Trial OSCE exam: 'jess M' by ClaireGo

You are taking part in a trial exam created by ClaireGo. There are 9 OSCEs in this exam including 1 double stations (100 minutes).
 

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

Scenario:

A junior RMO new to the ED comes to you for advice about the further investigation of a 44-year-old male who had a mechanical fall down 3 steps and struck his head. He was reported to have had a brief loss of consciousness with no seizure activity or incontinence. He roused back to normal. He has a small forehead haematoma, but no other injuries of note. He has not been vomiting and has no amnesia. His headache has improved with simple analgesia.

Instructions for the candidate

You are the consultant in a tertiary emergency department. You are to advise the registrar about the role of CT head in minor head injury and generate a management plan for this patient.

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 RMO with little ED experience. You are unsure if a CT head is merited in this case, but don't know of any guidelines around this.

The patient is a fit & well 44yo man with no PHx, on aspirin, no allergies. He drinks socially but not to excess. He fell after he missed a step and came down 3-4 steps about an hour ago. He had a LOC that was reported to be 3-4 minutes, but you have no collateral. He now feels fine except for a mild 2/10 headache frontally.

O/E his obs are normal, GCS 15. He has a frontal right haematoma with no bogginess, no other scalp injury. There are no facial or extremity injuries. His c-spine has been cleared by another consultant.

Questions to ask:
"Are these guidelines applicable for all mechanisms?"
"This patient is on aspirin - is that of concern? What if this patient were on clopidogrel or anticoagulated with a different agent?"
"Are there any other special groups to consider?"
"Are these guidelines applicable in paediatric patients?"

For the examiner

None.

Domains Assessment Objectives

Medical Expertise
Management of minor head injury
Guidelines on utilitisation of CT head in minor head injury

Prioritisation And Decision Making
Formulation of appropriate management plan

Scholarship and Teaching
Clear teaching technique, identify learning objectives and plan for junior doctor

Other Assessment Notes

1. Assessment of patient
- Review history and examination findings to identify any red flags
- Discuss risk due to aspirin in comparison to other anticoagulants

2. Knowledge of CT head guidelines
- General factors (GCS < 15 at 2/24, suspected open/depressed skull #, BOS #, vomits >2, elderly, retrograde amnesia > anterograde)
- Canadian, New Orleans or NICE CT head rules
- Identify indicators for CT head in this patient
- Acknowledge limitations (populations excluded, other risk factors - alcohol abuse, significant trauma, neurological findings)
- Knowledge of similar rules in paediatric groups (not required in great detail in this OSCE)
-- CATCH and PECARN

3. Management plan
- Identify no indication for CT head
- Plan for appropriate observation
- Discharge planning
- Written information
- Safety net - responsible adult, when to return, etc