OSCE

Question 1

Hyperthermia

Answer 1

Primary: D- remove from heat source (ambulance), RA: OP/LMA, B: O2/IPPV, CDE- remove clothes
VSS: temp, BGL, BP, ECG, SpO2/EtCO2
SITREP: CCP- ETT, cooled fluids
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T
Interventions: rapid cooling, IV access + fluids, analgesia, antiemetic, paracetamol
Transport, pre-notify

Question 2

Hypothermia

Answer 2

Primary: DRA: OP/LMA, B: O2/IPPV, CDE: remove wet clothing (carefully if compartment syndrome/<28C), insulate with blankets
VSS: temp, BGL, BP, ECG, SpO2/EtCO2
SITREP: CPP- warmed fluids
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T
Interventions: RESUS? IV access + warmed fluids

Question 3

Traumatic injury

Answer 3

Primary: DRABCDE
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T
Interventions

Question 4

TBI

Answer 4

Primary: D- QPS/safe scene, RA: OP/NP/LMA, B: ventilatory support (10b/m), ETCO2, C: IV fluids (SBP 100-120mmHg), D: c-spine support, E: maintain normothermia.
SITREP: CCP- hypertonic saline, RSI. Pt. is time critical- load & go, position head-up 30° to maximise cerebral perfusion and minimise cerebral ICP.
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T (distracting injuries)
Interventions: Actively vomiting IM = Ondansetron.
Transport, pre-notify (time is tissue)

Question 5

Barotrauma

Answer 5

Primary: D: remove from water/dry. RAB: 100% O2 (accelerate reabsorption of nitrogen), chest decompression if tension pneumothorax (release pressure in pleural space that is forcing the mediastinum to opposite side & crushing the heart). C: IV access + fluids (divers are often dehydrated, increase blood volume). DE: Remove wetsuit, maintain normothermia, position Pt. supine (nitrogen rises if standing up, also prevents AGE from becoming CAGE).
Hx.: SAMPLE
SITREP: CCP, ACP, Divers Alert Network (DAN).
Secondary: CVA, RSA, NSA, H-T
Interventions:
Transport, pre-notify (stabilise –> hyperbaric chamber)

Question 6

Burns

Answer 6

Primary: D: remove from heat source. RA: assure patency (CO poisoning?). B: 100% O2. C: IV access + fluids (continue fluid resus due to constant fluid shift causing hypovolaemia). D: analgesia. E: maintain normothermia (cool burn, warm Pt.), 20-60min under running water, glad wrap (pain, infection control, fluid loss, heat loss).
Hx.: SAMPLE
SITREP:
Secondary: CVA, RSA, NSA, H-T
Interventions:
Tx to burns centre, pre-notify

Question 7

Croup

Answer 7

Primary: DR: WCS? A: NEB Adrenaline, Dexamethasone. BCDE.
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T
Interventions

Question 8

PPH

Answer 8

Primary: DRABC: control haemorrhage, raise legs, IV access + fluids + TXA. DE: blood loss >500ml?
Hx.: SAMPLE, obstetric Hx.
SITREP: CCP (bloods) + ACP
Secondary: CVA, RSA, NSA, H-T, fundal massage
Interventions: Active management 3rd stage of labour, manage the T’s, control haemorrhage (external aortic/bimanual compression). Reassess fundal tone.

Question 9

Pre/eclampsia

Answer 9

Primary: DRABC: IV access. DE: maintain quiet environment, minimise body motion, attain position of comfort.
Hx.: SAMPLE, obstetric Hx.
SITREP: CCP- Mg sulphate
Secondary: CVA, RSA, NSA, H-T
Interventions: seizure- IV Midazolam preferred (5mg in 5ml NaCl 0.9%) or IM/NAS if IV not in situ.

Question 10

Pericarditis

Answer 10

Primary: DRAB: O2 to reduce anxiety? C: IV access + fluids, ECG. D: Analgesia (Paracetamol, Fentanyl), Aspirin (can’t rule out ACS), Fentanyl (CCP, low dose). E: reassurance, position of comfort.
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T
Interventions

Question 11

ACS

Answer 11

Primary: DRAB: O2. C: IV access, Aspirin, GTN. DE.
Hx.: SAMPLE
SITREP: CCP
Secondary: CVA, RSA, NSA, H-T
Interventions: Pain- Fentanyl/morphine. Other- Ondansetron, thrombolysis clot if >60min from pPCI capable hospital, or administer drugs for pPCI referral if <60 min.

