Management Osce

Question 1

What is the care bundle for a stroke

Answer 1

FAST test - face, arms, speech, time
Onset time - when did the symptoms start
Take a BM
Take a blood pressure - systolic and diastolic
Pre alert the stroke team

Question 2

What are some symptoms associated with a stroke

Answer 2

Numbness
Weakness/ paralysis
Slurred speech / speech disturbance
Sudden loss of vision
Confusion
Severe headache
Double vision

Question 3

What is the care bundle for a STEMI (st elevation myocardial infarction)

Answer 3

Aspirin (300 mg - CHECK JRCALC IN OSCE)
GTN
Two pain scores
Appropriate analgesia such as entonox or morphine

MAKE SURE TO CHECK FOR DRUG CONTRAINDICATIONS ON JRCALC BEFORE ADMINISTERING

Question 4

What is an acute myocardial infarction?

Answer 4

Necrosis of a portion of the myocardial due to a prolonged lack of oxygen

Question 5

What is the care bundle for sepsis?

Answer 5

Observations assessed - news score
Oxygen administered where appropriate - not if initial salts are between 94-98%
Fluids administered - sodium chloride
Pre alert hospital - check JRCALC for sepsis pathway scoring

Question 6

What is the trust specific care bundle for asthma?

Answer 6

Resp rate assessed
Encourage use of own inhaler
SpO2 recorded
Administere high levels of supplementary oxygen
Administer beta 2 antagonist (salbutamol) through nebuliser connected to oxygen - SAY ADETOUR and CHECK DOSAGE ON JRCALC)
If no improvement administer ibrotropium bromide by nebuliser - ADETOUR

Question 7

What is the trust specific care bundle for hypoglycaemia? - low blood sugars

Answer 7

Blood glucose recorded recorded before treatment
Blood glucose recorded after treatment
Treatment recorded

Question 8

What is the treatment for hypoglycaemia?

Answer 8

Severe - pt unconscious
IM glucagon - can only be given once
Pre alert if necessary

Mild/ moderate - pt conscious, orientated, able to swallow
If pt can swallow - 15-20g dextrosol, 1 bottle glucojuice, 1-2 tubes 40% glucose gell

If pt came swallow - IM glucagon if IV access not possible

Re access glucose levels 10-15 mins after treatment.

Question 9

What is the old care bundle for COPD?

Answer 9

Resp rate recorded
3 or 12 lead ECG
SPO2 before treatment
Salbutamol given - except if there are contra-indications for pt
02 administered - except if there are contraindications for pt

Question 10

For treatment a stroke, what does the fast test involve?

Answer 10

Face - does there face look the same on each side? Ask them to smile, stick out their tongue etc (does it look the same?, is there a facial droop?)
Arms - is there any arm weakness? Are they able to hold there arms up and keep them up?
Speech - ask the patient to repeat a phrase back to you. is there speech slurred or impaired? Is this abnormal?
Time - when did these symptoms start? When did family members notice a change?