After years of preparation, extensive reading, sleepless nights, marriage breakdowns and caffeine – your week of being show ponies has arrived as the F.UCEM examinations are upon us. Giving hope to those who pray to the Utopian FSM we have managed to locate and leak one of the OSCE examination questions for this weeks exam – hope it helps.
UCEM OSCE SCENARIO
You are the ED Consultant in charge of a tertiary hospital ED
You take handover from the night team.
Issue one: Please speak to the resident who has been constantly vomiting all night and taking hot showers. The overnight registrar suspected cannabinoid hyperemesis and advised capsaicin cream application. Unfortunately the resident failed to wash his hands prior to urinating and is now blaming the night registrar for his fiery genitals. He feels persecuted and paranoid. He denies drug use and would like to remind you that his uncle is chair of the executive board.
Issue two: At morning handover you are briefed that the night team diligently managed all the acutely psychotic patients and no staff were injured. The most feisty of these interactions involved an individual vehemently claiming to be the King of a small African country and speaking in tongues. You are informed that the gentleman in question was appropriately restrained both chemically and mechanically when he failed to succeed to verbal de-escalation. However, in the light of morning news reports pertaining to the disappearance of a Senegalese Ambassador; a Google search for recently arrived Regal diplomats and the attendance of 6 armed militia at triage…your presence has been requested in cubicle 12.
Issue three: Today is accreditation day. The nursing shift co-ordinator is not concerned with the armed militia. They are more troubled by the fact that the emergency generator has been running now for 6 hours; 4 psychotic sedated patients have been co-cubicled to share restraints; one of your residents suffering from an attack of tinnitus disabled all the monitoring equipment alarms overnight and the missing enflurane cylinder has been located, entrained into the oxygen supply of the resus bays. The accreditors arrive in 30 minutes.
Issue four: Local celebrity chef, Fou-de-FaFa attended during handover, triaged as a category 5 with an index finger ice-splinter injury. They are currently being interviewed by 60-minutes in the waiting room, infuriated they have had to endure a 45 minute wait with a potentially limb-threatening injury. Your presence is requested for comment.
Please manage the department.
You have 7.5 minutes to complete this task.
Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.