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Richard Taylor . Abdominal OSCEs. Aims. Acute illness management OSCEs Stomas Abdo exam tips . Things to remember. It’s about looking competent Inspiring trust Being systematic Being safe Having a bit of knowledge. Acute illness management.

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Presentation Transcript
slide2
Aims
  • Acute illness management OSCEs
  • Stomas
  • Abdo exam tips
  • ...
things to remember
Things to remember...
  • It’s about looking competent
  • Inspiring trust
  • Being systematic
  • Being safe
  • Having a bit of knowledge
acute illness management
Acute illness management
  • Mrs. Albert has presented to A and E with severe abdominal pain.
  • Assess the patient, take a focused history and present a plan
what do you have to do
What do you have to do?
  • Walk in and assess patient- stable or not
  • 3 minute history
  • Focused examination
  • Differential diagnosis
  • Basic, safe management plan
  • In 8 minutes...
assessing the patient 1
Assessing the patient 1
  • ABC...
  • Is not enough!
  • Airway:
      • Maintained or not
      • Adjuncts
      • O2
assessing the patient 2
Assessing the patient 2
  • Breathing
  • Work systematically
    • Start at the end of the bed, then hands etc.
      • RR, cyanosis, distress
      • Sats
      • Chest movements
      • (Auscultation)
      • (ABG)
assessing the patient 3
Assessing the patient 3
  • Circulation
    • Start at the end of the bed again
      • Obvious bleeds/ pallor
      • Cap refill
      • BP
      • Venflon
      • Hydration status
      • Urine output
assessing the patient 4
Assessing the patient 4
  • Disability
    • Keep it simple
      • AVPU
      • DEFG...
      • Pain relief
  • And move on- you have now passed...
focused history
Focused history

Signpost

  • Pain history
  • Associated symptoms
  • Menstrual history
  • Sexual history
  • Weight loss
  • PMHx
  • DHx
focused examination
Focused examination
  • Abdo exam
    • Examiner will tell you what you find
  • Expose the patient!
differentials
Differentials
  • Give 3- you’ll be right most of the time
  • Consider your patient’s demographics
  • Don’t forget gynae causes
slide13
Plan
  • Keep it simple
    • Bloods
    • Imaging
      • USS
      • AXR
      • CT
    • Analgesia
    • NBM
    • Fluids

INFORM MY SENIOR

stomas
Stomas
  • Will come up- have you gone through this already?
  • Know:
    • How to site
    • Types (and... and...)
    • Complications
      • How will you categorise them?
    • What kind of psychological problems?
categorise or die 1
Categorise or die 1
  • Or how to show that you’re competent
    • Don’t list things that come into your head
    • Categorise them
      • Early or late
      • Common or rare
      • By system
      • Specific or general
    • Give 2 or 3 examples
    • Then stop.
categorise or die 2
Categorise or die 2
  • The power of erm
  • The power of stopping
abdo exam 1
Abdo exam 1
  • This is real discriminator
  • Read Byrne, Hill...
  • Don’t waste time
    • First minute is:
      • Intro
      • Consent
      • General inspection
      • Hands
      • Face
  • And then the abdomen
abdo exam 2
Abdo exam 2
  • Use the phrase:

“There are no stigmata of...”

  • Talk through what you are doing
  • Get to the end
  • Look at the renal angles for scars
  • Feel the hernial orifices
  • Name some scars
  • Know McBurney’s point and the mid-inguinal point
conclusion
Conclusion
  • Acute illness management will come up
  • Stomas will come up
  • Abdo may come up
  • It’s mainly communication skills
    • Competent
    • Trust
    • Safe
      • Knowledge