- 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:ABCDEA Airway maintenance with C-spine controlB 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.Ã Ã 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.Ã Ã 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?Ã¢â¬Â¦What day of the week is today?"To the examinerÃ "Patient is alert, oriented, speaking, no noisy breathing, airway is patent."3.Ã Ã Airway management:GO TO BREATHING if airway is patent.OR Ã To the examiner "Patient isÃ¢â¬Â¦., an indication for endotracheal tube."2- Definitive airway management:-Ã 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 examinerÃ "Patient is not agitated, no cyanosis or pallor. Normal symmetrical chest movements, Normal respiratory effort & rate atÃ¢â¬Â¦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.Ã "Mr/Ms..., I'm going to uncover and feel your neck and chest, Okay."Ã "Any pain?"To the examiner "There is no tracheal shift, crepitus, flail segments, sucking wounds or subcutaneous emphysema."3- LISTEN: Ã Ã 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.Ã "Mr/Ms..., I'm going to listen your chest."To the examiner "Breath sounds are normal, symmetrical, no stridor, normal heart sounds / Ã¢â¬Â¦.Ã Ã Ã diminished air entry on the leftÃ¢â¬Â¦.."4- Assess Respiratory Function:Ã Ã Ã Ventilation modalities:Circulation:1.Ã 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/ tachypneaÃ¢â¬Â¦.".- 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 Ã¢â¬Â¦. mmHg lying and Ã¢â¬Â¦. 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 nurse1) "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)Ã Also send for:Ã 12- lead ECG, CXR, Head CT (if comatose),C-Spine & pelvic X-rays (if trauma)"5)Ã 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.Ã If BP low:Ã If Comatose:3. Rule out shock:Ã Ã Ã Ã FFFÃ Go to Detailed Secondary SurveyFFFÃ 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/ tachypneaÃ¢â¬Â¦.".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 toÃ 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."
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