Station - Instructions for candidate
You are an intern in the Emergency Department of a Perth metropolitan hospital.
Dimitri Georgiou is a 78-year-old man from a Perth residential aged care facility who has been brought to the Emergency Department with three days of marked abdominal distension and vomiting that began today. The ambulance handover reports that he has passed no flatus for two days. His initial observations are provided above.
| Emergency Department triage observations | Initial observations: HR 104 regular, BP 132/78 mmHg, RR 20, SpO2 97% on room air, temperature 37.4 degrees C, pain score 3/10. |
|---|---|
| Ambulance handover | The patient has arrived from a residential aged care facility by ambulance. No treatment has been given in the Emergency Department. |
Results provided:
Abdominal radiographs
| Item | Value | Reference range |
|---|---|---|
| Projection and adequacy | Supine and erect abdominal radiographs show marked gaseous dilatation of the large bowel, with a single very large loop arising from the pelvis and extending into the upper abdomen. No free subdiaphragmatic gas is seen. | - |
The abdominal radiograph report is handed over when the candidate requests abdominal imaging.
imaging other - read aloud by the examiner
The images show a markedly distended abdomen containing a very large smooth loop of gas-filled bowel. The loop rises from the pelvis into the upper abdomen. There is no visible free gas beneath the diaphragm.
Look up an example image: LITFL sigmoid volvulus abdominal radiograph
Your tasks are to:
- Take a focused history of the presenting complaint and relevant background, including medications and allergies.
- Perform a focused examination of the periphery, abdomen, hernial orifices and rectum. Describe to the examiner what you would look for or do; the relevant findings will be provided to you.
- Request appropriate investigations, including other imaging. Results will be provided by the examiner if appropriately indicated.
- Interpret the investigation results provided to you.
- State your most likely diagnosis and two to four differentials, with brief justification, to the examiner.
- Outline your initial management plan, including immediate treatment, escalation and definitive pathway.
- Summarise your findings and plan to the examiner.
- Please verbalise each examination step to the examiner; findings will be provided when you reach the relevant part of the examination.
- Request investigations clearly; results will be provided only when appropriately requested.
- You do NOT need to perform a procedure or prescribe on a medication chart.
- You must summarise your findings and plan to the examiner.
This is a 15-minute station, with 2 minutes of reading time.