You are a junior doctor in the emergency department. You are asked to see a 40 year old female with shortness of breath. Please assess the patient discuss you management plan with the examiner. You will have 8 minutes.
Please note a full ABCDE assessment is not required.
You are Carol Whitcome, a 40 year old. You came to the A&E because you have been feeling more short of breath over the last few days.
History of presenting compliant
Information to be volunteered at the start
You started to notice you are a bit more breathless over the last few days.
Information to given if asked
You can normally walk 100 yards before becoming breathless, but now you are breathless after just a few steps. Your chest feels very wheezy and tight (but no pain). You also have a cough and green coloured sputum.
You do not have any other symptoms.
Past medical history
- COPD (if asked: you have inhalers but no home nebulisers or oxygen. You have had 3 admissions to hospital last year. You have never been to intensive care but have to go to a high-dependence unit once for a tight fitting face mask that blowed air into your lungs at high pressure)
Medications and allergies
- Trimbow 87 micrograms/5 micrograms/9 micrograms 2 puffs BD
- Salbutamol inhaler PRN
- No allergies
- You smoke 30 cigarettes a day
- You do not drink alcohol
- Your daughter does the shopping but you do everything else at home
Examination findings to simulate
Act breathless and as if you are using accessory muscles.
Breath through pursed lips.
After the candidate auscultates your chest, play this sound:
Patient observations (give when asked for by candidate)
- Blood pressure 140/80
- Heart rate 78
- Respiratory rate: 22
- Oxygen saturations: 87% on air
- Temperature: 36.6