Resources
The ALS/APLS/NLS/ATLS and ETC manuals provide a good foundation and will cover a large number of the scenarios likely to come up in resuscitation stations. The RCEM learning website also contains useful modules, particularly on the environmental emergencies. The Wessex Adult and Paediatric trauma guidelines along with the NHS Clinical Guidelines on Major Incidents and Mass Casualty Events are also recommended reading for trauma stations.
Face to face OSCEs
These are typically focused on a candidates leadership of a scenario, but also there is often a skill or some sort of conflict to deal with, for example cardiac arrest due to inadvertent administration of an incorrect dose of local anaesthetic. Ensure you try to tease out what additional things the scenario wants you to cover and use the principles in the communication chapter (chapter 4) to manage this.
General Approach
It is difficult to try and provide a generic approach that encompasses both the variety of possible stations, and the nuances of the virtual and face-to-face OSCES to totally reflect the variety of resuscitation stations possible. Hopefully, the broad themes below are helpful in helping to develop your approach.
Introduction
“Hello, my name is Dr Smith I am one of the Senior Doctors working in the Emergency Department today.”
“Can I confirm your name and level of seniority?”
“We have received the following pre-alert…”
“We need to spend some time preparing the: Team; Environment and Equipment.”
Preparation – Team
Get team to Resus
2222 call via switch board for:
Trauma: Trauma call
Paediatric: Paediatric medical emergency/cardiac arrest
Adult: ITU/maternal crisis (obstetric emergencies/delivery)
Brief team
- Introduce yourself
- Give the ATMIST brief
- Ask the team to introduce themselves; their level of competance and what role they will be performing.
- State any anticipated problems and who will intervene if needed:
- Code red nurse for trauma
- Who will perform urgent interventions
- Who will manage defibrillation if needed
- If time perform a ‘mission rehearsal’ – describe what will happen in the first few minutes.
Preparation – Equipment
Ensure team in PPE
Airway
- Oxygen
- Suction
- Airway trolley
Breathing
- Sats probe
- BVM/Water’s circuit
- End tidal CO2
- Thoracostomy
Circulation
- IV access / IO
- Fluids
- Cardiac monitoring/ BP cuff
- Defibrillator
- Major haemorrhage trolley
- Thoracotomy equipment
Disability
- Pen torch
- Thermometer
- Bair Hugger/warming device
Drugs
- RSI packs
- Resuscitation drugs
- Tranexamic acid
Other
- Ultrasound
- Resuscitative hysterotomy equipment
- Resuscitaire
- PICU drug calculator + WETFLAG calculations
- Lateral canthotomy equipment
- Prealert: radiology / blood bank
Run the scenario
Run the scenario as appropriate
Close
Depends on scenario; may be:
- Handing over to another speciality
- Dealing with conflict appropriately
- Sign posting to further learning if a teaching element
- Team debrief
Example scenarios
As mentioned above your standard life support manuals provide a core foundation for these topics, and if there is an algorithm that is the management you should be following. Links have been added to relevant clinical presentations to direct to other sources of learning that previous candidates have found useful.
Adult ALS
Special circumstances:
- Anaphylaxis
- Asthma
- Cardiac
- Electrolyte disturbances
- Massive haemorrhage 1, 2
- Obstetric: eclampsia; emergency delivery; postpartum haemorrhage; resuscitative hysterotomy
- Toxicology
Paediatric – APLS/NLS
Special circumstances:
Trauma – ATLS/ETC
- Wessex Adult and Paediatric major trauma guidelines
- Airway
- Head injury
- Spinal cord injury
- Thoracic
- Abdominal
- Pelvic
- Major haemorrhage
- Resuscitative thoracotomy
- Trauma in pregnancy
- Silver trauma
- Environmental: