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Motorcyclist with chest pain and breathlessness after a crash - Regional Emergency Department

CurtinYear 515 min + 2 min readingEmergency & acute careChallengingPre-internship
  • A-E assessment
  • Request investigations
  • Dx + differentials
  • Initial Mx

Ready

2 min reading, 15 min station, warning at 2 min

Focus the timer and press Space to start or pause.

Station - Instructions for candidate

You are an intern working in the Emergency Department of a regional hospital 100 km from Perth. The hospital has a general surgeon and an anaesthetist on call, a CT scanner and a blood bank, but no interventional radiology or intensive care unit. It is 11 pm.

Joanna Reyes, 24, a motorcyclist, has just arrived by ambulance after being hit by a car at about 60 km/h and thrown from her bike. She was wearing a helmet and was not knocked out. The paramedics have placed a cervical collar and blocks, applied 15 L of oxygen and inserted one cannula. She is short of breath and complaining of left-sided chest pain. The senior doctor is 15 minutes away; a registered nurse is with you.

Ambulance handover24 F, motorcycle versus car, 60 km/h, thrown onto left side, helmet on, no loss of consciousness. On scene: HR 118, BP 104/70, RR 28, SpO2 93% on air. En route: increasingly breathless, HR 130, BP 88/56, SpO2 89% on 15 L. Collar and blocks. 18G right antecubital fossa. No analgesia given. Weight about 75 kg. Time from crash 25 minutes.

Your tasks are to:

  1. Perform a primary survey (A to E) with cervical spine protection, verbalising each step to the examiner, and treat problems as you find them.
  2. Request the bedside and laboratory investigations you need. The examiner will provide results where appropriate.
  3. State your working diagnosis and the injuries you are treating or must exclude to the examiner.
  4. Outline your immediate management and disposition plan to the examiner, including who you will call and where the patient needs to go.
  • 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; the on-call surgeon and anaesthetist can be contacted by phone.
  • State drug, dose and route for anything you give. Equipment for airway, chest and vascular procedures is on the trolley; describe each procedure rather than performing it.

This is a 15-minute station, with 2 minutes of reading time.

Ask the examiner

Say what you want out loud, then open it below. Each result stays hidden until you reveal it.

Investigations

Ask for a category the way you would in the station: “Can I have the obs and a set of bloods?”

Examination

Say what you would examine and how; the examiner reports what you would find.

After treatment

Once you have acted, ask how the patient has responded.

Generated by AI for practice; check doses and pathways against eTG / AMH before relying on them.