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VAQ 4 Monash Trial Exam . Sept 2014. 75 yr old man from home presents by ambulance after an episode of syncope. History of HT but otherwise well and independent. Obs : BP 80/60 RR 24 SpO 2 92% T 36.8 A: Describe and interpret his ECG B: Outline your initial treatment. ECG.

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slide2
75 yr old man from home presents by ambulance after an episode of syncope. History of HT but otherwise well and independent.

Obs: BP 80/60

RR 24

SpO2 92%

T 36.8

A: Describe and interpret his ECG

B: Outline your initial treatment

exam common sense
Exam common sense

2 part question

  • A+ B
  • Each part worth 50% of the marks
  • Tailor the time spent & volume written accordingly

Glossary of Terms

  • Describe and interpret
    • State the characteristics including relevant negatives
    • State a conclusion which includes DDx but excludes management
  • Outline your initial treatment
      • Measures undertaken to cure or stabilise the patient’s condition
exam savvy
Exam savvy
  • Tailor the answer to the stem
  • Well man from home, sudden syncope
    • Not about trauma
    • Not about hypothermia
  • Obs provided:
    • Each obs tells a story:
    • Hypotension = shock
    • Mildly hypoxic and tachypneic ?why
pass criteria part a
Pass criteria: Part A
  • Rate
    • Ventricular 27/min (accept 25-30)
    • Atrial 60/min (accept 55-65)
  • Rhythm CHB
  • AxisRAD (+130)
  • Broad QRS 0.16s, RBBB pattern
  • T inv II, III, aVF, V1-3, flat/inv V4-6

Interpretation

  • Haemodynamically significant CHB
  • DDx: Ischaemia2/4 to pass

Degenerative

Hyperkalaemia

Toxicity (bblocker, ca blocker, digoxin)

pass criteria part b
Pass criteria: Part B
  • Atropine
  • Adrenaline
  • Pacing - transcutaneous

transvenous

features of good answers
Features of good answers
  • Systematic description of ECG
  • No omissions
  • Extra detail eg
    • QRS measurement not just qualitative statement
    • Axis measurement, not just “RAD”
    • Doses including dose limits
      • eg atropine 600mcg  3mg
    • Realistic DDxeg degenerative, drug toxicity, ischaemia
features of good answers cont
Features of good answers (cont)
  • Related stem to ECG
    • shocked patient
    • noted tachypnoea…..
      • considered LVF
      • appropriate caution with fluids
      • Realistic O2
  • Evidence based approach eg ARC
features that detracted
Features that detracted
  • Poor adherence to glossary of terms = wasted time
    • Eg attempting to cover “management” instead of treatment
    • Including assessment eg investigations
  • Spending too much time on Part A at the expense of Part B
slide11

Omissions in ECG description

  • Failure to take interpretation any further than what has been covered in the ECG description
  • Formulaic approach to Part B
    • No value in wasting time with
      • “Resus cubicle, team approach, put pads on chest, large bore IV cannulae, take bloods”
    • 100% O2 ?why (SpO2 92% RA)
slide12

Unrealistic DDxeg trauma, hypothermia, SAH

    • Read the stem! This is not a trick
  • Lack of knowledge of guidelines eg ARC
  • Omission of adrenaline
  • Isoprenaline only drug mentioned
marks
Marks
  • Range 2 - 7