Station - Instructions for candidate
You are an intern working in the Emergency Department of a tertiary hospital in Perth with an on-site cardiac catheterisation laboratory.
Jose Dela Cruz, a 58-year-old man, has been brought in by ambulance with 70 minutes of central crushing chest pain that started while he was watching television. He is sweaty and nauseated. The 12-lead ECG recorded on arrival is printed below. He is on a monitored bed in the resuscitation bay and a nurse is with you.
12-lead ECG on arrival
| Item | Value | Reference range |
|---|---|---|
| Rate | 58 /min | 60-100 /min |
| Rhythm | Regular; a P wave before every QRS, upright in II | Sinus |
| Axis | +30 degrees | -30 to +90 degrees |
| P waves | Normal morphology | Normal |
| PR interval | 210 ms, constant | 120-200 ms |
| QRS duration and morphology | 90 ms, narrow; no pathological Q waves | <120 ms |
| ST segments | Elevated 3 mm in III, 2 mm in II and aVF, convex upwards; depressed 1.5 mm in I and aVL; elevated 0.5 mm in V1; isoelectric in V2-V6 | Isoelectric |
| T waves | Tall and broad in II, III and aVF; inverted in aVL | Concordant with QRS |
| QTc | 420 ms | <450 ms |
Your tasks are to:
- Perform an A to E assessment and treat as you go.
- Take a targeted history from Mr Dela Cruz.
- Interpret the ECG provided and request any further investigations you need.
- State your working diagnosis and differential diagnoses to the examiner.
- Outline your immediate management plan to the examiner.
- The nurse will carry out what you ask for and will report back.
- Examination findings are given as you say what you are examining.
- The ECG on arrival is printed on this sheet; further tracings and results are available from the examiner on request.
This is a 15-minute station, with 2 minutes of reading time.