Station - Instructions for candidate
You are an intern in the Emergency Department at Geraldton Regional Hospital.
Colin Dwyer is a 79-year-old man brought to the Emergency Department by his daughter because he has been quiet, muddled and unsteady on his legs for two days. Triage has recorded hypotension, tachycardia, a normal temperature and a raised capillary blood glucose. Blood test results are provided on the candidate sheet.
| Triage observations | Triage observations: HR 112 regular, BP 94/56 mmHg, RR 22, SpO2 96% on room air, temperature 36.8 degrees C, capillary blood glucose 13.8 mmol/L, pain score 3/10. |
|---|---|
| Nursing handover | His daughter reports that he has passed very little urine since yesterday and is more sleepy than usual. |
Results provided:
FBC and CRP
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 116 g/L | 130-180 g/L |
| White cell count | 18.4 x 10^9/L | 4.0-11.0 x 10^9/L |
| Neutrophils | 16.8 x 10^9/L | 2.0-7.5 x 10^9/L |
| C-reactive protein | 186 mg/L | <5 mg/L |
UEC and glucose
| Item | Value | Reference range |
|---|---|---|
| Sodium | 132 mmol/L | 135-145 mmol/L |
| Potassium | 4.8 mmol/L | 3.5-5.2 mmol/L |
| Urea | 18.2 mmol/L | 2.5-7.5 mmol/L |
| Creatinine | 168 umol/L | 60-110 umol/L |
| eGFR | 34 mL/min/1.73 m2 | >60 mL/min/1.73 m2 |
| Glucose | 13.8 mmol/L | 3.5-7.7 mmol/L |
Liver function and coagulation
| Item | Value | Reference range |
|---|---|---|
| Bilirubin | 92 umol/L | 3-20 umol/L |
| ALP | 486 U/L | 30-110 U/L |
| GGT | 612 U/L | 5-50 U/L |
| ALT | 178 U/L | 5-40 U/L |
| AST | 164 U/L | 5-40 U/L |
| Albumin | 29 g/L | 35-50 g/L |
| INR | 1.4 | 0.9-1.2 |
Venous lactate
| Item | Value | Reference range |
|---|---|---|
| Venous lactate | 4.1 mmol/L | 0.5-2.2 mmol/L |
vbg abg - read aloud by the examiner
The venous lactate is 4.1 mmol/L.
Look up an example image: LITFL sepsis lactate blood gas
Your tasks are to:
- Take a focused history from the patient and his daughter, including relevant medical, medication and allergy history.
- Perform a focused examination, verbalising your examination of peripheral stigmata, sclera and tongue, abdomen and upper abdominal structures; the relevant findings will be provided by the examiner.
- Interpret the blood test results provided on the candidate sheet.
- State the most likely diagnosis and two to four differentials with brief justification.
- Outline your initial management plan, including escalation, treatment, referral and safety-netting.
- You do NOT need to summarise your findings to the examiner.
- You are not required to request additional investigations beyond interpreting the provided blood tests.
- Please verbalise your examination to the examiner; findings will be provided when you reach each relevant step.
This is a 15-minute station, with 2 minutes of reading time.