OSCE Flashcards
INFORMED CONSENT
1-Understanding for the patient situation
2-Indication (for surgery)
3-Process (of anesthesia)
4-Benefits
5-Risk: common/benign (one)
6-Risk: rare/severe (one)
7-Mitigation
8-Alternative
9-Questions
10-Confirm I have your consent
HAVE THE PATIENT GIVE CONSENT IN THEIR OWN WORDS
PERIPROCEDURAL COMPLICATIONS
1-Understand
2-Elicit History
3-Physical
4-Potential causes (take responsibility)
5-Plan/Likely outcome
6-Questions
7-Summarize
TAKE RESPONSIBILITY
ETHICS
1-Understand the patient situation
2-Identify stakeholders
3-Name core ethical principles (beneficence, non-maleficense)
4-Elicit preferences
5-Clarify options (2 is enough)
6-Plan (may have to negotiate)
Stakeholders: is there anyone else you would like to help you make this big decision
COMMUNICATION WITH OTHER PROFESSIONALS
For cancelling a case:
-Understand the situation
-Elicit concerns
-Resolve
For remote crisis management:
-Call for help early
-Closed loop communication
Plan to sit down…and have the angry surgeon sit down
Practicate-Based Learning
1-Define problem
2-Measure
3- Stakeholders
4-Educate
5-Implement
6-Measure again
DNR
Many patient often suspend their DNR..
Has he mentioned what he would like to have happen if his heart were to stop…chest compression, shocks, medication
We can rescind DNR in part, not at all, or entirely
NEURO EXAM
Pupillary reflex
Follow my finger
Facial Sensation
Closs your eyes, smile big, puff out check
Shrug shoulder
Stick out tongue
MONITORS:
Upsloping EtCO2 expiratory phase…ddx
-Bronchospasm
-Anaphylaxis
Monitors:
-Elevated inspiratory EtCO2 baseline…ddx
1-Exhausted CO2 absorbent
2-Incompetent expiratory valve
MONITORS:
Incompent inspiratory valve…describe
Prolonged inspiratory downstroke
Prolonged QTC and torsades…ddx
Hypokalemia
Hypocalcemia
1-Mid-esophageal 4 chamber:
(mitral valve leaflets, tricuspid leaflets)
2-Mid-esophageal 2 chamber
(coronary sinus, left atrial appendage)
3-Mid-esophageal Aortic Valve Long Axis
(mitral valve leaflets)
4-Mid-esophageal Aortic valve Short Axis
(Cusps)
5-Mid-esophageal RV inflow-outflow
(Cusps)
6-Mid-esophageal Bi-Caval View
(Intraatrial septum)
7-Transgastric mid-papillary short axis view
(Posteromedial pap, anterolateral pap)
8-Mid-esophageal Ascending Aorta long axis
9-Mid-esophageal Ascending Aorta short axis
10-Descending Aorta long axis view
11-Descending Aorta short axis view
4 chamber:
-Posterior leaflet TV, septal leaflet TV
-Anterior leaflet, posterior leaflet
2chamber:
Posterior, anterior leaflet
Aortic valve Long Axis:
Posterior, anterior
-NCC, RCC
TTE
Parasternal short (papillary muscles)
R to L:
Posteriormedial…anterolateral
Parasternal short, mid-pap view
Tail toward head
PTX M-Mode
Barcode sign
Vascular:
1-IJ
2-Cubital Fossa
3-Radial vessels
4- Femoral vessels
1-SCM, Anterior scalene
2-Brachial (medial) , vein
3-Flexor carpi radialis (medial)
4-Fascia iliaca, Iliopsoas muscle
Femoral vessels…have them lie down
BLOCKS:
1-Supraclav
2-Infraclav
3-Interscalene
4-Axillary
5-Femoral
6-Adductor canal
7-Pop fossa block
8-TAP block
1-Supraclav:
Middle scalene muscle, subclavian artery, first rib…2 spots
2- Infraclav:
Pec major, pec minor, axillary artery, axillary vein, brachial plexus cords next to axillary artery
3-Interscalene:
Middle scalene muscle, C5/C6/C7 nerve roots, anterior scalene muscle, IJ, Carotid
4-Axillary
-Biceps, coarachobrachialis, musculocutaneous nerve
-Axillary artery (and MUR nerves)…3 spots
5-Femoral
-Facia iliaca, iliopsoas muscle, femoral artery and vein
6-Adductor canal
Sartorius, femoral artery, femoral vein, vastus medialis, saphenous nerve
7-Pop fossa
Semitendinosus, semimembranosis, tibial, common peroneal, popliteal vein, popliteal artery, biceps femoris…tibial and common personeal become sciatic nerve….1 or 2 spots
8-TAP block
-External oblique, internal oblique, transversus abdominus, peritoneum
Block positioning
INFRACLAV
AXILLARY
POP FOSSA
Blocks
Pay attention to laterality, check coags
Adductor Canal
Pop Fossa
…what nerves
Saphenous
Sciatic
OSCE…general
WASH HANDS
