Reset 10 mins Pause Candidate instructionsActor instructionsMark sheet Score Setting: You are a junior doctor based on a surgical firm. Patient: Kane White (DOB 22/03/1972, Hospital number 723111, Address: 12 Smith Street, Wareham, WR22 2HD) has come in this afternoon for admission prior to his Whipple’s procedure tomorrow. He has a history of pancreatic cancer, hypertension and peripheral vascular disease. He does not have any allergies and weighs 81kg. He brought a list of his medications (click to enlarge): The patient says he stopped aspirin 6 days ago as advised by an anaesthetist he saw in clinic. Blood results: Hb 103 g/L (130-180), WCC 4.5 x10^9/L (4-11), Plt 266 x10^9/L (150-500), Na+ 137 mmol/L (133-146), K+ 4.5 mmol/L (3.5-5.4), Ur 4.5 mmol/L (2.5-7.8), Cr 92 mmol/L (59-104), Mg 0.4 mmol/L (0.8-1.0), INR 1.0 (0.8-1.2) Task: Please complete the patients drug and fluid prescription charts. You have clarified with your consultant and she has specified: The patient should have venous thromboembolism prophylaxis this evening but not on the day of the operation The patient should have maintenance intravenous fluids overnight as he will be nil by mouth from midnight (please prescribe 2L initially in case of delay in list) Aspirin can be resumed on day 5 post-op Any antihypertensives should not be given today or on the day of the operation Any electrolyte abnormalities must be corrected intravenously Please also write up an antiemetic and paracetamol in case the patient needs them post-op. You have 8 minutes and there will be no questions. Your national formulary (e.g. BNF in UK) is available if needed. Drug chart can be printed here. Fluid chart can be printed here. There is no patient present in this station. An example of a correctly completed drug chart can be viewed here. An example of a correctly completed fluid chart can be viewed here. Category Question Done Excellent Patient Patient details completed correctly on both charts Full name Hospital number DOB Address (drug chart only) Allergies Allergy box completed on both charts None known Signed and dated Other Other details completed on both charts Date chart started Chart number Weight entered Fluids Fluid chart 1 Prescribed IV magnesium replacement Fluid = 0.9% saline Additive = 2-5g magensium sulfate Volume = 200-500ml (depending on magnesium content) Duration = 100ml/h (or total duration equivalent) Dated and signed Fluids Fluid chart 2 Maintenance fluid prescribed Fluid choice = 2x dextrose-saline (preferred); or 1x dextrose, 1x normal saline 1L volume bags x2 Additive 20mmol KCl in one or both bags Rate = approximately 1.5ml/kg/h Dated and signed PRN 1 As required medication 1 Paracetamol 1g Route = IV or PO or IV/PO Indication for nurses given (e.g. pyrexia/pain) Frequency 4-6 hourly Max dose 4g Signed and dated PRN 2 As required medication 2 Anti-emetic e.g. Cyclizine 50mg or Ondansetron 4mg Route = IV or PO or IV/PO Indication for nurses given (e.g. nausea/vomiting) Frequency Cyclizine 6-8 hourly, Ondansetron 4-6 hourly Max dose Cyclizine 150mg, Ondansetron 16mg Signed and dated Regular Regular medications Enoxaparin 40mg S/C or Dalteparin 5000units S/C or local hospital alternative Anti-embolism stockings should not be given in PVD (IPCs may be considered instead) Aspirin 75mg PO Ramipril 5mg ON Times correct Indications completed Special instructions completed Aspirin suspended correctly until day 5 post-op Enoxaparin/Dalteparin suspended on day of operation Ramipril suspended today and on day of operation Signed and dated Other Other points Considers (or says they would check) drug interactions Submit your answers to get your score.