Primary FRCA SOE October 2008 - MEDICAL EDUCATION at ...
Primary FRCA SOE October 2008 - MEDICAL EDUCATION at ...
Primary FRCA SOE October 2008 - MEDICAL EDUCATION at ...
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University Hospitals Coventry & Warwickshire NHS trust- LFTs were normal- Assessed the airway- I wasn’t sure wh<strong>at</strong> else should I do or ask for12- PEA post cholecystectomy on the ward- No manikins or p<strong>at</strong>ients, just a ch<strong>at</strong> with the examiner- Had to diagnose PEA (ECG sinus rhythm, but pt. has no pulse)- Wh<strong>at</strong> would u do- Went through ALS Algorithm- Had to mention all the reversible causes- Wh<strong>at</strong> do u think is the most possible cause- CO is back, wh<strong>at</strong> would u do now?- Was straight forward13 – Defibrill<strong>at</strong>ion st<strong>at</strong>ion- CPR in progress on a manikin (one ventil<strong>at</strong>ing the pt, another doing chestcompression + resuscit<strong>at</strong>ion officer for the defib + the examiner)- LMA insitu- Monitor showing VF (Asked me to identify it)- Asked me wh<strong>at</strong> do u think about the CPR (compressions were slow & notproperly on the sternum)- Wh<strong>at</strong> would u do now (I said connect the defib & shock the pt.)- They <strong>at</strong>tached the leads for me and asked why we place them like th<strong>at</strong> i.e.across the heart.- Then I had to switch on the defib & shock the pt. myself- I made sure no one is touching the table; I left the oxygen as it was connectedto the LMA, which was in place.- Then asked wh<strong>at</strong> next- When would u reassess, how often u give adrenaline- Finally he’s back to sinus rhythm with a cardiac output.14 – History taking from an elderly pt. coming for a c<strong>at</strong>aract oper<strong>at</strong>ion15- Fast bleeped by the ITU nurses. Pt deeply sed<strong>at</strong>ed on a tracheostomy. Trache tube fell offwhilst transferring him. Pt. known difficult to intub<strong>at</strong>e- I went in, the nurse was panicking- Monitors on SPO2 dropping- Called for help- Other parameters were Ok, but I didn’t comment- Trolley with an laryngoscope, ETT, Guedal, Tracheostomy tube and LMA- Tried to bag & mask him while the nurse was occluding the hole, no luck- Tried to pass another another trache tube, false track- I thought to see if I can intub<strong>at</strong>e, laryngoscope hasn’t got light (I think it wassilly for me to try this anyway knowing th<strong>at</strong> he’s difficult to intub<strong>at</strong>e)- Inserted a Guedal airway & went for 2 hands technique, whilst occluding thehole, started to get some air entry- Inserted LMA, ventil<strong>at</strong>ion was much better & they stopped me there.10
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