Approaching Emergency OSCE Stations Dr Beth Woolley 07.12.2010

1. Approaching EmergencyOSCE StationsDr Beth Woolley07.12.2010

2. Background • Why I chose this topic • Plan for this session: • General approach • 2 worked examples • Interactive practice cases

3. General Approach Identify it’s an emergency station Assessing an acutely ill simulated patient Discussing with the examiner how you would approach an acutely ill patient ABC

4. Example 1 – Chest pain “In this station it is just you and the examiner. They will ask you questions about how you would assess and manage the following patient. A 76 year-old man with hypertension and hypercholesterolaemia presents to A&E with a gripping pain in the centre of his chest, which spreads to his left arm. He feels a bit breathless. He is clutching his GTN spray.”

5. Example 1 – Chest pain How would you assess this patient? What is your differential diagnosis? How would you initially manage this patient? If there is ST elevation? If there is no ECG signs of acute MI?

6. Example 2 – Post-op patient “In this station there will be you, the examiner and an SP. You are an F1 in Surgery. You have been asked to see a 60 y-o lady, Susan, who has abdominal pain. The nurse tells you that the patient had a laparotomy yesterday for the removal of a colon cancer. The nurse is worried since Susan’s pain came on suddenly and she is starting to look clammy. Please conduct a focussed physical examination. The examiner will give you the relevant findings. You will then be asked questions about the case.”

7. Example 2 – Post-op patient Identify it’s an emergency station Start with ABC Do an abdo exam How would you manage this patient?

8. Over to you!Station 1 “In this station there will be a simulated patient. You are an F2 in A&E majors. Your patient is a 18 year old female called Lucy. She has come to A&E because she is wheezing and can’t catch her breath. Please take a brief focussed history and examine the patient. You will then be asked for your differential diagnosis.”

9. Station 1 Qs How would you start this station? What are the important components of the history? How would you examine her? What is your differential diagnosis?

10. Station 2 “ In this station there will only be an examiner. You are an F1 in Paediatric A&E. You will be asked questions about the following patient’s case: A 7 year old boy has been brought in by his mum, who is very concerned because over the past 2 hours he has become drowsy. She has noticed that over the last few weeks he has been drinking loads, going to the toilet more than usual and has lost some weight.”

11. Station 2 Qs What would you initially do with this patient? What are the important components of the history? How would you examine the child? What is the management?

12. Station 3 “In this station there will be a simulated patient and an examiner. You are an F1 on the ward in General Surgery. A healthcare assistant calls you over to a patient because she just saw him vomit blood. You haven’t met the patient yet. He has just arrived for an elective operation tomorrow. Please take a brief history and examine the patient.”

13. Station 3 Qs How would you start this station? What would you ask for in the history? How would you examine him?

14. Closing Tips Oxford handbook emergencies section Oxford handbook for the Foundation Programme The OSCE emergency stations won’t be obscure or rare conditions Show how you will be a safe F1 Enjoy a bit of time off at Christmas. Good luck! beth.woolley@doctors.org.uk