Station - Instructions for candidate
You are an intern working in the Emergency Department of a regional hospital in the Wheatbelt of Western Australia. The hospital has a laboratory that can run coagulation tests and a well-stocked pharmacy. It is 2 pm; the senior doctor is available by phone and will attend when called.
Achol Kuol, 35, presented an hour ago following a snakebite. She is in the resuscitation bay with a drip in.
| Triage note | 35 F. Snakebite L ankle approx 1 hour ago on farm near Narrogin. Bandage applied by husband. Nauseated, vomited once in the car. Cannula L antecubital fossa; bloods taken and sent (results to follow). Husband in the waiting room. |
|---|---|
| Observations on arrival | HR 108 /min, BP 118/72 mmHg, RR 18 /min, SpO2 98% on room air, T 36.6 degrees C, GCS 15, glucose 5.6 mmol/L, weight 70 kg |
Your tasks are to:
- Take a focused history of the bite, the first aid given and the patient's symptoms since.
- Perform a focused examination: the bite site and the bandage, and the signs of the effects of venom on the body. Describe to the examiner what you are looking for; the findings will be provided.
- Request the investigations you need. The examiner will provide results where appropriate. State your assessment and differential diagnoses to the examiner.
- Outline your initial management plan to the examiner and the patient, including any drug with its dose and route, who you will call, and how long she will stay.
- You do NOT need to summarise your findings to the examiner.
- Do not remove or reapply the bandage yourself; tell the examiner what you would do with it and when.
- Plan the station: about 4 minutes for the history, 3 for the examination, and the rest for investigations, assessment and management.
This is a 15-minute station, with 2 minutes of reading time.