362 OSCE Flashcards
ASPIRIN
Aspirin is a non steroidal anti-inflammatory drug.
Indications:
- Suspected Acute Coronary Syndrome Chest pain/discomfort
- Acute cardiogenic pulmonary oedema
Contraindications:
Allergy/adverse reaction
bleeding OR clotting disorders
Current GI bleeding or peptic ulcers
<18 years of age
Onset: 10 minutes
Half-life: 3.2 hours
Route of administration: per oral
Dosage: 300mg - chewed and swallowed.
Glucose Gel
Indications: Symptomatic hypoglycaemia (bgl <4)
Contraindications:
Unconscious
Patient with difficulty swallowing
<2 years of age.
Onset: 10 mins
Route of Administration: per oral
Dosage: 15g. Repeat once at 15 mins if BGL is still <4mmol/L
Total dose 30g
Glyceryl Trinitrate (GTN)
Vasodilator that decreases preload by increasing venous capacity.
Indications:
Suspected ACS (with pain)
Pulmonary Oedema
Autonomic dysreflexia
Contraindications:
Allergy or adverse reaction
heart rate <50 or >150 bpm
systolic BP <100mmHg
acute CVA
Head Trauma
Onset:<2 mins
Route of Administration:
Spray Sublingual - under the tongue
Dosage: 400micrograms. repeated at 5 minute intervals. No max dosagr
Methoxy
Indications: Pain
Contraindications:
Allergy
<1 year of age
history of liver or renal disease
Onset: 1 - 3mins
Route of Administration: Inhalation
Dosage: 3ml bottle. repeated once after 20 mins. total dose 6ml.
Paracetamol
Indications: Mild to moderate pain
fever
Contraindications:
allergy adverse reaction
<1 month old
Onset: 10 –60 mins
Route of Administration:per oral
Dosage: 0.5 - 1g. repeated every 4 hours. Total max does 4g in 24 hours.
Salbutamol - acts as a bronchodilator
Indications: bronchospasm
suspected hyperkalemia
Contraindications:
allergy or adverse reaction
<1 year old
Onset:2-5 mins
Route of Administration:
Metered Dose Inhaler
Nebuliser
Dosage:
Adult
Inhaler - 12 MDS Inhalations. 1.2mg. repeated at 10 mins. no max dose.
Nebuliser - 5mg. repeated prn. no max dose.
Paed:
MDS <6 years - 6 inhalations. 600 micrograms no max dose
>6 years 12 inhalations
Neb - 2.5 mg. single dose only
Ipratropium Bromide
Promotes bronchodilation
Indications: moderate bronchospasm (unresponsive to salbutamol)
Contraindications:
allergy / adverse reaction
<1 years old
Onset:1.5 - 3 mins
Route of Administration: nebuliser
Dosage:
Adult:
500 micrograms. repeated 20 min intervals. max dose 1.5mg
child:
> 6 years 500 micrograms. repeated 20 min intervals. max dose 1.5mg
<6 years - 1.5 microgram. max dose 750 microgram.
NSA
- Level of Consciousness
AVPU / GCS - Pupils equal and reactive
- Motor Function
Palpate for tenderness. Coordination, strength and tone, seizures, tremors, movements occur normally or to painful stimulus. - sensory function
hearing and verbal communication - Vitals
Resp Rate - 12- 20 breath/pm
BP - systolic 100-120mmHg
Pulse - 60-100
Temp - 36-37 degrees
BGL - 4-7mmol/L
Oxygen >95%
Pain Assessment
OPQRST
Onset: what were you doing when the pain started? Did it come on suddenly or was it more gradual?
Provocation: Is there anything that makes the pain better or worse?
Quality: What does it feel like. Is it more of a crushing pain, is it sharp, stabbing?
Radiation: Is the pain just in one spot or does it move?
Severity: On a scale of 1-10?
Timing: When did the pain start? Does it come and go?
Perfusion Status Assessment
Skin, Pulse, BP, Consciousness
Adequately perfused if:
Skin warm, pink, clammy
Pulse 60-100bpm
BP >100mmHg systolic
Alert and orientated in time and place
Borderline Perfused if:
skin: cool, pale, clammy
pulse: 50-100bpm
bp: 80-100 systolic
alert and orientated in time and place
Inadequately perfused if:
skin: cool, pale, clammy
pulse: <50 or >120bpm
bp: 60-80
either alert or altered in their orientation to time and place.
Respiratory Status Assessment - RSA
CAPERRSSS
Assess the following and auscultation of the chest.
Conscious State -
normal = alert
resp. distress = altered
appearance -
normal = calm and quiet
resp. distress = distressed, anxious, struggling to breath , exhausted
pulse
normal = 60-80
resp. distress = tachycardic, bradycardic
effort -
normal = minimal with little chest or abdomen movement
resp. distress = use of accessory muscles.
resp rate -
normal = 12-18
resp. distress = >18
rhythm -
normal = regular even cycles
resp. distress = no resp pause, prolonged expiratory phase.
skin
normal = pink
resp. distress = pale and sweaty
speech -
normal = clear and fluent
resp. distress = difficult, short sentences or phrases
sounds
normal = quiet
resp. distress = upper airway stridor
bronchospasm - wheezing
pulmonary oedema - crackles with possible wheeze.
Mental Status Assessment
ABSMATTPI
Appearance: grooming, posture, build, clothing
Behaviour: eye contact, mannerisms, activity level
Speech:rate, volume, pitch, tone, flow, pressure
Mood: emotions as described - anxious, depressed, cheerful
Affect: emotion as observed - restrictive, blunted, labile.
Thought form: amount, rate, derailment, flight of ideas
Thought content: disturbances, delusions, suicidal, obsessions
Perception: illusions, hallucinations
Insight and Judgement: cognition, illness, understanding
Obstetrics History Taking
Adult History Taking
SAMPLE
Signs and symptoms - OPQRST
Allergies
Medications
Past medical history
Last ins and outs
Events prior
Geriatric History Taking
12 Lead ECG Placement
V1,V2,V4,V6,V3, V5
V1 - Fourth intercostal space, just right of the sternum
V2 - Fourth intercostal space, just left of the sternum
V4 - Fifth intercostal space, mid clavicular line
V6 - Fifth intercostal space, mid axillary line
V3 - Midway between V2 and V4
V5 - Midway between V4 and V6
V7, V8, V9, V10, V11, V12
Smoke over fire, snow on trees
White right anterior wrist.
Green right leg anterior ankle
Black left anterior wrist
Red left anterior ankle
5 Step Process of ECG reading
Regularity
Rate
P wave
Pr intervals
QRS Complex
Define the physiology behind a Pulse & normal range
A pulse is the expansion in diameter of an artery following the contraction of the left ventricle and the subsequent movement of blood through the arterial system. 60-100bpm measured by 15 seconds X4
IPPV / BVM Ventilation
Used to provide oxygen to a patient who cannot maintain their airway. 10-15 L/min at 60-80% oxygen. If oxygen sats remain above 94% for over 5 mins flow rate is adjusted accordingly.
Face masks and nasal cannula
Simple Face mask - used to deliver low to moderate amounts of oxygen (6-10L/min at 40-60%)
Partial Rebreather - 10-15L/min 60-80% oxygen
Non rebreather - High concentration of oxygen - more than partial rebreather. 10-15 L/min 80% oxygen
Nasal cannula - If the patient has obvious face or jaw deformities this nasal cannula is beneficial for low amounts of oxygen. 4-6 L/min
