junior discussion scenario 2
candidate brief
One of the FY2s in ED would like to discuss a few patients with you.
actor brief
- 1st patient - 35yo asthmatic came in wheezy
- No previous ICU/hospital admissions - asthma is managed well in community usually
- Has had 1 round of nebs (salbutamol + ipratropium) and prednisolone 30mg and feels much better now
- Does not use peak flows normally so doesn't know baseline
- Non-smoker, generally healthy apart from asthma, thinks trigger is recent flu-like illness
- 2nd patient - 79yo fall now unable to weight bear
- 79yo fall from standing while in toilet
- PMH aortic stenosis, AF, macular degeneration
- Usually walks with frame
- note she has been persistently tachycardic (110-120) despite oramorph
- XR pelvis NAD
- you want to send to physio/CDU for good analgesia in the hopes that will control hte pain
- 3rd patient - head injury in 16yo
- 16yo who was kneed in the eye during rugby
- no LOC, no vomiting since
- currently ℅ nausea and double vision - in fact got more nauseated when you tested his vision
- tender around orbit but you think it's mostly soft tissue
- you want to send him home with good analgesia and eye clinic?
examiner brief
- Introduces self to junior doctor
- Confirms their level of experience
- Allows junior doctor to present first case
- Asks relevant questions to gain additional information
- Asks about observations
- Checks treatment received
- Safe discharge advice - steroids TTO (prednisolone), check inhaler/spacer technique
- Allows junior doctor to present second case
- Asks relevant questions to gain additional information - character of pain etc.
- Asks about observations
- Recognise possible differentials for persistent tachycardia
- Need for CT pelvis to rule out vascular injury and/or occult bony injury
- Teaching re pelvic injuries
- Allows junior doctor to present third case
- Asks relevant questions to gain additional information
- Recognise need for CT head due to diplopia - either cranial nerve defect or could be entrapped ocular muscles
- Teaching re maxfax fractures!
- elicits questions
- agrees for plan
- advice regarding accessing further information
- global mark from FY2
- global mark from examiner