OSCE powerpoint 2009 - Royal College of Emergency … · He had no chest pain. • Vital signs: BP:...
Transcript of OSCE powerpoint 2009 - Royal College of Emergency … · He had no chest pain. • Vital signs: BP:...
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OSCE
2 December 2009
PYNEH
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Question 1
• A 54 year old male with history of old MI was
sent in A&E after convulsion in street. The
convulsion had stopped spontaneously and he
was still drowsy. He had no chest pain.
• Vital signs:
BP: 110/60mmHg; pulse=66/min; SaO2: 96% at
room air; afebrile and Glasgow Coma Scale
was 11/15 (E=2, V=4, M=5 )
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Referring to the ECG of this patient:
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Q1 Questions
• Describe the ECG finding?
• Would you consider thrombolysis or PCI?
• What is the more likely diagnosis?
• What would be your next step to confirm your
suspicion?
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Question 2
• A 68 year old male collapsed at home after
being unwell for 2 days. His vital signs were:
– BP = 74/46;
– pulse = 80/min;
– GCS = 5/15;
– temp = 36.0
– SaO2 = 92% with 100% oxygen.
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Q2 questions
• Name 4 differential diagnoses that a bedside
echocardiogram can help in this patient.
• Name 2 conditions that a bedside USG
abdomen can help in his situation.
• What condition has been shown from this
echocardiogram?
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Question 3
• A 32 year old female Marathon runner collapsed just
after finished the race. She was drowsy. The vital signs
were as follow: BP:110/80mmHg; P=75/min. SaO2 98%
at room air. RR 14/min; Temp: 36.5 oral.
• This was her first time running Marathon. It was a cool
whether and the lady took totally 5 liters of water and
electrolyte drink before and during the race. She was
resuscitated by the on-site medical team with 1 liter of IV
normal saline at full rate but there was no improvement.
She has no urine output since the race started.
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Q3 Questions
• What is the most likely diagnosis?
• What investigations would you order to
confirm your suspicion?
• The patient became much drowsier in front of
you after fluid bolus. What would be your
intervention to rectify her situation?
• How could you explain why there was no
urine output?
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Question 4
• : A 72 year old lady collapsed at home. She
was sent in by ambulance and has received 3
AED shock on the way. On arrival, she has
regained circulation with blood pressure
100/70mmHg, Pulse 65/min, SaO2 99% with
28% oxygen, GCS = 3/15 and core body
temperature of 34.5C. 12-lead ECG showed
sinus rhythm.
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Q4 Questions
• The rhythm before AED shock was found to be
ventricular fibrillation. What drug would you
give to prevent cardiac arrest?
• She was intubated and going to be admitted
to ICU. Her CT brain was unremarkable. What
treatment would you like to offer for her body
temperature?
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Question 5
• A 77 year old lady was sent to R-room for
chest discomfort for 1 day. Her vital sign: BP:
95/50mmHg; Pulse 108/min, SaO2=93% with
6L nasal oxygen; She had no fever and was
fully alert. Her chest XR was clear and
unremarkable.
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Her ECG was as shown:
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Q5 Questions
• What are your ECG findings?
• What investigation would you order as first
priority?
• How could bedside USG help in her situation?
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Question 6
• A 33 year old lady with past history of
depression present with seizure after
intentional drug overdose of 80 tablets of
unknown drugs. On arrival, she was comatose
with GCS 3/15. Her blood pressure was 84/45.
Both her pupils were dilated and sluggish in
response.
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Her ECG was shown:
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Q6 Questions
• Describe 3 abnormalities of the ECG.
• Name 4 drugs that can produce similar ECG
pattern in overdose situation.
• What antidote(s) would be indicated in this
condition?
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Thank you