A-E Station 7
Station 7
Take some deep breaths…
Candidate Instructions
Setting:
You are an FY1 doctor working in Trauma and Orthopaedics. You have been called to see a patient with a low respiratory rate.
Dorris Walker
Tasks:
1. Conduct an A-E examination on the patient.
2. State your preferred diagnosis to the examiner.
3. Give an SBAR handover to your senior.
Simulated Patient Instructions
Briefing
Please act as the patient and reveal signs and results only as the candidate performs actions or requests tests.
Diagnosis: Opiate Overdose
You are Dorris Walker an 85 year old lady.
Appearance and Behaviour
You are unresponsive and do not respond to either pain or voice. You should attempt to breathe as slowly as possible and make a snoring noise on every inspiratory breath until the candidate performs a head tilt. If the student gives you naloxone you should wait a few seconds and then immediately become spontaneously responsive with resolution of your symptoms.
Patient Results
Please interpret these results
Name: Dorris Walker
DoB: 12/10/1936
Date of Results:
| Analyte | Result | Normal Range |
|---|---|---|
| pH | 7.25 | 7.35-7.45 |
| pCO2 | 13 kPa | 4.7 - 6.0 kPa |
| pO2 | 8 kPa | 11 - 13 kPa |
| cHCO3 | 24 | 22 - 26 |
Start the Timer and Begin
Examiner Instruction
As the candidate enters please give them this handover (acting as the nurse on the ward)
“Doctor, this is Doris. She’s an 85 year old lady who’s post op day 1 after a fractured neck of femur. We were doing obs and noticed her respiratory rate is really low. Please could you take a look at her, we’re very concerned.”
Intro
Airway
Assessment
Intervention
Breathing
Assessment
Treatment
Name: Dorris Walker
DoB: 12/10/1936
Date of Results:
| Analyte | Result | Normal Range |
|---|---|---|
| pH | 7.25 | 7.35-7.45 |
| pCO2 | 13 kPa | 4.7 - 6.0 kPa |
| pO2 | 8 kPa | 11 - 13 kPa |
| cHCO3 | 24 | 22 - 26 |
Cardio
Assessment
Treatment
Disability
Assessment
Treatment
Exposure
Assessment
Examiner Instruction
At this point please direct the candidate to give their differential diagnosis and any further management plans.
Diagnosis & Further Management
Diagnosis
Handover
Further Managemnet
Summary
Naloxone is a competitive anatagonist of opioid receptors that rapidly reverses the effects of opioids. That being said, it has a very short half life so you may need repeated dosing +/- for a sustained effect whilst the offending agent is cleared from the body.
It’s worth being aware that it can precipitate withdrawal symptoms - so if you give it just be aware your patient might also start shaking like a paint mixer depending on how much they’ve had…but plus side, they’ll be breathing.
Submit for Scoring
Tags | A-E | Shock | Anaphylaxis
Station Written by: Dr Ewa Kunysz
Peer Reviewed by: Dr Rhys Taylor
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