• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You have been called by the ward sister to see a patient who is scoring in their MEWS

Patient: 40 year old patient, has become acutely unwell whilst on the ward

Task:
– Take a focused history from the patient
– Perform a full ACDE assessment, a nurse will be available to help you with investigations or management that you require.
– After 6 minuets you will be asked a series of questions by the examiner.
– Answer any questions that the patient may have

Note to actor: Try to restrain yourself from volunteering to much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.

You are usually fit and well, working as a gardener. You become unwell and went to see your GP who has sent you up to the hospital. You are a little confused and keep mixing up the details. You apologise to the doctor a lot as you are not making sense. You do not regularly see a doctor about anything, take no regular medications and do not have any drug allergies.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Medical school or medical grade
Clarifies who they are talking to
Asks patient for preferred name


History History
Patient acutely unwell
Recognizes confusion
Current medications
Drug allergies


Airway assessment Airway assessment
Patient talking, airway patent


Breathing assessment Breathing assessment
Oxygen saturation = 96% on room air
Respiratory rate = 30
Position of trachea = central
Chest expansion = equal
Chest sounds = no additional chest sounds


Breathing investigations Breathing investigations
Requests ABG


Breathing treatment Breathing treatment
Oxygen 15L through non-rebreathing mask


Circulation assessment Circulation assessment
Blood pressure – 82/60
Heart rate – 120
Peripheral and central cap refill – < 4 seconds
Heart sounds = I + II + 0


Circulation investigations Circulation investigations
2 large bore IV cannulae
Bloods = FBC, U&E, CRP, LFT


Circulation treatment Circulation treatment
500ml of 0.9% normal saline STAT


Disability assessment Disability assessment
Blood glucose = 6.0
Temperature = 39
AVPU score = V on AVPU
Pupils equal and reactive to light


Exposure
Exposure

If patient exposes legs, please show picture
Candidate offers to draw line around line of erythema


Diagnosis Diagnosis
Candidate identifies the patient is septic
Caused by soft tissue infection


SEPSIS 6 Patient identifies sepsis and treats according to sepsis 6:
Fluids
Broad spectrum antibiotics
High flow oxygen
Urine output
Lactate
Blood cultures


Esculation After initial assessment
Patient offers to call / bleep medical registrar
Reassesses the patient in an ABCDE approach


Question What route would you give this patients antibiotics?
Intravenous


Question When would you convert from IV to oral antibiotics?
Reassess after 48 hours
Change to oral if clinically appropriate
If patient clinically stable: MEWS = 0, not spiking temperatures



Score