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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.

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