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OSCE > OSCE Emergency Stations > Flashcards

OSCE Emergency Stations Flashcards

1
Q

Describe the steps in DRS ABCD for emergency assessment of a patient

A

DANGER: check around the patient and environment for dangers
RESPONSE: Try speak to the patient and look for a response (shake, squeeze traps)
SHOUT: Ask for help if unresponsive

AIRWAY: open airway, perform head-tilt and chin-lift and look for any obstruction to the airway
BREATHING: assess breathing for up to 10 seconds while maintaining chin-lift manoeuvre, listen for breath sounds, look for chest movement and feel carotid pulse at the same time
CPR / CALL AMBULANCE: If patient is not breathing, start CPR and ask helper to call an ambulance (if no one to help, then you call ambulance yourself). Ask helper to get an automated external defibrillator if one is available.
DEFIBRILLATION: Apply pads to bare chest - one below right clavicle and one over cardiac apex - continue CPR while applying chest pads if there is a helper.

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2
Q

What is the ratio of chest compressions to breaths for adults?
What is the rate and depth of chest compressions?

How do you perform chest compression and rescue breaths?

A

Adults: 30 chest compressions to 2 rescue breaths
Rate of chest compressions: 100-120bpm and depth of 5-6cm.

CPR: Fully extend elbows, wrists and fingers, both palms downwards with fingers interlocked and compress.

Rescue breaths: apply pressure to the patients forehead with palm, occlude nostrils with index and thumb of the same hand. With your other hand perform head tilt-chin lift and form a full seal around the patients lips and expire for 1 second. Watch for chest movement. Repeat.

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3
Q

Ratio of chest compressions to breaths for children?

A

At birth: 3:1 ratio

Children: start with 5 rescue breaths and then 15:2 ratio.

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4
Q

What are the reversible causes of cardiac arrest?

4Hs and 4Ts

A

Hypoxia
Hypovolemia
Hypo/hyperkalaemia or metabolic disturbance
Hypothermia

Thrombosis - coronary or pulmonary
Tension pneumothorax
Tamponade
Toxins

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5
Q

Talk through the steps in ABCDE of a critically unwell patient and management throughout.

A

AIRWAY: head-tilt, chin-lift, look in airways for obstruction.
Treatments: remove debris, suction, airway opening manoeuvres, oropharyngeal/nasopharyngeal airway intubation (if GCS <8).
Treat any reversible causes: anaphylaxis, foreign body.

BREATHING: O2 sats, RR, chest examination (cyanosis, tracheal deviation, chest inspection, accessory muscle use, expansion, percussion, auscultation). Calves.
Treatments: 15L NRB mask.
Treat any underlying causes: pneumothorax, asthma/COPD exacerbation, opiate overdose, PE
Tests: ABG, CXR

CIRCULATION: CRT, HR, BP, Temperature, Auscultate heart, JVP, Fluid overload/status
Tests: Wide bore IV cannula, take bloods, ECG, Catheter and fluid balance monitoring
Treatment:
Hypotension (lay flat, elevate legs, 500mL saline STAT)
Shock (2 large bore IV cannulas, 1L saline STAT, replace blood with blood)
Treat any underlying arrhythmia, sepsis, bleeding etc.

DISABILITY: GCS/AVPU, Pupils, Pain assessment, Blood glucose, Temp if not done before
Tests: Consider CT head if GCS reduced
Treatment: Correct glucose, give analgesia if in pain

EXPOSURE: look for bleeds, rashes, injuries, drains, lines.
Examine the abdomen
Focussed exam of relevant systems
Treatment: manage any other abnormal findings as appropriate.

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6
Q

Classic history for PE?

