Trial OSCE exam: 'Three's a crowd' by Adam

You are taking part in a trial exam created by Adam. There are 3 OSCEs in this exam (30 minutes).
 

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

Scenario:

A 34yo patient has been observed in your ED's short stay unit overnight following an anaphylactic reaction last night. They had significant perioral oedema, stridor, wheeze and urticaria on arrival. They were treated with IM adrenaline (2 doses of 0.5mg), antihistamines and steroids. Their symptoms have completely resolved.

View attached:   Attachment 1

Instructions for the candidate

You are the consultant on in the short stay unit. You are to advise the patient on how to use an EpiPen(tm) adrenaline auto-injector. You may use the attached image in your explanation to the patient.

Domains being examined

  • Medical Expertise
  • Communication
  • Health Advocacy
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

You are usually fit and well with no prior medical conditions nor allergies. You had eaten chestnut paste (or some other interesting food) for the first time, and immediately noted tingling around the lips and in the mouth. This developed over 5 minutes into swelling and difficulty breathing with an associated rash. Your friend called an ambulance, who gave you IM adrenaline with significant improvement, and you were given a second dose in the hospital due to ongoing wheeze and lip swelling.you now feel completely back to normal.

The doctor is coming to disuss ongoing management of your allergy including use of an adrenaline auto-injector (EpiPen).

For the examiner

Requirements: ideally EpiPen training model, failing that, use an EpiPen (don't inject anyone) or the attached photo.

Domains Assessment Objectives

Medical Expertise
Allergy and anaphylaxis first aid and management including action plan description
Proficient use of the EpiPen auto-injector

Communication
Establish rapport.
Clear, articulate and concise explanations.
Allow opportunity for questions and answer appropriately

Health Advocacy
Allergy prevention advice and management
Include patient's living environment (home, work, social) in discussion of management

Other Assessment Notes

1. Allergy action plan
- avoid allergen
- signs of allergic reaction
- management steps (eg antihistamine, epipen, call for help)
- when to use epipen
- bonus: empty ventricle syndrome
- action plan example available here: http://www.allergy.org.au/health-professionals/anaphylaxis-resources/ascia-action-plan-for-anaphylaxis

2. EpiPen technique
- Remove from carry case
- Pull off blue safety cap
- Press orange end firmly against lateral thigh until click
- Hold for 10 seconds
- Call ambulance
- Take used epipen with you to hospital
- If you have doubts about how to use an EpiPen(tm) have a look here: http://www.allergy.org.au/health-professionals/anaphylaxis-resources/how-to-give-epipen

3. EpiPen general information
- Prescription for 2 pens - 1 on person, 1 at home or at work. Can buy more off PBS
- Expiry in 2 years, need to replace - take old EpiPen to pharmacy
- Replace earlier if adrenaline discoloured (viewing window)
--- Can still use if no other adrenaline available
- Need to replace old/used epipens immediately
- Need to educate family, friends, coworkers on signs of anaphylaxis and how to administer epipen (use action plan / posters)
- Can use others' epipens if only ones available - but make sure it is immediately replaced!
- In a survival setting you can get more adrenaline out of a used epipen: http://adelaideemergencyphysicians.com/2014/07/short-on-adrenaline-get-a-bit-more-from-the-epipen/

4. Allergy preventative care and follow up
- Avoid allergen
- Medicalert bracelet indicating anaphylaxis
- Allergy specialist follow up considered
- Letter to GP to inform