Station - Instructions for candidate
You are an intern working in the Emergency Department of a metropolitan hospital in Perth. It is 5 am.
Sophia Andreou, 24, has known asthma. She has just been brought in by ambulance after waking at 4 am unable to breathe; her own inhaler and two nebulisers from the paramedics have not helped. She is in the resuscitation bay on oxygen. A registered nurse is with you; the senior doctor has been called and is on the way.
| Ambulance handover | 24 F, known asthma, previous ICU admission. Woke 4 am short of breath, used salbutamol puffer about 20 times. On scene RR 32, SpO2 88% on air, HR 128, speaking single words. Given salbutamol 5 mg nebulised x2 and oxygen 8 L via Hudson mask; minimal improvement. Weight about 65 kg. Partner reports she ran out of her preventer about 6 weeks ago and has had a cold for 3 days. |
|---|---|
| Triage observations | RR 34 /min, SpO2 89% on 8 L via Hudson mask, HR 132 /min, BP 138/86 mmHg, T 37.2 degrees C, GCS 15. Peak flow: unable to perform. |
Your tasks are to:
- Perform an A-E assessment, verbalising each step to the examiner, and treat problems as you find them.
- Request the bedside and laboratory investigations you need. The examiner will provide results where appropriate.
- State the severity grade and your working diagnosis, and the differential diagnoses you must exclude, to the examiner.
- Outline your management plan to the examiner, including drug doses, when you would escalate and where the patient should be cared for.
- 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; describe procedures rather than performing them.
- State drug, dose, route and frequency for anything you give.
This is a 15-minute station, with 2 minutes of reading time.