Emergency · A-E assessment

Known asthma, cannot speak in sentences - 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 5 am.

Sophia Andreou, 24, has known asthma. She has just been brought in by ambulance after waking at 4 am unable to breathe; her own inhaler and two nebulisers from the paramedics have not helped. She is in the resuscitation bay on oxygen. A registered nurse is with you; the senior doctor has been called and is on the way.

Triage observations
RR 34 /min, SpO2 89% on 8 L via Hudson mask, HR 132 /min, BP 138/86 mmHg, T 37.2 degrees C, GCS 15. Peak flow: unable to perform.

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.
  • You do NOT need to take a full history, and you do NOT need to summarise your findings to the examiner.
  • A registered nurse is at the bedside and will carry out your instructions; describe procedures rather than performing them.

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.