Station - Instructions for candidate
You are an intern working in the Emergency Department of a Perth metropolitan hospital.
Kosta Kostas, a 42-year-old sole parent, presented 90 minutes ago with chest discomfort that woke him from sleep. An ECG has been performed and blood tests sent; initial troponin is back. He has just told the nurse that he needs to go home to look after his two children, aged 6 and 9, who are alone in the house. The emergency registrar has asked you to speak with him before the second troponin result is due back.
| Initial observations | HR 102 regular, BP 156/94 mmHg, RR 20, SpO2 97% on room air, temperature 36.8 C |
|---|---|
| Initial troponin I | 0.15 mcg/L (upper limit normal 0.04) |
| ECG findings | New ST depression and T wave inversion in leads V1-V3 |
Your tasks are to:
- Assess the patient's cardiac risk and explain why he must stay for further investigation and monitoring.
- Manage his request to leave hospital: explore his reasons and concerns, assess his decision-making capacity, and explain the risks of discharge.
- Negotiate a plan: if he still wishes to leave, arrange safe discharge with appropriate follow-up and safety-netting.
- You do NOT need to examine the patient further.
- You are not required to write prescriptions or detailed orders.
- You do NOT need to summarise your findings to the examiner.
This is a 10-minute station, with 2 minutes of reading time.