Trial OSCE exam: 'Sarah&Clarence3' by ClaireGo

You are taking part in a trial exam created by ClaireGo. There are 8 OSCEs in this exam (80 minutes).
 

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

Scenario:

The senior ED nurse has approached you to discuss a notification call about a 46 year old male post ingestion of Diazinon (an organophosphate insecticide).

The ambulance service is in attendance and report that he is currently seizing, has copious secretions, but has not yet been assessed or treated as the attending crew is awaiting arrival of HAZMAT to facilitate decontamination. Once complete, they will transport the patient to you.

Instructions for the candidate

You are the consultant on in the resus area of your ED. You are to formulate a plan with the senior nurse to care for this patient on his arrival.

Domains being examined

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

For the actor

Senior Nurse:
You have just received a notification call from the ambulance service communications centre about a 46yo man that has ingested a large amount of Diazinon, an organophosphate insecticide. They have informed you that he will be transported to your department. The patient has not yet been fully assessed as the crew are awaiting a HAZMAT team to decontaminate the patient. They are able to see that he is seizing and has copious secretions.

You want to prepare the department for his arrival. So far you plan to:
- evacuate current patients from the department
- set up a resus area in the ambulance bay so as not to expose other patients or staff
- prepare the decontamination shower so the patient can be decontaminated prior to entering the department

You are concerned that your staff will be at risk if this is not done. The department is currently running well and has capacity to manage a resus patient in the resus room.

If the candidate is clear and convincing, you are open to reassurance that there is no risk of staff toxicity from this patient, as long as PPE is advised. You are reluctantly agreeable to have the patient come to the resus room for treatment prior to decontamination.

Questions to ask:
- What is the risk to my staff from exposure to the patient?
- What do you want prepared in the resus room?
- Are there any medications you'd like prepared?

For the examiner

Domains Assessment Objectives

Medical Expertise
Management of organophosphate ingestion, risks to staff and other patients

Communication
Clear explanation and instruction

Leadership and Management
Preparation of resus room, team and rest of department

Other Assessment Notes

Candidate should explicitly advise:
- resuscitation takes precedence over decontamination
-- airway management high priority
- allocated staff to prevent cross contamination
- PPE
- prepare medications:
-- arrange large amounts of atropine to be prepared
-- pralidoxime
-- benzodiazipines for seizures
- to contact ambulance crew to begin treatment prior to decontamination
- consider rest of department in terms of capacity and staffing