Best practise in an acute care OSCE

[@drneenuchandramohan2121]

Im glad i found this channel.. i have my plab 2 exam in a few weeks.. and clearly demonstrates how this station should go.

[@ShahidMehmood-md3hh]

Neenu Chandramohan me too but it’s not accurate demonstration for PLAB2

[@shallomn4746]

How did it go

[@Jan-yt2re]

A few months into 5th year now and acute scenarios terrify me (only had it in simulation sessions, never seen it irl) and this was brilliant. thank you so much!

[@alexanderpora6426]

I think something a lot of people struggle with is realising when it becomes an acute situation from just talking to the patient if you arent told its an acute station - at what point do you stop taking a normal history and then start with the ABC stuff

[@Djspeeda]

As soon as you have finished taking the history of presenting complaint (if you are allowed to take a brief history beforehand), you should formally begin doing an A to E assessment

[@ChrisEightyNine]

I'm currently confused who's being tested?

[@HaydnG266]

I think the examiner is portraying multiple parts 😂 Examiner, another doctor, the patient and a general dickhead

[@sagarwahab8112]

😂

[@LiamDaLemon]

Really useful video - any chance of doing another scenario?

[@0xcxunt]

He did well, the only thing he missed initially was BVM when resp. rate dropped below 12 breaths/ min.

[@jkp6600]

Helpful video - will be watching a few times before finals.. If someone has arrested, when/how do you rule out reversible causes? Hypoxia and hypoglycaemia seems straight forward, but with tension pneumothorax do you interrupt chest compressions to check expansion/air entry (assuming someone else is ventilating them?) Equally, with PE do you just base your decision to give thrombolysis on the history?

[@mm-s4194]

Hi guys, I'm a medical student taking finals in a few weeks so it's good to have a video which shows how to look competent in this station. I have a couple of questions. 1) The oxygen goes on very early in the assessment, before Breathing has been covered. Is this strictly necessary, and would it confound assessment of breathing by buffing up sats? 2) May be due to camera angle, but wouldn't it be better to fully expose the mannekin's chest for breathing assessment? 3) Should lower limb pulses and inspection of shins form a routine part of primary survey, or could they be covered in secondary survey/top-to-toe assessment? I'd be grateful for your feedback. Thanks very much for creating this resource and helping calm the nerves!

[@PREPARE4FY1]

Hi thanks 4 your q's 1) no1 is ever going to criticise you for putting oxygen on early in an acutely unwell patient. It's better to give oxygen while assessing patient and then titrate down according to the clinical picture. That's even the case for patients with COPD! The 'What about their hypoxic drive?' Question comes up time and time again. We are talking about high flow oxygen (15L via a non-rebreathe face mask) for a short duration to allow time for safely assessing an acutely unwell patient. An easy way to remember this is considering the 8 causes of reversible cardio-respiratory arrest. Would like someone to comment and give some details on the these in the comments below please! 2) Yes patients should always be fully exposed in exams and in real life. They weren't in this one due to filming constraints! Sorry! 3) Shins / calves important to assess generally under 'E' of an A-E assessment, unless they fall into earlier categories such as bleeding. Good luck! P4FY1Team

[@berkaygazikara]

Did you pass your finals?

[@999aki]

quick question - at what point would you fit in ECG leads? Should it be done routinely or at the first mention of 'chest pain' / only if any cardiac pathology picked up? Because I always forget to do an ECG

[@PREPARE4FY1]

Hi Jonathan, thanks for your question. Again as with the oxygen comment below, when assessing acutely unwell patients in the real world - the first thing one tends to do, once they are in a resus cubicle is attach monitoring this includes ECG electrodes. You want as much information about what's going on with these patients as quickly as possible. In the exams there is a temptation to cover ECG in C, but we would implore you ask for it earlier If there was enough in your assessment to suggest a cardiac cause/association for their deterioration. Best of luck with your exams! The PREPARE4FY1® team

[@efeogidiagba3900]

In view of need for anaesthetist along the management chain to secure an airway, is it not ok to say you want to call for help e.g from anaesthesia registrer before commencing rescuscitation?

[@DrRussell]

The delay would be life-threatening, so we commence resus to the limits of our skills/team/equipment until the arrival of an anaesthetist and additional staff

[@AW-pz4ev]

What would you do in real life/OSCE, would you try and auscultate/percuss the lungs on the back or just do the front?

[@drneenuchandramohan2121]

Where do we assess the gcs?

[@infusion6478]

I think GCS falls under disability, from what I've been taught you do AVPU to start with

[@ammar3465]

thanks alot

[@dsmdsm2186]

Did he was to expose the patient, considering that they were post ok andbthe wound site may be contributing the his acute illness. Hindsight is a great thing lol.

[@railim1542]

thank you!

[@priyaghavri6738]

PLAB2

[@yogeeyogee9034]

👍👍

[@doctorsaap]

its a complete mess

[@je6874]

Any chance you could make a video showing how it’s really done then, Dr. Gaurav? As another medic, constructive criticism is crucial.

[@DrDinooshDeLivera]

Thank you!