A-E Station 2

 

Station 2

An unconcious patient

 

Candidate Instructions

Setting:

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


Name: Amy Strange


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: Hypoglycaemia

You are Amy Strange (aged 28)

You have become drowsy and then lost consciousness.

Appearance and Behaviour

You are barely conscious, muttering the odd word, irrelevant to the context. GCS E2 (open to pain, do not open your eyes to command) V3 (mutter inappropriate words, do not speak in sentences) M5 (localises to pain, only move when the candidate performs a trap squeeze or similar), total 10/15.

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 in for D&V, she’s not been eating very well but other than that she’s been fine up to this evening. I noticed she’s become drowsy the last 3 hours and now she’s not even responding to me. Please can you assess her, I'm very worried.”

Intro

 

Airway

 

Assessment

Breathing

 

Assessment

At this point it is not un-reasonable to order a CXR, but as there is no definite indication there is no mark for this.

Cardio

 

Assessment

Treatment

Disability

 

Assessment

Consciousness - if the candidate comments on consciousness please prompt them to complete a GCS assessment (give mark if candidate is +/- 1 from the given score.)

Treatment

A CT head is a reasonable request in a patient with reduced GCS of unknown cause but given that this patient has a low BM which is a common cause of low GCS it would be reasonable to treat before exposing such a young patient to CT scans.

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

Examiner Instruction

 

At this point please direct the candidate to use the BNF guidance below to prescribe initial glucose treatment with the digital prescription form. The patient has IV access. They have no allergies.

Prescribing Task

 

Prescribing Glucose

Please prescribe appropriate glucose solution using the guidance below.

 

GLUCOSE

Hypoglycemia

By intravenous infusion

Note: 10% glucose contains 10g of glucose per 100ml

 

IV Digital Drug Prescription Form

Fluid Volume (ml) Rate (minutes) Prescriber

Fill out the above form and hand back to the examiner.

 

Further Managemnet

Note: never prescribe using ranges, this has only been done to simplify the ranges the candidate could have prescribed within.

Submit for Scoring

Tags | A-E | Hypoglycaemia | Diabetes

Station Written by: Dr Benjamin Armstrong

Peer Reviewed by: Dr Megan Burns

Want to suggest an edit?

Comment below and we'll get right to it!