Practical - practice OSCE/Scenario - COPD PDF

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Practice OSCE/Scenario - COPD...

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Practice OSCE/Scenario – COPD

Clinical Presentation You are called to a 70 year old male suffering shortness of breath. Has a history of the same.

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

Access/Egress Danger

Primary Survey 2000 hours Fine 10 minutes 25 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 sitting upright on lounge. Patient struggles to speak. Can speak in short sentences phrases. Appears to have significant difficulty in breathing. Rapid radial pulse present - irregular.

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

28 110 irregular 160/80 36.5 °C 7.2 mmol 90% Atrial Fibrillation

SAMPLE: Signs and symptoms Allergies Medications Past medical history Last ins/outs

Events leading up to complaint

States he is struggling to get the air in tonight. Cough – productive – white sputum – normal according to patient Nil Ventolin, Atrovent, Lanoxin, Renitec Emphysema Recent chest infection Hypertension Last ate at 1700 hours Last drunk water approximately 1 hours ago Bowels open this morning Has been progressively getting worse over the day. Initially own medications were assisting but not now. Last used ventolin via nebuliser about 30 minutes ago.

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 anxious Able to talk in short phrases 28 Prolonged expiratory phase Dry 110 irregular Expiratory wheezes to all fields.

Expected Course of Action Patient should be placed on oxygen therapy ASAP if delay in setting up nebuliser Salbutamol nebulisation should be instigated ASAP Patient is in moderate respiratory distress – earlier SITREP to provide update. Arrange for transport to hospital. Reassessment after first Salbutamol nebulisation. Should question regarding past chest infection – possible reoccurrence. Reassessment Respiration Rate Pulse Pulse oximetry Conscious state General appearance Speech Ventilatory rate Ventilatory rhythm Breath sounds

24 110 irregular 95% on nebulisation GCS 15 Anxiety decreasing Able to speak in short sentences 24 Prolonged expiratory phase Expiratory wheezes to all fields but not as pronounced as initial assessment.

Expected Course of Action Should recognise that patient is improving. Continue Salbutamol nebulisation Transport for further assessment and treatment

PUB280 – Foundations of Paramedic Practice...