned method of administration
A clear list of monitoring parameters to prepare for including ECG, pulse oximetry, Etco2 and BP.
A reassuring and professional manner, thus instilling confidence in the patients mother.
A clear explanation in nonmedical terms of the management plan and why this needs to happen
A clear explanation/discussion regarding risks/benefits and the gaining of consent
Offer an opportunity for Rebecca to ask questions, provide answers, reassurance