ABCDE Assessment | Asthma Exacerbation | Emergency Simulation | OSCE Guide | UKMLA | CPSA | PLAB — Transcript

Full transcript

1. 0:03[Music]
2. 0:18hi there my name's Leah I'm one of their
3. 0:20A&E doctors how can I help hi Leah
4. 0:22thanks for coming so quickly I'm Grace
5. 0:24one of the nurses this is Callum he's 20
6. 0:26years old and he's just been brought in
7. 0:28by ambulance with shortness of breath
8. 0:30he's got a background of asthma but it's
9. 0:32usually well controlled in the ambulance
10. 0:34they gave him in nebulizer and he seemed
11. 0:36a lot better but he's just now got
12. 0:38really breathless I'm very worried about
13. 0:40him I was hoping you could assess him
14. 0:42yeah of course no worries thanks just
15. 0:44let me know if you need anything thank
16. 0:45you hi Callum my name's Leah I'm one of
17. 0:47the doctors I'd just like to give you a
18. 0:49check over today to make sure your
19. 0:51breathing's all right is that okay yes
20. 0:54thank you very much I'm just going to
21. 0:56start by checking your full name and
22. 0:57date of birth Callum Smith 10th of July
23. 1:022004 okay that's great and I'm just
24. 1:04going to start off um just by having a
25. 1:06little listen to your Airway so how is
26. 1:08your breathing feeling at the minute I
27. 1:10just can't catch my breath okay I'm
28. 1:12happy with this Airway cuz I can hear
29. 1:14him talking to us I'm just going to move
30. 1:15on to Assassin breathing whilst I'm
31. 1:17doing that would it be okay to just get
32. 1:18his oxygen saps and respiratory rate
33. 1:20please yes of
34. 1:26course Callum I'd like to start by
35. 1:28having a listen to your chest is it okay
36. 1:29okay if I just remove your T-shirt go
37. 1:31ahead okay thanks okay I'm just going to
38. 1:34start by having a feel of your wind
39. 1:38pipe okay that feels all right I'm going
40. 1:40to pop my hands on your
41. 1:42chest if you just take some big breaths
42. 1:44for
43. 1:51me okay now just have a tap on your
44. 1:53chest
45. 2:07okay and just breathe normally for me
46. 2:09Callum
47. 2:50okay his Ras rate is 32 and the oxygen
48. 2:54saturation on
49. 2:5691% okay would it be right to put him on
50. 2:5815 lers of oxygen fire non re breathe
51. 3:00mask please I'll do that right
52. 3:09now Callum I'm just going to pop this
53. 3:11oxygen on okay to help with your
54. 3:13breathing go
55. 3:16ahead okay now that he's un oxygen I'm
56. 3:18going to do an arterial blood gas he was
57. 3:20also quite Wheezy on examination of his
58. 3:22chest so I'm going to request a chest
59. 3:23exray would you mind just preparing a
60. 3:25nebulizer of Sal on it for Trum and I'll
61. 3:27go and prescribe it yeah I'll do that
62. 3:29now thanks very
63. 3:51okay so looking at the arterial blood
64. 3:52gas the pH is normal the pco2 is a
65. 3:56little bit low and the Oxygen's normal
66. 3:58but he is on 15 l of oxygen VI a non-
67. 4:00rebreath
68. 4:10mask okay so the airway looks Central
69. 4:13and the lung Fields look clear I think
70. 4:15this is probably a normal chest x-ray
71. 4:17okay so now that we've given him the
72. 4:18oxygen the nebulizers I think we should
73. 4:19just reassess to make sure that he's
74. 4:21improving would it be okay if you just
75. 4:22recheck his oxygen sets I'm respirat R
76. 4:24and I will listen to his chest yeah of
77. 4:26course thanks
78. 4:54perfect the oxygen sats are now 95% and
79. 4:57the rest rate is 27 okay that's great
80. 5:00sounds like we're going in the right
81. 5:01direction so we'll continue with the
82. 5:02treatment we're just going to move on to
83. 5:03assess circulation would it be okay to
84. 5:05check his heart rate blood pressure and
85. 5:07a fluid balance as well please of course
86. 5:09thank you Callum I'm just going to start
87. 5:11by having a feel of your hands and
88. 5:12checking your temperature okay yes
89. 5:33[Music]
90. 5:51okay okay Callum if you could just turn
91. 5:53your head over to the left for me I'm
92. 5:54just going to have a look at your
93. 5:58neck okay that's that's great thank
94. 6:00you you can turn your head back okay
95. 6:03Callum I'm just going to have a little
96. 6:04listen to your heart
97. 6:30okay and then finally I just need to
98. 6:31have a quick check of your
99. 6:33legs okay there's only pain when I'm
100. 6:36pressing on your legs no no
101. 6:39pain
102. 6:46okay there's no
103. 6:49swelling so the blood pressure was 110
104. 6:52over 88 and the heart rate was 95 okay
105. 6:55that sounds all right um on examination
106. 6:57he was perfectly warm and well profused
107. 6:58his heart sounds would normal and
108. 7:00there's no peripheral EMA and so I'm
109. 7:02just going to put a canul in and take
110. 7:03some blood tests would you mind just
111. 7:04doing an ECG please yeah of course
112. 7:10thanks okay so I'm going to take a full
113. 7:12blood count use the knes lfts and a
114. 7:15[Applause]
115. 7:24CR here's colum ECG thank you
116. 7:38okay so it's sinus rhythm the rate is
117. 7:4295 I can't see any abnormalities there
118. 7:45okay I'm just going to move on with my
119. 7:46assessment I'm going to check his
