Station - Instructions for candidate
You are an intern working in the Emergency Department of a metropolitan hospital in Perth. It is 2 pm.
Andreas Nikolaidis, 78, has been brought in by ambulance from his nursing home because he has become drowsy and confused since last night and was shivering this morning. He has a long-term urinary catheter. The triage nurse has placed him in a resuscitation bay and called you; a registered nurse is with you and the senior doctor is with another patient.
| Nursing home transfer letter | 78 M. Type 2 diabetes (metformin 1 g twice daily), hypertension (ramipril 10 mg daily), benign prostatic enlargement with long-term indwelling catheter (last changed 5 weeks ago), osteoarthritis. Allergy: penicillin - rash as a child. Usually alert and oriented, mobilises with a frame. Weight 70 kg. For full active treatment; daughter Eleni is next of kin. Temperature 38.9 at the home this morning. |
|---|---|
| Triage observations | HR 118 /min, BP 84/48 mmHg, RR 26 /min, SpO2 93% on room air, T 39.1 degrees C, GCS 13, glucose 9.8 mmol/L. One 20-gauge cannula in the left hand from the ambulance. |
Your tasks are to:
- Perform an A-E assessment, verbalising each step to the examiner, and treat problems as you find them.
- Request the bedside and laboratory investigations you need. The examiner will provide results where appropriate.
- State your working diagnosis and the differential diagnoses to the examiner.
- Outline your management plan for the first hour to the examiner, including drug doses, who you will call and where the patient should be cared for.
- You do NOT need to take a full history, and you do NOT need to summarise your findings to the examiner.
- A registered nurse is at the bedside and will carry out your instructions; describe procedures rather than performing them.
- State drug, dose and route for anything you give, and the volume and rate of any fluid.
This is a 15-minute station, with 2 minutes of reading time.