OSCE Emergency Stations Flashcards
(57 cards)
Describe the steps in DRS ABCD for emergency assessment of a patient
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.
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?
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.
Ratio of chest compressions to breaths for children?
At birth: 3:1 ratio
Children: start with 5 rescue breaths and then 15:2 ratio.
What are the reversible causes of cardiac arrest?
4Hs and 4Ts
Hypoxia
Hypovolemia
Hypo/hyperkalaemia or metabolic disturbance
Hypothermia
Thrombosis - coronary or pulmonary
Tension pneumothorax
Tamponade
Toxins
Talk through the steps in ABCDE of a critically unwell patient and management throughout.
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.
Classic history for PE?
- pleuritic chest pain
- haemoptysis
- SOB
- Recent long haul flight, surgery or immobility
Classic signs of PE on examination? (CV, Resp, Calves)
- 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
Investigations for PE
- Bloods - D-dimer raised
- CTPA
- ECG: tachycardia, RV strain
- ABG: hypoxaemia, hypocapnia
- CXR: may show wedge opacity, enlarged pulmonary artery, effusions
Treatment for PE
Treatment dose anticoagulation
Thrombolysis if massive
Classic history for pneumonia
- fever
- SOB
- productive cough
- pleuritic chest pain
- confusion
Classic examination findings in pneumonia
- tachypnoea, cyanosis
- coarse crepitations and bronchial breathing
- dullness to percussion
- increased vocal resonance
Investigations for pneumonia
CXR - consolidation
Inflammatory markers - raised
Identifying a cause
- sputum culture
- urinary pneumococcal and legionella antigens
Treatment for pneumonia
CURB65
Antibiotics depending on score
Classic history for pneumothorax
- sudden onset pleuritic chest pain
- may have SOB if large
- risk factors e.g. marfan’s syndrome, COPD, asthma
Classic examination findings in pneumothorax
- reduced chest expansion
- absent breath sounds
- hyperresonance
Tension pneumothorax
- raised JVP, hypotension, respiratory distress, tracheal deviation
Investigation for pneumothorax
CXR: shows air in pleural space
Management for pneumothorax
primary
- <2cm = cxr and watch
- > 2cm = aspirate
secondary
- <1cm = observe for 24 hours
- 1-2cm = aspirate
- > 2cm = chest drain
Classic history of asthma exacerbation
- dyspnoea
- wheeze
- known asthmatic
Examination findings in asthma exacerbation
- tachypnoea
- use of accessory muscles
- polyphonic wheeze
- reduced air entry
- reduced peak flow
Investigations for asthma exacerbation
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
Management of asthma exacerbation
- salbutamol nebs
- ipratropium nebs
- steroids
- magnesium IV
- antibiotics if evidence of infection
Classic history for ACS?
- crushing central chest pain
- radiates to neck, left arm
- associated nausea, SOB, sweatiness
- CV risk factors
Examination findings for ACS
might be normal
- general: sweaty, SOB, pain
- CV: bradycardia/tachycardia
Investigations for ACS
ECG: ST elevation or new LBBB
Troponin: increased (normal levels in unstable angina)
CXR: normal or signs of HF
Coronary angiography
