Loading ...
Sorry, an error occurred while loading the content.

OSCE STATION

Expand Messages
  • ALERTS UPDATES
    1) Improving your performance during an emergency OSCE station. 2) Today s OSCE Exam preparation tips.
    Message 1 of 1 , Feb 17, 2008
    View Source
    • 0 Attachment
      1) Improving your performance during an emergency OSCE station.
      2) Today's OSCE Exam preparation tips.
      ____________ _________ _________ _________ _________ _________ _________ _________ ____
      1)     Improving your performance during an emergency OSCE station:
      ":
      Rapid Primary Survey & resuscitation:
       ABCDE
       
      A Airway maintenance with C-spine control
      B  Breathing and ventilation.
      C Circulation (pulses, hemorrhage control).
      D  Disability (neurological status).
      EExposure (complete) and Environment (Temperature control).
      Restart ABCDE if patient deteriorates.
      Always deal with A & B first as they may kill the patient now not C.
      Airway:
      1. Â  Immobilize cervical spine with collar or sand bags. In Trauma case ONLY.
       
      To the examiner/ nurse "A Collar or sand bags please to immobilize the C-spine."
       
      2. Â  Airway assessment: Assess ability to breath and speak.
      If patient is already responded appropriately to you so far, indicates patent airway & ability to breath is normal.
      "Mr./Ms.., Where are you now?…What day of the week is today?"
       
      To the examiner  "Patient is alert, oriented, speaking, no noisy breathing, airway is patent."
       
      3. Â  Airway management:
       
       
      GO TO BREATHING if airway is patent.
      OR  To the examiner "Patient is…., an indication for endotracheal tube."
      2- Definitive airway management:
      -  Endotracheal intubation (ETT):
      Find out them at the ebook " A Step By Step Guide To Mastering The OSCEs"
      Breathing:
      1- LOOK: for:
        1. Mental status: anxiety, agitation.
        2. Color: cyanosis / pallor.
       3. Chest movements.
       4. Respiratory rate & effort.
        5. JVP. (if collar on don't remove it. If sand bags, do it.)
      To the examiner  "Patient is not agitated, no cyanosis or pallor. Normal symmetrical chest movements, Normal respiratory effort & rate at…bpm, JVP is...."
      2- FEEL: for: 
        1. Airflow.
      2. Tracheal shift. (if collar on don't remove it. If sand bags, do it.)
        3. Chest wall for crepitus.
       4. Flail segments & sucking chest wounds.
      5. Subcutaneous emphysema.
       "Mr/Ms..., I'm going to uncover and feel your neck and chest, Okay."
       "Any pain?"
      To the examiner "There is no tracheal shift, crepitus, flail segments, sucking wounds or subcutaneous emphysema."
      3- LISTEN:  Â Ã‚ Ã‚ Ã‚  1. Sounds of obstruction (Stridor) & Air escaping.
      2. Breath sound & symmetry of air entry. Both sides: apex, lower, & sides.
      3. Heart sounds. If muffled with high JVP: Temponade: pericardiocenthesis.
        "Mr/Ms..., I'm going to listen your chest."
      To the examiner "Breath sounds are normal, symmetrical, no stridor, normal heart sounds / …. Â Ã‚  diminished air entry on the left….."
      4- Assess Respiratory Function:
       
       Â Ã‚  Ventilation modalities:
       
      Circulation:
      1.  Ask for Vital signs:
       
      To the examiner/nurse "What are his/her vitals, please?"
      Carefully listen to what the examiner says and comment: e.g. "Normal/ so, he has fever/tachycardia/ tachypnea….".
       
      - Blood pressure: If conscious mobile patient, take it on:
      "Mr/Ms.., I'm going to check your blood pressure in both your arms then your leg, (if no collar) and I'll recheck your arm while sitting/standing for a minute?."
      Note: Usually the examiner will stop you and give you the results, but start doing it until he/she stops you.
      Measure BP in unconscious yourself on one arm.
       
      To the examiner "Blood pressure is …. mmHg lying and …. mmHg standing. No postural hypotension, No significant upper/lower extremities difference. (aortic dissection)"
       
      To the nurse "Put him on cardiac monitor & pulse oxymeter. Repeat vitals every (5-15) minutes & inform me."
       
      2. IV lines & Investigations:
       
      To the nurse
      1)     "I want 2 wide pore gauge 14-16 IV lines established, please.
      2)     Start Normal Saline/ Ringer Lactate, one liter on each at 125-1000 ml/h each (choose).
      3)     Take a blood sample and send for:
      - Blood group, Rh & cross-match,
      - CBC, Lytes, (ABGs, CK-MB, Tropinin) if respiratory/ cardiac case
      - Liver function test (ALT, AST, ALP, & amylase),
      - Renal function tests (BUN, Cr),
      - Coagulation profile (INR/PTT),
      - Rapid bedside Blood sugar,
      - Toxicology screen (if indicated).
      4)  Also send for:  12- lead ECG, CXR, Head CT (if comatose),
      C-Spine & pelvic X-rays (if trauma)"
      5)  Foley's catheter / Nasogastric tube (if needed).
      "Mr/Ms .., I'll put a bee tube inside in order to monitor your urine output, okay..?"
      Note: If blood seen from meatus: NO FOLEY'S (? Urethral injury)
       
      Assess Respiratory Function:
      Change to assisted ventilation or ETT if needed.
       If BP low:
       
       If Comatose:
       
      3. Rule out shock:
       
       
       
       Â Ã‚ Ã‚  FFF  Go to Detailed Secondary Survey
       
       
      FFF  Go to management below.
       
      Management of hemorrhagic shock:
       
      1 - Ask for vitals again: "What are his/her vitals, please?"
      Carefully listen to what the examiner says and comment: e.g. "Normal/ so, he has fever/tachycardia/ tachypnea….".
      2 - Secure airway and O2: Already done but check the mask and O2 level.
      3 - Control bleeding by:
      Find out them at the ebook " A Step By Step Guide To Mastering The OSCEs"
      4 - Replace lost blood:
      5 - Vasopressors:
      -          Not during bleeding.
      -          Used if hypotension persists despite appropriate volume administration. Also for septic and anaphylactic shocks.
       
      * If Patient is stable now: Proceed to Disability.
      If not: Repeat ABC until becomes stable.
       
      Then you have to  go into D, E and then detailed survey.
       
      ____________ _________ _________ _________ _________ _________ _________ _________ _____
       
      2) Today's OSCE Exam preparation tips:
       
      We also asked you to prepare steps for every emergency management of common emergencies like:
      ** IF Diabetic Emergencies:
       
      To the nurse "Run the Normal Saline at 1000cc/h each;
      Give 5 (-10) IU Insulin IV bolus, then another 5 (-10)/h by IV infusion"
      "When Blood glucose reaches 15 mMol/L change the fluid to two third 5% dextrose water (D5W) and one third Normal Saline. Then add 20 mEq/L KCL to the fluid."
      "Send for urine glucose and ketones."


      Subscribe to events_updates
      CONFERENCE / WORKSHOP UPDATES
       
      Powered by groups.yahoo.com
       


      Looking for last minute shopping deals? Find them fast with Yahoo! Search.
    Your message has been successfully submitted and would be delivered to recipients shortly.