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Primary OSCE 83

Created: 10/7/2017
1. Simulator manikin
Demonstrate how to change a tracheostomy tube on a simulator manikin.
- Discuss your preparation, the procedure, how to confirm the tube position, how to check the tube, and your back-up plan if you fail to insert the tube.

2. Clinical anaesthesia
You are shown a picture of the pressure effects on the head following positioning on the theatre table and are asked to identify the injury and causes for it.
- You are then shown pictures of patient positioning on the table and asked questions on possible injuries, and to demonstrate on yourself the areas affected and the nerves compressed.

3. Resuscitation
Discuss your treatment of an elderly lady in peri-arrest (pulseless electrical activity [PEA] scenario).

4. History taking
Take a history from a young ASA 1 patient presenting for knee arthroscopy.

5. Clinical measurement/Physics
You are shown a photograph of a monitor screen, and asked questions on what gases are being measured, gas analysis methods and partition coefficients.

6. Resuscitation
You are given an ECG trace showing ventricular fibrillation and asked questions on the management.

7. Communication
Reassure a 46-year-old woman presenting for laparoscopic cholecystectomy who is anxious about anaesthetic awareness, as her cousin has experienced awareness under general anaesthetic for emergency lower uterine segment Caesarean section.

8. Simulator manikin
A young man has had a road traffic accident and presents with a fractured femur. The senior house officer has induced anesthesia with rapid sequence induction for fixation. Demonstrate your management on a simulator manikin. The patient is tachycardic and desaturating. Ultimately, you find that the patient is in hypovolaemic shock.

9. Simulator manikin
Demonstrate the technique for insertion of a subclavian vein central venous pressure catheter and its complications.

10. Anatomy
You are shown a picture of a spinal cord-cross section and are asked questions on ascending and descending tracts, blood supply and the complications of ischaemia.

11. Scans
You are shown a chest X-ray taken from an elderly woman who is a heavy smoker and is acutely unwell, presenting with shortness of breath, and in respiratory failure. You are asked some true/false questions on her diagnosis and management.

12. Scans
You are shown a lateral X-ray of the cervical spine from a young man following a fall. It shows a C2 fracture. You are asked true/false questions on paralysis, breathing, ventilatory support, management.

13. History taking
Take a history from a 26-year-old female presenting for laparoscopic cholecystectomy. She is a smoker, has had previous surgery under sedation, with a previous uneventful general anaesthetic, and has a family history of drug reaction under general anaesthesia, requiring intensive care unit admission.

14. Anaesthetic machine check
You are asked to carry out a check on a Mapleson F system (it has a leaking bag). You are asked questions on flow rates.

15. Examination/skills
You are asked to examine the respiratory system of a young patient. He has bilateral thoracotomy scars and intercostal tube scars.

16. Anatomy
You are shown a picture of the pons and medulla and asked to identify them. You are then shown a picture of parasympathetic and sympathetic outflow and are asked questions on identifying nuclei and nerves, and on neurotransmitters and ganglia.

17. Equipment
You are shown pictures of an anaesthetic machine and wall oxygen flowmeters. You are then asked about rotamaters and their physical principles.

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