Station - Instructions for candidate
You are an intern working in the Emergency Department of a metropolitan hospital in Perth with an on-call gastroenterology service. It is 7 pm.
Vikram Menon, 58, has just vomited blood in the waiting room and has been rushed to the resuscitation bay. A registered nurse is with you and the senior doctor is with another critical patient. His wife is in the waiting room.
| Triage note (an hour ago) | 58 M. Black stools x 2 days, light-headed on standing. Taking naproxen for back pain. Drinks 6-8 beers a night. No previous history. HR 104, BP 108/70. One 20-gauge cannula. Category 3 - upgraded to Category 1 after vomiting blood in the waiting room (estimated 1 L fresh blood with clots). |
|---|---|
| Observations on arrival in the resuscitation bay | HR 118 /min regular, BP 92/58 mmHg, RR 22 /min, SpO2 96% on room air, T 36.4 degrees C, GCS 15, glucose 6.8 mmol/L, weight 85 kg |
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 your working diagnosis and the differential diagnoses to the examiner, including the source you must consider in a heavy drinker.
- Outline your management plan to the examiner, including drugs with doses, blood products and transfusion targets, who you will call 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 and route for anything you give, and the volume of any fluid or blood product.
This is a 15-minute station, with 2 minutes of reading time.