Osce Year 2 Airway

Question 1

First approach

Answer 1

Wash hands, use PPE if needed,
introduce yourself,
Explain assessment,
Gain consent.

Question 2

Airway 1. Talk?

Answer 2

Is patient talking to you? If so, no obstruction.

If not, assess airway using look, listen, feel.

Question 3

Airway 2. Look.

Answer 3

Look for signs of obstruction:
Paradoxical breathing;
Laboured breathing.

Question 4

Airway 3. Listen

Answer 4

Listen - abnormal sounds such as snoring, grunting, wheezing, strider, gurgling.

Silence?

Question 5

Airway 4. Feel.

Answer 5

Feel - hand over patient’s mouth. Is air moving in and out? Airway is patent if so.

If not, airway is obstructed.

Question 6

Airway 5. Actions.

Answer 6

If obstruction, call crash team.
Check for foreign bodies or use suction if needed.
Head tilt/chin lift or jaw thrust to open airway.
Airway adjuncts - Guedel airway or nasopharyngeal airway.

Question 7

Breathing 1.

Obs.

Answer 7

Take respiratory rate and oxygen saturation.

Normal 12-20. Normal 95-99%. COPD 88-92%

Question 8

Breathing 2.

Look at breathing.

Answer 8

Look at rhythm, depth, symmetry and any abnormal pattern, such as seesaw breathing or apnoea.

Question 9

Breathing 3.

Effort.

Answer 9

Does patient look distressed? Look for accessory muscle use, nasal flaring, pursed lips,

Question 10

Breathing 4.

Patient’s colour.

Answer 10

Look at skin colour and mouth and mucous membranes. Cyanosis.
If blueish centrally - may indicate poor oxygenation.

If blueish peripherally - may indicate poor circulation.

Question 11

Breathing 5.

Cough.

Answer 11

Ask patient if they have a cough. How long for, when they cough.

Ask about sputum. Obtain sample, look for frothiness, infection, blood.

Question 12

Breathing 6.

Ask patient.

Answer 12

Ask patient how their breathing feels to them. Is it normally like this?

Or are they feeling breathless?

Question 13

Circulation 1.

Heart Rate

Answer 13

Take pulse manually for rate. Normal 60-100 bpm.

Regularity, strength. Weak and thready, bounding? Any chest pain?

Question 14

Circulation 2.

BP

Answer 14

Take BP, systolic and diastolic pressure. Normal systolic 100-139 mmHg, normal diastolic 60-90mmHg.

Pulse pressure? Normal 35-45 mmHg.

Question 15

Circulation 3.

Capillary refill

Answer 15

Capillary refill time - normal 2secs / extended / shortened?

Peripheries - colour? Pallor/cyanosis?
Peripheries - cool, warm, sweaty, clammy.

Question 16

Circulation 4

Temperature

Answer 16

Central temperature reading?

Pyrexia above 37.5
Hypothermia below 35.5.

Question 17

Circulation 5

Fluid status.

Answer 17

Urine output normal (1/2 ml urine per kilo per hour) - Fluid input.
Fluid balance chart - negative or positive pressure?
Dehydration or overload - skin turbot, mucous membranes dry? Oedema?
If hypotension and in negative fluid balance needs IV fluids.

Question 18

Disability 1.

AVPU

Answer 18

AVPU or GCS

Question 19

Disability 2.

Pain

Answer 19

Pain assessment

Question 20

Disability 3

CBG

Answer 20

Take blood glucose measurement.

Question 21

Disability 4

Meds.

Answer 21

Medication review, also check for opiates.

Question 22

Exposure 1.

Bleeding

Answer 22

Check for signs of bleeding and check any drains.

Question 23

Exposure 2

Oedema

Answer 23

Check for fluid overload, oedema in arms, legs, hands, feet.

Pitting oedema at ankles

Question 24

Exposure 3

Allergy

Answer 24

Check for allergic reactions or rashes, urticaria.

Question 25

Exposure 4

VTE

Answer 25

Check for VTE. Is one leg Swollen, red, hot? Is patient breathless?

Question 26

Exposure 5

Infection

Answer 26

Check for signs of infection on skin or in wounds, cellulitis etc.

Question 27

Escalation 1

Answer 27

Calculate News

Use SBAR. Call MET team, doctor or Outreach.

Question 28

Escalation 2.

Speed

Answer 28

Score NEWS 0-4 - low. Obs 4 hourly. (12 hourly for 0).
Score NEWS 5-6 - medium concern. Obs 1 hourly or less. Escalate to doctor and advise outreach team. Response - 30 mins.
Score NEWS 7+. Escalate to outreach, doctor, met or crash. Stress urgency and immediate response needed. Continuous obs.