A-E Station 9
Station 9
Another breathless patient?!
Candidate Instructions
Setting:
You are an FY1 doctor working on a surgical ward. You have been called to see a patient that is post-op day 3 for an uncomplicated appendicectomy who has new onset tachypnoea.
Name: Karen Burton
Tasks:
1. Take a history of the presenting complaint only.
2. Complete an A-E assessment of the patient.
3. State your differential diagnoses to the examiner.
4. Please give your management plan to the examiner.
Simulated Patient Instructions
Briefing
Please act as the patient and reveal signs and results only as the candidate performs actions or requests tests.
Diagnosis: Pulmonary Embolism
You are Karen Burton (DOB 19.06.1966, aged 55)
You have become increasingly breathless following an operation.
Appearance and Behaviour
You appear short of breath and are breathing quickly (please don’t hyperventilate and pass out whilst acting - although we appreciate the commitment to the cause).
Start the Timer and Begin
Examiner Instruction
As the candidate enters please give them this handover (acting as the nurse on the ward)
“Doctor, I’m glad you’re here, Mrs Burton has become very breathless, she was fine when I last checked on her 15 minutes ago.”
Intro
Airway
Assessment
Breathing
Assessment
When the candidate performs auscultation please play the follow-up sound files as they auscultate. (for reference the both lungs are “normal”.)
Interventions
Show the candidate the following Blood Gas results only if they request them.
Please interpret these results
Name: Karen Burton
Date of Study:
| Analyte | Value |
|---|---|
| pH | 7.37 (ref 7.35-7.35) |
| pCO2 | 4.8 kPa (ref 4.7 - 6) |
| pO2 | 6.8 kPa (ref >10.5) |
| HCO3 | 23 mEq/L (ref 22 - 28) |
| BE | -0.2 (ref -2 to +2) |
Cardio
Assessment
Treatment
Disability
Assessment
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
Further Managemnet
Submit for Scoring
Tags | A-E | PE | Pulmonary Embolism | Generally unwell patient
Station Written by: Dr Rishil Patel
Peer Reviewed by: Dr Benjamin Armstrong