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
