stridor scenario
candidate brief
You have been asked to see a patient in the waiting room. Charlie Bingham is a 45yo who has self-presented with a sore throat and the triage nurse is very worried about them.
actor brief
You are 45yo Charlie. You have had a very bad sore throat for the last few days and your GP prescribed you antibiotics for tonsillitis over the phone yesterday. Today you felt much worse, you have lost your voice and find it difficult to swallow.
PMH: nil
Nil regular meds
NKDA
Usually fit and well
You are worried because you feel extremely unwell - you thought the antibiotics would make you feel better - and you are starting to wonder if this might be life-threatening.
examiner brief
Initial obs:
A: stridulous, hoarse voice
B: RR 28, SpO2 94% on air, chest clear + good air entry to bases
C: hot to touch, crt <2s, HR 124, BP 136/90
D: GCS 15/15, PEARL 4mm
E: abdo SNT, shotty cervical lymphadenopathy, pharynx appears inflamed but grossly normal
- Washes hands, introduces self
- Confirms patient identity
- Identifies team competencies
- Takes handover and appropriate history
- Moves patient to appropriate area
- Airway assessment
- recognises compromise with potential for rapid progression → escalate to ICU/anaesthetics, ENT
- IV dexamethasone
- Adrenaline nebulised (1ml 1:1000 in 4ml NS)
- prepare difficult airway trolley
- Breathing assessment
- spO2, RR
- inspects, palpates, auscultates chest
- Circulation
- ECG, BP
- IV access
- 500ml crystalloid bolus
- Disability
- GCS
- glucose
- Exposure
- Throat examination
- Appropriate management plan
- Affirms drug history and allergy status
- Chooses appropriate antibiotic
- Establishes appropriate escalation to specialty (ENT, critical care)
- Requests appropriate investigations
- Plans for ... critical care, intubation, inotropes...
- Leads team well
- Global mark from examiner