Station - Instructions for candidate
You are an intern on placement in the Emergency Department of a Perth metropolitan hospital.
Rahul Singh, a 76-year-old of Indian-Australian heritage, presented at 2:30 am with central crushing chest pain that began at 1:15 am while he was sitting at home. The triage nurse has recorded his observations and handed you an ECG that was performed on arrival. You are asked to assess him.
ECG
| Item | Value | Reference range |
|---|---|---|
| Rate | 92 bpm | 60-100 bpm |
| Rhythm | Regular sinus rhythm | - |
| Axis | Normal | - |
| P waves | Normal, one per QRS | - |
| PR interval | 180 ms | 120-200 ms |
| QRS duration | 90 ms | <120 ms |
| ST segments | Horizontal ST-segment depression 0.5 mm in V2-V4; T-wave inversion in lateral leads V5-V6, II, and aVL | - |
| T waves | Inverted in V5-V6, II and aVL | upright or biphasic |
| QTc | 420 ms | <440 ms |
Your tasks are to:
- Take a focused history.
- Perform a focused examination.
- Interpret the ECG provided.
- State your most likely diagnosis and differential diagnoses to the examiner.
- Outline your immediate management plan to the examiner.
- Please verbalise your examination to the examiner; findings will be provided on request.
This is a 15-minute station, with 2 minutes of reading time.