STEMI (2026) | OSCE Station

Candidate instuctions

Location: You are an FY1 on medical ward cover. The ward sister has bleeped you to see a patient

Patient: 55 year old man has developed central crushing chest pain

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

Note to actor

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.

Central crushing chest pain came on 1 hour ago. Pain is a 10/10, radiates to jaw and left shoulder. You have not experienced anything like this before. You feel sweaty and terrible like you are going to die. You have vomited once and feel incredibly nauseous.

PMH = hypertension, type 1 diabetes

DH = novorapid, levemir insulin

No known drug allergies

Mark sheet	😊	😃
Candidate appropriately introduced themselves with: Full name Medical school, year or grade Clarifies who they are talking to Asks patient for preferred name	3	4
History Ascertains central rushing chest pain Radiation to left shoulder PMH: hypertension, type 1 diabetes DH: NKDA, insulin regime clarified	2	4
Airway assessment Patient talking Airway patent	1	2
Breathing assessment Oxygen saturation = 89% on room air Respiratory rate = 30 Position of trachea = central Chest expansion = equal Chest sounds = clear Percussion = normal	3	5
Breathing investigations Requests ABG CXR	1	2
Breathing treatment Oxygen 15L through non-rebreathing mask	1
Circulation assessment Patient sweaty / clammy Blood pressure – 90/55 mmHg Heart rate – 100/min Peripheral and central cap refill – less than 2 seconds Heart sounds = I + II + 0	3	5
Circulation investigations 2 large bore IV cannulae Bloods = FBC, Urea and electrolytes, CRP, troponin, HbA1c ECG	2	3
ECG interpretation ST elevation in anterolateral leads (mainly V1-V4) Q waves in septal leads (V1-2) Peaked T waves in V2-4	2	3
Diagnosis Candidate confirms anteroseptal STEMI	1
STEMI treatment Analgesia: Morphine 5-10mg IV titrated to pain Antiemetic e.g IV Cyclizine 50mg IV STAT or Metoclopramide 10mg IV STAT Aspirin 300mg PO STAT Nitrate - sublingual GTN if not hypotensive (then PRN) – IV infusion can also be used P2Y12-receptor inhibitor (prasugrel or ticagrelor or clopidogrel) ACS-dose anticoagulation (fondaparinux or unfractionated heparin) O2 administered if hypoxic Primary PCI or Thrombolysis	4	6
Circulation treatment 500ml of 0.9% normal saline or Hartmanns or Plasmalyte STAT	1
Disability assessment A on AVPU Pupils equal and reactive to light Blood glucose	2	4
Exposure Candidate adequately exposes patient Abdominal examination Assesses calves Temperature = 37.3°	1
Escalation Candidate offers to call / bleep medical registrar	1
Reassessment Candidate offers to reassess in an ABCDE approach	1

Raw score: 0/0
Your percentage: 0%

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Your percentage

Average user score for this station

67%

Station pass mark

55%

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Previously completed stations

%	Date
12	06-10-26

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