Location: You are an FY1 on the medical assessment unit

Patient: You have come to take blood from a patient, as you are walking into the bay the emergency buzzer has been activated and a nurse is shouting for help

– Perform a full ABCDE assessment, a nurse will be available to help you with investigations or management that you require.
– After 6 minuets you will be asked a series of questions by the examiner.
– Answer any questions that the patient may have

Note to actor: Try to restrain yourself from volunteering to much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.

You will be laying on your right hand side. Your arms and legs are shaking, your teeth are gritted shut and will not open

Nurse history:
– Patient is a known epileptic
– Patient has just been transferred to the wards this morning, after being admitted late last night.
– Nurse saw patient begin seizing and shouted for help at same time
– No drug allergies

Category Question
History History from nurse
Patient is a known epileptic
Nurse saw patient begin seizing and shouted for help at same time
No drug allergies

Airway assessment Airway assessment
Teeth are grit shut
Unable to insert gadel to maintain airway. Candidate offers a nasopharyngeal airway

Breathing assessment Breathing assessment
Oxygen saturation = 88% on RA
Respiratory rate = unable to determine
Position of trachea = central
Chest expansion = equal
Chest sounds = clear

Breathing treatment Breathing treatment
Oxygen 15L through non-rebreathing mask

Circulation assessment Circulation assessment
Blood pressure – 90/87
Heart rate – 110
Peripheral and central cap refill – < 2 seconds
Heart sounds = I + II + 0

Circulation investigations Circulation investigations
2 large bore IV cannulae
Bloods = FBC, U&E, CRP, VBG

Additional bloods Additional blood tests requested
Any one of: Na, B-hcg, Alcohol, Drug levels

Circulation treatment Circulation treatment
500ml of 0.9% normal saline STAT

Disability assessment Disability assessment
Blood glucose = 6.7
Temperature = 37

Diagnosis Diagnosis
Candidate verbalizes diagnosis of status epilepticus

Status treatment Status treatment
Lorazapam 4mg IV bolus OR Diazepam 10mg PR (if no IV access)

Question If after 10mins the patient is still having a seizure what should you do?
If ongoing seizure give 2nd dose of Lorazapam 4mg IV

Question If after 2 doses of lorazepam patient is still in status, what other medication can be given?

Question What is the most likely cause of status for this patient?
Not prescribed regular medications

Submit your answers to get your score.

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