Primary FRCA SOE October 2008 - MEDICAL EDUCATION at ...

University Hospitals Coventry & Warwickshire NHS trustClinical60 year old lady scheduled for emergency retinal detachment repair. Asthmatic on inhaledsteroidsDiscussed Regional vs GAAvoidance of drugs which cause bronchospasmPONV prophylaxisOther considerations in eye surgery – avoid raised IOP, oculocardiac reflex.Critical Incident - Failure to breatheMentioned relaxants and reversal, opioids and reversal, bronchospasm, hypercarbiaOSCE1. Resus – Sim man anaesthetised patient SV with LMA – rhythm change. Monitorshowed AF with BP 75/30. Cardioversion and what else to do if cardioversion didn’twork after 3 shocks (amiodarone and shock again)2. CVP – USS pictures of IJV and carotid. Asked what type of transducer used???Which side of neck looking at. How to make sure line in correct place and what iscorrect tip placement. CVP waveform waves and descents3. Resus – Just talk with examiner. Pt collapsed on ward, nursing staff doing CPR.Wanted you to confirm cardiac arrest first. Rhythm strip asystole – how would youmake sure it was true reading (check leads and gain). Management of asystolic arrestwith reversible causes4. History – 25 year old Nigerian woman for hysteroscopy. Been unwell as child andstayed in hospital, had murmur, not as tall as other siblings (not sure if they weregetting at rheumatic fever?). Dry cough for 18 months, had recent chest x-ray in clinic5. Sim man – 16 year old elective spinal surgery still in anaesthetic room. Colleagueasking for help. MH with low SpO2, hypertension, tachycardia, high PaCO2, raisedtemp. (Only thing I forgot was to change anaesthetic machine!!)6. CXR – pulmonary venogram from patient hypotensive and tachycardic. Post op NOF#. Questions on management of PE.7. Airway management. – demonstrate correct position for bag mask ventilation ofanaesthetised patient. Differences in children. Nasopharyngeal airway – complicationsand contraindications8. Anatomy – Antecubital fossa and wrist. Relations of radial nerve, brachial artery anddirection it takes down the arm before branching. Relations of median nerve at wrist.Where would you block the ulnar nerve at the elbow9. History follow on – 60 year old man scheduled for left hemicolectomy. Extensivecardiac history including MI 2 weeks ago as a result of bleeding. Lots of info to get inshort space of time – I ran out of time!10. CXR – 75year old lady with pansystolic murmur at apex c/o increasingbreathlessness. (mitral regurg)11. Equipment – epidural set. Given epidural packet with hole in top and out of date andasked if would use (No!). How to check catheter and filter. Size of filter and uses.Complications12. Temperature measurement – shown picture of thermistor. Principles of thermistor.Heat loss under anaesthesia. How to minimise loss through radiation (4 ways – Icould only think of 3)4