A
  • pleuritic chest pain
  • haemoptysis
  • SOB
  • Recent long haul flight, surgery or immobility
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7
Q

Classic signs of PE on examination? (CV, Resp, Calves)

A
  • CV: Tachycardia, raised JVP, RV heave, loud P2, split S2. If BP <90 systolic/persistent bradycardia = massive PE
  • Respiratory: tachypnoea, clear chest/pleural rub
  • Calves: DVT signs
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8
Q

Investigations for PE

A
  1. Bloods - D-dimer raised
  2. CTPA
  3. ECG: tachycardia, RV strain
  4. ABG: hypoxaemia, hypocapnia
  5. CXR: may show wedge opacity, enlarged pulmonary artery, effusions
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9
Q

Treatment for PE

A

Treatment dose anticoagulation

Thrombolysis if massive

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10
Q

Classic history for pneumonia

A
  1. fever
  2. SOB
  3. productive cough
  4. pleuritic chest pain
  5. confusion
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11
Q

Classic examination findings in pneumonia

A
  • tachypnoea, cyanosis
  • coarse crepitations and bronchial breathing
  • dullness to percussion
  • increased vocal resonance
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12
Q

Investigations for pneumonia

A

CXR - consolidation
Inflammatory markers - raised

Identifying a cause

  • sputum culture
  • urinary pneumococcal and legionella antigens
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13
Q

Treatment for pneumonia

A

CURB65

Antibiotics depending on score

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14
Q

Classic history for pneumothorax

A
  • sudden onset pleuritic chest pain
  • may have SOB if large
  • risk factors e.g. marfan’s syndrome, COPD, asthma
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15
Q

Classic examination findings in pneumothorax

A
  • reduced chest expansion
  • absent breath sounds
  • hyperresonance

Tension pneumothorax
- raised JVP, hypotension, respiratory distress, tracheal deviation

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16
Q

Investigation for pneumothorax

A

CXR: shows air in pleural space

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17
Q

Management for pneumothorax

A

primary

  • <2cm = cxr and watch
  • > 2cm = aspirate

secondary

  • <1cm = observe for 24 hours
  • 1-2cm = aspirate
  • > 2cm = chest drain
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18
Q

Classic history of asthma exacerbation

A
  • dyspnoea
  • wheeze
  • known asthmatic
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19
Q

Examination findings in asthma exacerbation

A
  • tachypnoea
  • use of accessory muscles
  • polyphonic wheeze
  • reduced air entry
  • reduced peak flow
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20
Q

Investigations for asthma exacerbation

A

clinical diagnosis

  • CXR can rule out infection & pneumothorax
  • ABG: usually normal PaO2 and low PaCO2 due to hyperventilation (if oxygen low and CO2 high = patient is tiring!)
  • blood and sputum cultures if evidence of infection
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21
Q

Management of asthma exacerbation

A
  • salbutamol nebs
  • ipratropium nebs
  • steroids
  • magnesium IV
  • antibiotics if evidence of infection
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22
Q

Classic history for ACS?

A
  • crushing central chest pain
  • radiates to neck, left arm
  • associated nausea, SOB, sweatiness
  • CV risk factors
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23
Q

Examination findings for ACS

A

might be normal

  • general: sweaty, SOB, pain
  • CV: bradycardia/tachycardia
24
Q

Investigations for ACS

A

ECG: ST elevation or new LBBB
Troponin: increased (normal levels in unstable angina)
CXR: normal or signs of HF
Coronary angiography

25
Q

Immediate management for ACS

Longer term to consider

A

MONAP

  • Morphine 10mg in 10ml slow IV +/- anti-emetic (10mg metoclopramide IV)
  • Oxygen if sats <94-98%
  • Nitrates - GTN spray if not hypotensive
  • Aspirin 300mg PO loading dose and then 75mg OD
  • PCI

Longer term

  • Second antiplatelet (prasugrel, ticagrelor or clopidogrel)
  • Beta blocker
  • ACEi
  • Statin
26
Q

classic history for AAA

A
  • tearing chest pain of very sudden onset
  • radiates to back
  • pain in arms, legs, head, neck
27
Q

classic examination findings in AAA

A
  • unequal BP/pulse in arms
  • may develop aortic regurgitation
  • expansile mass in abdomen
  • peritonitis
28
Q

investigations for AAA

A
  • CXR: widened mediastinum
  • CT angiogram
  • USS abdo
  • ECG: may show signs of MI (usually inferior)
29
Q

treatment for AAA

A

type a: surgical repair

type b: BP control

30
Q

classic history for pericarditis

A
  • retrosternal chest pain
  • relieved by sitting forward
  • may radiate to trapezius ridge, neck, shoulder
  • viral prodrome is common
31
Q

classic examination findings in pericarditis

A
  • pericardial rub
  • tachycardia
  • JVP distension and pulsus paradoxus may indicate tamponade
32
Q

investigations for pericarditis

A

clinical diagnosis
ECG: PR depression, saddle shaped ST elevation
CXR: globular heart if pericardial effusion present
ECHO if pericardial effusion is suspected

33
Q

management of pericarditis

A
  • NSAIDs

- Treat cause if known

34
Q

classic history for myocarditis

A
  • chest pain
  • SOB
  • palpitations
  • fever
  • fatigue
35
Q

examination findings for myocarditis

A
  • signs of HF
  • S3 gallop
  • Fever
  • Tachypnoea/tachycardia
36
Q

Investigations for myocarditis

A
  • ECG: diffuse T wave inversions, ST elevation or depression
  • Inflammatory markers: raised
  • Troponin: raised
  • Serology: identify cause
37
Q

Management for myocarditis

A
  • treat cause
  • treat complications like HF
  • bed rest
38
Q

Classic history for GORD

A
  • retrosternal burning chest pain

- related to meals, lying, straining, water brash

39
Q

examination findings for GORD

A
  • usually none but might have some epigastric pain if associated gastritis
40
Q

management for GORD

A
  • lifestyle advice

- PPI

41
Q

classic symptom of peritonitis

A
  • severe generalised abdominal pain
42
Q

classic examination finding for peritonitis

A
  • shock
  • no abdominal movement with respiration
  • guarding
  • firm
  • rebound tenderness
  • severe pain to light palpation and to percussion
43
Q

investigations for peritonitis

A
  • ERECT CXR - initial investigation which can show air under the diaphragm
  • CT ABDO/PELVIS - diagnostic test - shows the area of perforation
44
Q

management of peritonitis

A
  • urgent surgical repair
45
Q

classic history for appendicitis

A
  • young patient
  • peri-umbilical pain initially then moves to RIF
  • anorexia/nausea
  • fever
46
Q

examination findings for appendicitis

A
  • tender RIF
  • worse at McBurney’s point
  • Guarding / local peritonitis
  • Rosving’s positive
47
Q

investigations for appendicitis

A
  • USS abdo
  • raised inflammatory markers
  • bHCG to rule out ectopic
48
Q

management of appendicitis

A
  • appendicectomy
49
Q

classic history for acute pancreatitis

A
  • severe epigastric pain
  • radiates to back
  • relieved sitting forward
  • vomiting
  • history of possible cause - alcohol, gallstones, trauma, hypertriglyceridaemia, medications, surgery
50
Q

investigations for acute pancreatitis

A
  • clinical diagnosis
  • amylase or lipase as initial investigation: raised
  • deranged LFT
  • USS abdo to confirm cause, check triglycerides and immunoglobulins
51
Q

management of acute pancreatitis

A
  • supportive management
  • aggressive fluid resuscitation with Hartmann’s - 1L every 4 hours
  • NBM until nausea or pain improve
  • No ABX unless proven infection, gas on CT or raised procalcitonin
  • Treat/withdraw cause
  • ICU may be needed
52
Q

Typical presentation of a stroke/TIA

A
  • sudden onset neurological symptoms (facial weakness, slurred speech, hemianopia)
  • risk factors: age, HTN, smoking, DM, vascular disease, AF
53
Q

Investigations for TIA/Stroke

A
  • CT head is diagnostic
  • ECG: check for AF
  • Coag screen
  • Carotid dopplers
54
Q

Acute management for stroke

Long term management for stroke

A
  • CT head to exclude haemorrhagic stroke
  • antiplatelet or thrombolysis if ischaemic stroke (alteplase) if within <4.5hrs

Long term

  • clopidogrel
  • statin
  • BP control
55
Q

Life-threatening asthma attack classification

A

33, 92, CHEST

33: PEFR <33% of predicted
92: Sats <92%
Cyanosis
Hypotension
Exhaustion
Silent chest
Tachycardia

56
Q

Severe asthma attack classification

A

PEFR <50% expected
Can’t complete sentences
Respiratory rate >25
HR >110

57
Q

Treatment of asthma exacerbation

A

Oxygen
Salbutamol 2.5-5mg NEB
Hydrocortisone 100mg IV or 40mg PO prednisolone
Ipratropium 500mcg NEB
Theophylline - senior decision
Magnesium sulphate 2mg IV over 20 mins - senior decision
Escalate care - senior decision

OSCE (1 decks)

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