Station - Instructions for candidate
You are an intern working in the Emergency Department of a metropolitan hospital in Perth with a CT scanner and a stroke service; the comprehensive stroke centre with clot retrieval is 20 minutes away. It is 9.20 am.
Wei Liu, 68, has just arrived by ambulance after his wife, Mei, saw the right side of his face droop and his right arm go weak while they were having breakfast. His speech is slurred. The paramedics have pre-notified a stroke call; the stroke registrar is on the way and a nurse is with you. Mei is at the bedside.
| Ambulance handover | 68 M. Witnessed onset of right facial droop, right arm weakness and slurred speech at about 8.10 am. FAST positive. Glucose 6.4. Known atrial fibrillation, not anticoagulated; on aspirin and amlodipine. No trauma. Weight about 80 kg. |
|---|---|
| Observations on arrival | HR 92 /min irregularly irregular, BP 168/94 mmHg, RR 16 /min, SpO2 96% on room air, T 36.8 degrees C, GCS 14 (E4 V4 M6), glucose 6.4 mmol/L. Time now 9.20 am. |
Your tasks are to:
- Take a focused history from Mr Liu and his wife, including the information that determines eligibility for reperfusion treatment.
- Perform a focused neurological examination of the face, arms, legs, speech and visual fields, verbalising each step. The examiner will provide findings.
- Request the investigations you need and interpret the results the examiner provides.
- State your working diagnosis, the vascular territory, and the differential diagnoses to the examiner.
- Outline your immediate management plan to the examiner, including reperfusion treatment with doses, blood pressure and swallow management, and where the patient should go, and explain the plan to Mr and Mrs Liu.
- You do NOT need to summarise your history and examination findings to the examiner.
- State drug, dose and route where relevant.
- Assume the stroke registrar will be with you within 10 minutes; act as the doctor at the bedside until then.
This is a 15-minute station, with 2 minutes of reading time.