Myocardial infarction scenario
candidate brief
You are asked to see Mr Lee. The waiting room nurse has just taken his ECG and is concerned.
actor brief
examiner brief
Patient is initially conscious, although with ongoing chest pain. Around minute 2, he collapses and is in cardiac arrest.
He will be moved to resus with CPR ongoing.
Initial rhythm = VF
Prompt rhythm check soon afterward - ROSC after 2 shocks
- Washes hands, introduces self
- Confirms patient identity
- Interprets ECG - recognises STEMI
- Gives 300mg aspirin, clopidogrel or other suitable antiplatelet
- Takes brief history
- Past medical history
- Drug history and allergies
- Offers GTN
- Responds promptly to change in clinical status
- Moves to appropriate clinical area i.e. resus
- Facilitates good BLS initially - 30:2
- Airway adjuncts and ventilations depending on skill level of helper
- Recognises shockable rhythm
- Requests appropriate investigations
- Initiates good post-ROSC care
- ETT
- Normoxia, normocarbia
- MAP > 65
- Remain sedated
- Plans for PCI
- Structured handover to cardiology registrar
- Leads team well
- Global mark from examiner