120. 7:47conscious level and his pupil would you
121. 7:49mind just checking his blood sugar
122. 7:51whilst I'm doing that and can I borrow
123. 7:52your pen torch please yeah of course
124. 7:54thank
125. 7:55you okay Callum I'm just going to shine
126. 7:57a bright light in your eyes for a second
127. 8:04okay that's great and can you tell me
128. 8:05whereabouts you are at the minute yes
129. 8:08I'm in
130. 8:09hospital okay thank you so that blood
131. 8:11sugar was 5.8 okay thank you very much
132. 8:14um I'm just going to move on to assess
133. 8:15his tummy and his legs would you mind
134. 8:17just checking his temperature please
135. 8:18yeah of course thanks um Callum do you
136. 8:20have any pain in your tummy at the
137. 8:22minute no no I don't okay so ideally I'd
138. 8:25lay you a bit more flat to check your
139. 8:26tummy but because you're struggling with
140. 8:28your breathing I'm going to keep you sat
141. 8:29where are I'm just going to have a
142. 8:30little feel of your tummy there okay
143. 8:56okay okay and then I'll just have a
144. 8:58little look at your legs can I just lift
145. 9:00your gown up a bit yes
146. 9:06thanks okay there's no rashes there
147. 9:09Callum I'm just going to pop this in
148. 9:11your ear to check your temperature okay
149. 9:17okay so the temperature was
150. 9:1936.8 okay thanks very much um so that
151. 9:22completes our assessment um based on the
152. 9:24investigations and examination findings
153. 9:26it sounds like there's a non-infective
154. 9:28exacerbation of asthma and we've already
155. 9:30treated Callum with some oxygen and some
156. 9:32nebulizers I think we probably need to
157. 9:33give him some steroids so I'm just going
158. 9:35to prescribe some oil prisone 40
159. 9:37milligrams if you wouldn't mind getting
160. 9:38that for me yeah no problem thank
161. 9:48you hi Leah he's had his predas alone
162. 9:51and I put up another cell beable
163. 9:53nebulizer okay that's great thank you um
164. 9:55I'm just going to go and hand over to
165. 9:56our senior and just to let him know
166. 9:58about what's been going on
167. 9:59um would you mind just repeating the
168. 10:00patient's observations whil I'm away and
169. 10:02then I'll come back yeah of course
170. 10:04thanks hi there it's Dr farington it
171. 10:06registar on call hi there my name is
172. 10:08Leah I'm one of the doctors in Ed um I
173. 10:11was just calling to discuss um a
174. 10:12gentleman who's come in with an acute
175. 10:14severe exasperation of asthma sure go
176. 10:16ahead um so I've got a 20-year-old man
177. 10:19he's called Callum Smith he does have a
178. 10:20known background of asthma but he's
179. 10:22coming today with a deterioration of his
180. 10:24symptoms um his SATs were 92% on room a
181. 10:27when he first came into the department
182. 10:29that has improved to 95% on a 15 L non-
183. 10:32rebreath mask and it stayed at 95% with
184. 10:35some cbal nebulizers that we've given MH
185. 10:38um on examination of his chest is
186. 10:40globally Wheezy but we've done a chest
187. 10:42x-ray which shows that there's no other
188. 10:43pathology um and a blood gas um was also
189. 10:46normal aside from a slightly low carbon
190. 10:49dioxide um on the rest of his assessment
191. 10:51he is properly warm and well profused
192. 10:53he's hemodynamically stable and his
193. 10:55carves were soft non tender the rest of
194. 10:57the examination was also normal
195. 11:00um so in total we've given him two cbal
196. 11:02nervs 5 milligrams each he's also had
197. 11:04some otrum bromide um and we've just
198. 11:07given him a start of predis loan um his
199. 11:09rest ratees currently sat at 27 his
200. 11:12hearts are still
201. 11:1395% um and his chest is starting to
202. 11:15settle so I'm planning to do a peak flow
203. 11:17soon um but because of his SATs when he
204. 11:19came in he does fall into the acute
205. 11:21severe category for his exacerbation so
206. 11:24I think he probably needs an IT review
207. 11:26okay can I just clarify a few points
208. 11:28what was the the respiratory rate
209. 11:30originally um so it was 32 when he came
210. 11:32in and it's now come down to 27 okay and
211. 11:35the blood gas you mentioned that the
212. 11:37oxygen levels were normal and the CO2
213. 11:39was low can I just clarify was that on
214. 11:41oxygen yes that was on the 15 liters non
215. 11:43re breathe okay what are the vital signs
216. 11:45at the moment um so his blood pressure
217. 11:47is 110 over 88 his temperature is 36.8
218. 11:51his respiratory rate is 27 and his
219. 11:53oxygen SATs and 95% um is currently on a
220. 11:56Sabal nebulizer okay great and is is
221. 11:59that oxygen driven yes it is yeah great
222. 12:01okay so I think continue doing what
223. 12:03you're doing with the backtack subut Mal
224. 12:05nebulizers I'll be down right away
225. 12:07that's great thank you very much check
226. 12:09out the geeku Medics collection of over
227. 12:111,000 osy stations you can practice with
228. 12:14friends using our group study mode or
229. 12:16chat with our amazing AI powered virtual
230. 12:19patients