Hypotensive patient scenario 1

candidate brief 1 min

The triage nurse asks you to assess Mr Wong, a 65yo man, in ambulance handover. He has come in by ambulance with his wife.

80%

actor/facilitator brief

Mr Wong is a 65yo man brought in by ambulance. He has been unwell for 3 days with a chesty cough, today his wife found him drowsy and struggling to breathe.

PMH: T2DM, angina, gout
DHx: metformin, dapagliflozin, GTN PRN
NKDA

He lives with his wife, is usually fit and well, playing golf 3x/week and works as a lawyer in London.

examiner brief

Initial obs:
Drowsy, delirious
RR 28
SpO2 84% on air → improves to 92% on 15L
HR 128
BP 80/40
Temp 39C
Glucose 8
GCS E3 V4 M5

O/E
Absent breath sounds L base, widespread crackles
Cool peripheries

Candidate can ask for help but the EM consultant is currently involved in a trauma call in resus with critical care and won't be available for 20 minutes.

  • Introduces self, confirms patient identify, Washes hands
  • PPE
  • Confirms team competencies
  • Explains Plan
  • Summons appropriate help
  • Takes handover and appropriate history
  • A/B – applies oxygen
  • C – IV access, cultures and bloods inc VBG
  • Gives fluid bolus of 500ml crystalloid and re-assess
  • D – GCS, Lateralising signs
  • E – looks for source
    • Brain
    • Abdomen – Liver, Bladder, Bowel
    • Chest
    • Bone/Joint
    • Skin
  • Checks medications, allergy status
  • Chooses appropriate antibiotic
  • Asks for collateral history
  • Functional baseline and establish appropriate escalation status
  • Plans for disposition of patient - decision for critical care
  • Plans for central access, further investigations, inotropes
  • Leads Team well
  • Plans for further appropriate investigations

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