Clinical Scenario Questions Flashcards
Tell us about a time where you disagreed with your senior
S:
Working in ANASS -> 32/40 with flank pain. Concerned about renal colic, bloods/baby NAD, however pt appeared quite unwell and was home along > 1.5hrs from hopsital
A:
Discussed with consultant about admission for observation + USS -> consultant deem that admission was not necessary given biochemically NAD. I advocated for the patient using graded assertiveness given her distance from hospital + clinical state despite normals bloods
As a team we made the decision to admit her for observation which was fortunate as she was later taken to OT with an infected obstructed kidney after further clinical deterioration
R
- KEY*
- Assessing the whole story and listening to patient concerns
- Senior clinicians are usually correct about clinical decisions, however junior doctors often know the patient the best and must act to advocate for them
- Using graded assertiveness to effect clinically safe care
Describe a situation where your clinical communication made a difference to patient care
S
- Care of a multigravid indigenous woman Esmerelda who presented frequently to birth suite in threatened pre-term labour. Significant social stressors without previous children in her care
A
- Clinical experience in Arnhem Land where she was from.
- Provided culturally appropriate clinical care whenever I was around and advised her case-load midwife about communication techniques that are culturally safe
- Actually listened to her concerns which were often not related to PTL at all
R
- KEY*
- Listen to the patient
- Provide culturally appropriate care and be aware of bias
Describe a situation where you were involved in a bad outcome
S
- PG for ripping for GDM metformin
A
- Placed a Cooks balloon catheter as per the consultant
- Fresh bleeding immediately during insertion, procedure ceased, escalated to consultant -> aware -> advised finish procedure and observe
- CTG following + Clinical picture NAD
- Review some areas later due to maternal ab pain. Uterus was tender. CTG was abnormal and further PVB approx 100mls
- Immediate senior review + consultant
- Offered IOL now vs C/S -> proceeded to C/S
DISCLOSURE
- Involved patient in open disclosure process
- Apologies for outcome
- Debrief over multiple days
- Document events + Discussions extensively
- Case escalated for clinical governance review
Follow up
R
- All interventions have risks
- Open disclosure is best for both parties
You attend a delivery for a NRCTG and you cut an episiotomy to expedite delivery. A screaming baby is brought up to the other with clear morphological features of T21. How do you handle the situation
Immediate care of mother
- Congratulate mother of safe delivery of baby
- Manage PPH if present -> Suture episiotomy
Discusss Dx
- Confirm abnormality with pads quickly whilst there is period of bonding between couple/baby
Have discussion in safe space with support people present
- Warning shot -> do you have any concerns
- “Your babies features are a little different, they may suggest your baby has Down’s syndrome, however -> need to do Dx tests
- Down syndrome is an incurable condition that can affect people in multiple ways, the most notable being physical features and intellectual impairment
Clinical Governance
- Send case for review if order to ensure pt was offered FTCS -> if not Ix personal/systems issues
Describe a critical incident that you were involved in in the work place, and what you learned from it
S
- Inducting PG who was deaf for GDM
- Issues with epidural -> repeat top up
- Fetal bradycardia and unresponsive patient
A
- Attended for review of fetal bradycardia
- Consented pt for internal examination, pt noted to be somewhat drowsy but consented
- 4-5cm dilated -> on attempting to discuss with patient via interpreter, pt noted to be un responsive.
- Assed for signs of breathing and circulation -> none
- Code blue-> I remained calm and started CPR ->
- Began resuscitation of patient without a clear leader
- Considered resuscitative hysterectomy but thankfully had ROSC
- Crash C/S in OT
R
- PT was transferred to ICU -> extubated later that day
- Extensive debrief and open disclosure + documentation + clinical governance review
Learning
- Real focus on debrief nd disclosure for families at patients following a traumatic event
- Clear team leadership and communication is essential in emergency situations
- Need to support people in their clinical decision making
- Long process of open disclosure is best for patient outcomes and satisfaction
How might stress impact the wellbeing of yourself/patient, what strategies do you focus on to manage stress
Impacts
- Personal: Stress -> blunt communication style and direct language. this can affect my relationships with staff and patients
- Professional: Decision making becomes difficult and inaccurate during times of stress
Strategies
- Focus on Self-awareness and self-regulation -> AMA emerging leadership program _. collaborative leadership
- Look after yourself, able to deal much better if fed/watered/slept/urinated
how would you counsel a woman who was smoking marijuana in pregnancy
Discussion about how much she uses, who else is using, why she uses marijuana.
there isn’t evidence it causes abnormalities but a significant portion of it crosses the placenta and can lead to poor growth learning and behaviour problems in the future and poorer memory
support the woman to make meaning change
- Quitline
- support family, make reasonable goals to achieve
Growth scans
