Emergency · A-E assessment

Confused, feverish and hypotensive from a nursing home - Emergency Department

HardYear 5 · Curtin style · 15 min + 2 min reading · 4 tasks

2 min reading · 15 min station · reminders at 2 min

Station - Instructions for candidate

You are an intern working in the Emergency Department of a metropolitan hospital in Perth. It is 2 pm.

Andreas Nikolaidis, 78, has been brought in by ambulance from his nursing home because he has become drowsy and confused since last night and was shivering this morning. He has a long-term urinary catheter. The triage nurse has placed him in a resuscitation bay and called you; a registered nurse is with you and the senior doctor is with another patient.

Triage observations
HR 118 /min, BP 84/48 mmHg, RR 26 /min, SpO2 93% on room air, T 39.1 degrees C, GCS 13, glucose 9.8 mmol/L. One 20-gauge cannula in the left hand from the ambulance.

Your tasks are to:

  1. Perform an A to E assessment and treat as you go.
  2. Request any relevant investigations and interpret the results provided.
  3. State your working diagnosis and differential diagnoses to the examiner.
  4. Outline your management plan to the examiner.
  • A registered nurse is at the bedside and will carry out your instructions; describe procedures rather than performing them.
  • You do not need to take a full history.

This is a 15-minute station, with 2 minutes of reading time.

Ask the examiner

Say what you would examine or request, the way you would in the station. Nothing is named until you ask for it.

Whatever the examiner recognises is revealed below. Or pick a numbered item to reveal it blind.

Investigations

Ask for a category the way you would in the station: “Can I have the obs and a set of bloods?”

Examination

Say what you would examine and how; the examiner reports what you would find.

After treatment

Once you have acted, ask how the patient has responded.