Reset 10 mins Pause Candidate instructionsActor instructionsMark sheet Score Location: You are junior doctor on medical ward cover. A ward charge nurse has bleeped you to see a patient. She is concerned about his blood pressure and heart rate. Patient: 35 year old male who has been admitted with an acute kidney injury Task: – Perform a full ABCDE assessment, a nurse will be available to help you with any investigations or management that you require. – After 6 minuets you will be asked a series of questions by the examiner. You are a 35 year old patient who has been admitted with kidney problems of unknown cause, you do not know anymore details than this. You have been feeling dizzy over the last couple of hours. You are not on any regular medications. You have no drug allergies. Category Question Done Excellent Intro Candidate appropriately introduced themselves Washes hands Full name Role Clarifies who they are talking to Asks patient for preferred name Hx Asks brief history Brief events leading up to now A Airway assessment Patient talking, airway patent B Breathing assessment Oxygen saturation = 97% on RA Respiratory rate = 18 Position of trachea = central Chest expansion = equal Chest sounds = clear C Circulation assessment Blood pressure = 95/65 Heart rate =108 Peripheral and central cap refill – < 2 seconds Heart sounds = I + II + 0 C Circulation investigations ECG Establish IV access Bloods = FBC, U&E, CRP, VBG Cardiac monitor ECG photo_camera The nurse kindly performs an ECG, please review the trace No demographics/date No calibration details Rate = 102 PR interval prolonged Broad, bizarre QRS complexes Peaked T waves VBG photo_camera The nursing assistant returns with the patient's VBG result, please discuss any abnormalities Metabolic acidosis Hyperkalaemia Dx What is your working diagnosis at this point? Hyperkalaemia Category of hyperkalemia = severe Secondary to acute kidney injury Mx Hyperkalemia treatment 30ml Calcium gluconate 10% IV over 15 minutes 10 units of Actrapid Insulin in 125ml of 20% dextrose IV over 15 minuets 10mg salbutamol neb Sodium zirconium cyclosilicate 10g PO TDS for up to 72 hours IV 0.9% saline 250-500ml fluid bolus (hypotensive) D Disability assessment Blood glucose = 6.5 Temperature = 37 A on AVPU Pupils equal and reactive to light E Everything else Feel abdomen Exposure for rashes etc. Reassess Candidate offers to reassess patient in an ABCDE approach Repeat ECG after treatment Question After you have completed your initial assessment who would you contact? Medical registrar Question If the patient's potassium does not respond to your management above, what would be the next step? Contact ICU Renal replacement therapy Submit your answers to get your score.