Trial OSCE exam: 'not again again' by Naanu Neenu

You are taking part in a trial exam created by Naanu Neenu. There are 18 OSCEs in this exam including 2 double stations (200 minutes).
 

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

Scenario:

You are a consultant in a tertiary ED, and your senior registrar comes to ask you for help regarding the assessment and management of a patient, a 32 year old man who is pacing up and down the waiting room, and becoming increasingly agitated and frightening the relatives waiting.
You will advise him on how best to deal with the situation.

Instructions for the candidate

Your registrar is competent and is safe to practice unsupervised. You are busy tending sick patients in the resuscitation area, so can only advise him verbally. You will not see the patient.
You will be expected to provide comprehensive advice regarding the assessment and management of the situation

Domains being examined

  • Medical Expertise
  • Communication
  • Teamwork and Collaboration
  • 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 competent senior registrar. You are confident in managing various emergency situations, but want some senior advice on magian this complex situation.
You will answer any questions of the candidate, but not offer information unless specifically asked.
You have seen this patient from a distance. He is pacing up and down the waiting room. He appears sweaty and dishevelled. He is swearing and agitated. He is not making much sense, and is vaguely threatening to the other people in the waiting room. You get the feeling he may be under the influence of stimulants, but you have no definitive history.
Your concerns are:
- Making sure you are abreast of all the possible differential diagnoses
- ensuring safety of waiting room and staff
- wanting to know the best way of escalating control, and the different methods of gaining definitive control (verbal, physical, chemical)
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For the examiner

Domains Assessment Objectives

Medical Expertise
Display expert knowledge of:
- differential diagnosis of agitated patient - with at least 5 possible differentials - substance abuse, withdrawal, hypoglycaemia, head injury, decompensated psychiatric presentation, sepsis, (plus many other small print ddx)
- addressing situational awareness, planning on marshalling resources, removing pt from waiting room, ensuring safety of staff, patients
- discuss verbal de-escalation,
- rapid progress to security/5 point restraint/ take down procedures
- preparation for chemical restraint (variety of methods accepted, as long as safe (with pt selection/drug selection/doses/endpoints/side effects)
- monitoring and safety post sedation
- assessment post sedation
- need to mention duty of care to make assessment

Communication
Ascertaining level of competence of registrar in complex and difficult environment

Teamwork and Collaboration
Appropriate use of team members in resource intensive environment

Scholarship and Teaching
Assisting registrar to learn whilst imparting safe information and standards

Other Assessment Notes