Question 12

SVT

Answer 12

Primary: DRAB: O2. C: IV access, PO Aspirin (if myocardial ischaemia suspected). DE.
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T
Interventions: Modified Valsalva manouvre.

Question 13

APO

Answer 13

Primary: DRAB: O2, IPPV/PEEP/CPAP. C: IV access. D(drugs): GTN (@ 5mins), Aspirin. E: Posture Pt. sitting up, 12-lead ECG, manage dysrhythmias/ACS/cardiogenic shock.
Hx.: SAMPLE
SITREP- CCP
Secondary: CVA, RSA, NSA, H-T
Interventions

Question 14

PE

Answer 14

Primary: DRAB: O2. C: IV access + fluids (250-500ml). D(drugs): analgesia (PO paracetamol, IV Fentanyl). E: position of comfort, minimize movement, maintain normothermia.
Hx.: SAMPLE
SITREP: CCP (Adrenaline)
Secondary: CVA, RSA, NSA, H-T
Interventions: Anticipate further deterioration, commence RESUS if required.

Question 15

Drowning

Answer 15

Primary: DR: U –> RESUS. A: OP/NP/LMA. B: O2/IPPV/PEEP. C: IV access. DE: remove wet clothing, dry Pt., maintain normothermia.
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T
Interventions: Correct reversible causes

Question 16

COPD

Answer 16

Primary: DRAB: O2 (88-92%)/CPAP, NEB Salbutamol/Ipratropium (@ 6L). C: IV access + fluids (if BP requires, beware overloading). D (drugs): Hydrocortisone (IM 100mg). E: reassurance, minimal exertion, maintain normothermia.
Hx.: SAMPLE
SITREP: CCP- IV Salbutamol
Secondary: CVA, RSA, NSA, H-T
Interventions

Question 17

Anaphylaxis

Answer 17

Primary: D: remove obstruction/allergen, IM Adrenaline. R. A: advanced airway, NEB Adrenaline. B: O2, NEB Salbutamol/Ipratropium bromide. C: IV access + fluids. DE: expose, position supine.
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T
Interventions

Question 18

Asthma

Answer 18

Primary: D: asthma severity- IM Adrenaline. RA: advanced airway. B: O2, NEB Salbutamol/Ipratropium bromide, IPPV/CPAP. CD: Hydrocortisone. E: Position Pt. upright/position of comfort.
Hx.: SAMPLE
SITREP: CCP- Mg sulphate.
Secondary: CVA, RSA, NSA, H-T
Interventions

Question 19

OD

Answer 19

Primary: DRABCDE
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T
Interventions

Question 20

Hypoglycaemia

Answer 20

Primary: DRA: support airway (OP/NP/L lateral). B: 02. C: IV access + Glucose 10%. DE: look for insulin pump, H-T for bites/scratches/medialerts).
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T
Interventions: Glucose gel (A/P: 15g, repeated once @ 15mins –> max 30g) / Glucose 10% (A: 150ml repeated 1ml/kg boluses @5mins, P: 2.5ml/kg repeated 100ml boluses @5mins)

Question 21

CVA

Answer 21

Primary: : DRAB: O2 (don’t over-oxygenate = vasoconstriction). C: IV access. D (drugs): Ondansetron (reduce risk of increased ICP), consider analgesia. E: Position 45° (increase perfusion + decrease cerebral oedema).
Hx.: SAMPLE
SITREP: CCP
Secondary: CVA, RSA, NSA, H-T, NHISS-8, modified Rankin score, stroke referral.
Interventions: IM Ondansetron (4-8mg)

Question 22

Thoracic or abdominal aneurysm

Answer 22

Primary: DRAB: O2. C: IV access. D (drugs): Fentanyl. E: if moving –> to ambulance).
Hx.: SAMPLE
SITREP: CCP (Bloods)
Secondary: CVA, RSA, NSA, H-T
Interventions: NAS/IV Fentanyl (25-100mcg at 10/5mins, max 200mg).

Question 23

Seizure/status epilepticus

Answer 23

Primary: DRABCDE
Hx.: SAMPLE
Secondary: CVA, RSA, NSA, H-T
Interventions