OSCE

• What is the treatment per the CPGs for hypovolaemia from controlled bleeding?

  • gain IV access
  • keep pt warm
  • signs of poor perfusion or hypovolaemia = 500ml 0.9% NaCl
  • administer TXA if fluids are given (1g)
• What is the treatment per the CPGs for hypovolaemia from uncontrolled bleeding?

  • compress external bleeds
  • apply tourniquet if needed
  • do not remove anything
  • cover sucking chest wounds
  • LATER
  • keep pt warm
  • IV access
  • 1g TXA
  • severe shock (ALOC) = 500ml 0.9% NaCl
• What comes under uncontrolled bleeding?

  • ectopic pregnancy
  • penetrating truncal trauma
  • leaking AAA
  • peripheral bleed that cannot be controlled
• What comes under controlled bleeding?

  • anything that does not fit into the uncontrolled bleed category
• What is the treatment per the CPGs for a severe TBI?

  • oxygen
  • open airway if needed
  • BGL
  • IV access
  • administer 1L fluids to maintain SBP of 120mmHg
• What is the treatment per the CPGs for anaphylaxis?

  • 0.5mg adrenaline
  • IV access
  • 0.9% NaCl if signs of poor perfusion or hypovolaemia = 1L
  • repeat IM adrenaline every 10min or 5min if deteriorating
  • CCP backup if no improvement after the first dose
• What is the treatment per the CPGs for sepsis?

  • assess whether antibiotics are needed (clinical features table)
  • 1g cefazolin if the source is soft tissue or joint
  • 1g ceftriaxone for other sources
  • administer 1-2L of fluids if poor perfusion or hypovolaemic
• What is the treatment for a haemothorax?

  • administer fluids for poor perfusion or signs of hypovolaemia= 500ml
  • manage symptoms
  • oxygen
• What is the treatment for a pneumothorax?

  • recognition
  • breathing/circulation (O2)
  • treat symptoms
• What is the treatment for burns?

  • primary + secondary survey
  • cool burns for 20 min
  • cover in cling film
  • gain IV access
  • fluids (1L for signs of poor perfusion or hypovolaemia)
  • bronchospasm = salbutamol + ipratropium
  • stridor = neb adrenaline
  • transport + backup for airway support if airway burns
• What is the treatment for medication poisoning?

  • manage ABCs
  • request backup (GCS <10 or airway issues)
  • airway support
  • keep pt warm
  • IV access if signs of poor perfusion (1L fluids)
  • ALOC = 0.1-0.4mg naloxone every 5 min IV
• What is the treatment for hyperglycaemia?

  • manage ABCs
  • monitor vital signs (BGL)
  • IV access
  • with BGL >20mmol/L + signs shock + ALOC = give 1L of fluid over 1hr
• What is the treatment for hypoglycaemia?

  • oral glucose (if conscious)
  • gain IV access 2 x 50ml bolus of 10% glucose
  • unable to get IV access = 1mg glucagon
  • repeat glucose every 10min
• What is the treatment for seizures?

  • manage ABCs
  • pt positioning
  • manage reversible causes (IV glucose, active cooling, O2)
  • gain IV access and administer IV/IM midazolam if it lasts longer than 5min or recurrent
  • after 2 doses midazolam = levetiracetam
  • consider R50 for RSI
  • manage postictal state
  • transport to ED
• What is the treatment per the CPGs for meningococcal septicaemia?

  • recognition
  • backup from CCP
  • large bore IV
  • 1-2L fluids if poor perfusion or hypovolaemia
  • 2g ceftriaxone (preferably IV)
  • transport to hospital