Station - Instructions for candidate
You are an intern working in the Emergency Department short-stay unit of a metropolitan hospital in Perth.
Nyibol Kuol, a 21-year-old hospitality student, was brought in by her housemate at 1 am after taking 16 paracetamol tablets at home. The toxicology team has reviewed her bloods this morning and cleared her medically. Your registrar has asked you to assess her before the mental health team is contacted. She is sitting on the bed in a gown; her housemate has gone home to sleep.
| Observations | Temperature 36.7 degrees C, heart rate 88 /min, blood pressure 118/72 mmHg, SpO2 99% on room air, GCS 15 |
|---|---|
| Toxicology note | Paracetamol 8 g at ~2300 with alcohol. 4-hour level 620 micromol/L, below the treatment line; no acetylcysteine required. ALT 22 U/L, INR 1.0 at 12 hours. Ethanol 0.06 on arrival. Urine hCG negative. Medically cleared for psychiatric assessment. |
Your tasks are to:
- Take a focused history, including the circumstances of what happened last night and a risk assessment.
- Present the mental state findings you have observed during the interview, and your assessment of risk, to the examiner.
- State your provisional diagnosis to the examiner.
- Outline your initial management plan to the examiner, including what needs to happen before she could leave hospital.
- No physical assessment is required, and the medical management of the ingestion is complete.
- Present the mental state findings and your risk assessment to the examiner in the last part of the station; you do not need to summarise the rest of the history.
- You do not need to write in the notes or complete any forms in this station.
This is a 15-minute station, with 2 minutes of reading time.