A-E Station 4

 

Station 4

A patient passing dark stool

 

Candidate Instructions

Setting:

You are a Foundation Year doctor working a night shift. You have been called to see a patient who has become unwell.


Name: Valerie Redpath


Tasks:

1. Please examine the patient using an A-E approach.

2. Give you differential diagnosis to the examiner.

3. Give you management plan to the examiner.

You are not required to take a history.

Simulated Patient Instructions

Briefing

Please act as the patient and reveal signs and results only as the candidate performs actions or requests tests.

Diagnosis: PR-bleeding with haemodynamic compromise

You are Valerie Redpath a 71 year old female

You have just passed 500ml + of melaena.

Appearance and Behaviour

Nearly unconscious, unable to answer more than name. Eyes - closed, open to command. Voice - orientated. Motor- localises to pain. (GCS 13/15).

If possible place a sheet over your legs and lower abdo - this will be hiding a puddle of blood in a real OSCE that the candidate would be expected to look for during their full examination within "E"

Start the Timer and Begin

Examiner Instruction

 

As the candidate enters please give them this handover (acting as the nurse on the ward)

“Doctor, this patient is NEWSing a 4, they’ve just passed a lot of very dark stool”

Intro

 

Airway

 

Assessment

Breathing

 

Assessment

Treatment

Clinical 💎 -  
? In clinical practice, the majority of patients with low O2 sats will get a CXR, they are handed out like candy in ED. Some conservative clinicians may hold off given other examination findings. As a result there is no mark for this in this station. It certainly would not be unreasonable in an OSCE.

Cardio

 

Assessment

Treatment

If the candidate requests FBC or a gas then give them the following results to interpret.

Disability

 

Assessment

Exposure

 

Assessment

Examiner Instruction

 

At this point please direct the candidate to give their differential diagnosis and any further management plans.

Diagnosis & Further Management

 

Diagnosis

Further Managemnet

Summary

 

A bleed large enough to cause haemodynamic instability is worrying. The surgical reg would likely request a CT Abdomen/ CT Angiography which you can order under their advice.

PR bleeding can be categorised into minor, moderate and severe.

Many PR bleeds will self terminate if clotting is not deranged but be aware that small bleeds can herald a further, larger bleeds so it is important to call for help early.

Submit for Scoring

Tags | A-E | GI bleed | Gastrointestinal Bleed

Station Written by: Dr Megan Burns

Peer Reviewed by: Dr Benjamin Armstrong

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