Practical - practice OSCE/scenario - APO PDF

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Practice OSCE/Scenario - APO...

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Practice OSCE/Scenario – APO

Clinical Presentation You are called to a 64 year old male suffering shortness of breath. Has a cardiac history. Wife in attendance.

Case Details Time of Day Weather Time to scene Time to Hospital Back up

Access/Egress Danger

Primary Survey 0300 hours Mild 12 minutes 35 minutes An ICP is available and 20 minutes away. Nil issues Nil on arrival

Danger Response

Airway

Breathing

Circulation

Nil on approach to patient Patient watches crew approach Patient is lying semirecumbent in bed. Patient struggles to speak. Can speak in short sentences phrases. Appears to have significant difficulty in breathing. Radial pulse present irregular.

Vital signs Survey Respiratory rate Pulse Blood pressure Temperature BSL Pulse oximetry ECG

28 80 irregular 190/100 36.2 °C 7.8 mmol 96% Atrial Fibrillation

SAMPLE: Signs and symptoms

Allergies Medications Past medical history Last ins/outs

Events leading up to complaint

States he is awoke with difficulty in breathing. Has dry cough. Denies chest pain. No signs of peripheral oedema or JVD. Nil Tritace, GTN spray, aspirin, Lanoxin Recent AMI with angioplasty and stent (3 months ago). IHD Hypertension Last ate at 1700 hours Last drunk water approximately 5 hours ago Bowels open this evening. Stated that he felt Ok prior to going to bed tonight. Has had some similar episodes over past 2 weeks but have resolved quickly. Has not see GP about these. Has not taken any medications since onset.

PUB280 – Foundations of Paramedic Practice

Respiratory assessment: Conscious state General appearance Speech Ventilatory rate Ventilatory rhythm Skin Pulse rate Breath sounds

Conscious – orientated, GCS 15 Looks slightly anxious Able to talk in short phrases 26 Normal Dry 80 irregular Crackles to mid zones (when sitting) – Full fields crackles when lying..

Expected Course of Action Patient should be positioned in the sitting position. Patient should be placed on oxygen therapy ASAP. Patient is in moderate respiratory distress – earlier SITREP to provide update. GTN (pertinent negative – erectile dysfunction use) Reassessment after first GTN. Should question regarding history over past 2 weeks and any history of fluid on lungs. Reassessment Respiration Rate Pulse Pulse oximetry Conscious state General appearance Speech Ventilatory rate Ventilatory rhythm Breath sounds

24 80 irregular 98% on oxygen GCS 15 Anxiety decreasing Able to speak in sentences 24 Normal Crackles to bases now..

Expected Course of Action Should recognise that patient is improving. Continue GTN whilst signs of pulmonary oedema. Transport for further assessment and treatment

PUB280 – Foundations of Paramedic Practice...