Interactive OSCE Checklists – ClinCaseQuest

Checklist – Counseling “Explain a bone marrow aspiration”

Nataliia Lopina — Sun, 04 Dec 2022 22:28:25 +0000

Introduction	Points
Introduces and identifies patient	1
Gains consent	1
Explore
Checks patients understanding for reason for Bone Marrow Aspiration	2
Check’s patients understanding of the procedure	1
Inform
Preparation: Taken in as a day case	1
Procedure: Takes 10 minutes. You are laid on your back and given a local anaesthetic which is make it less sore. They tunnel a needle into you pelvis bone and suck out some cells. Then given a dressing over the site.	3
Post-procedure: Apply pressure over site for 5 minutes. Given pain medication. Will be sore for 2-3 days	2
Risks and complications
Very safe procedure. Bleeding may occur	2
Pain is the main problem post procedure	1
Closure
Any questions	1
Alleviate fears	1
Offer further information source	1
Closure
Gave information in chunks and tested understanding	1

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Сообщение Checklist – Counseling “Explain a bone marrow aspiration” появились сначала на ClinCaseQuest.

Interactive OSCE Checklist – Emergency care of a patient with chest pain – Acute Coronary Syndrome with ST-segment elevation and equivalents

Nataliia Lopina — Sat, 14 May 2022 12:10:00 +0000

Additional materials:

Chest Pain History Taking / OSCE guide

Pericarditis: symptoms, diagnosis, treatment

Stephen Smith’s formula for Subtle Anterior STEMI online Calculator

Two masks of the same syndrome: Wellens syndrome

Aslanger’s Pattern

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Сообщение Interactive OSCE Checklist – Emergency care of a patient with chest pain – Acute Coronary Syndrome with ST-segment elevation and equivalents появились сначала на ClinCaseQuest.

Interactive OSCE Checklist – Counseling a patient who is taking warfarin

clincasequest — Wed, 12 Jan 2022 16:14:11 +0000

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Checklist – Counseling “Explain a bone marrow aspiration”

IntroductionPointsIntroduces and identifies patient1Gains consent1Explore Checks patients understanding for reason for Bone Marrow Aspiration2Check’s patients understanding…

Checklist – Counseling “History of Acute Intermittent Porphyria”

IntroductionPointsIntroduce and check the details1Consent1Presenting Compliant Elicit intermittent nature of abdominal pain1Details on length of suffering…

Interactive OSCE Checklist – Emergency care of a patient with chest pain – Acute Coronary Syndrome with ST-segment elevation and equivalents

Email (indicate if you want the results to be sent to your email)

Date

Student name

Group, faculty

• Opening the consultation

Wash your hands and don PPE if appropriate

Introduce yourself to the patient including your name and role

Confirm the patient's name and date of birth

Explain the reason for the consultation

Obtain consent for counseling and care

• Availability of a defibrillator

Provide the availability of a defibrillator

Start ECG monitoring

• Presenting complaint

Use open questioning to explore the patient’s presenting complaint

• History of presenting complaint

Site: ask where the pain is

Onset: clarify when the pain first started and if it came on suddenly or gradually

Character: ask the patient to describe how the pain feels

Radiation: ask if the pain moves anywhere else

Associated symptoms: ask if there are any other associated symptoms

Time course: ask how the pain has changed over time

Exacerbating or relieving factors: ask if anything makes the pain worse or better

Severity: ask how severe the pain is on a scale of 0-10

• Past medical history

Screen for conditions that may be associated with chest pain

Ask about other medical diagnoses and previous surgical history

Ask if the patient has any allergies and if so, clarify what kind of reaction they had to the substance

• Drug history

Ask the patient is currently taking any prescribed medications or over-the-counter remedies

Ask the patient if they’re experiencing any side effects from their medication

• Physical examination

Assessment of general condition and vital functions according to the ABCDE algorithm

Visual assessment of the color of the skin, the presence of swelling of the cervical veins, and edema

Assessment of the state of the cardiovascular system

Assessment of the state of the respiratory system

Pulse oximetry to determine blood oxygen saturation (normal ≥ 95%)

Oxygen therapy (supporting saturation over 94-95%)

• Intravenous access

Intravenous access

Starting the infusion of Ringer's lactate solution

• Registration of a 12-channel ECG

Recording ECG

Assess the presence/absence of pathological ST-elevation according to formal STEMI criteria

Exclusion of other causes of benign ST-elevation in the presence of such ST-elevation – to exclude a possible non-coronary or acute coronary origin: early ventricular repolarization syndrome, left ventricular aneurysm, secondary ST-changes in LVH, recording artifacts, and others

Assessment of additional ECG patterns and conditions that may be caused by critical coronary artery occlusion (STEMI-equivalents) – in the absence of ST-elevation - make sure that there are no other signs of coronary artery occlusion (STEMI equivalents)

Identification of the localization of myocardial ischemia

Assess for the presence of right ventricular myocardial infarction

• Express test for the determination of cardiac troponin, myoglobin, creatine phosphokinase-MB, if possible

The timing of the increase in markers of myocardial damage

Analysis of other causes that may lead to increased markers of myocardial necrosis

• Making preliminary diagnosis

Criteria for ACS with ST-segment elevation (STEMI)

STEMI Equivalents

Localization

Killip score

• Drug therapy (basic)

Acetylsalicylic acid

Anticoagulant

Nitroglycerin

Beta-blocker

Administering solutions as needed

Pain relief

Midozalom administration for cocaine-induced STEMI

Concomitant therapy as needed

• Evaluation of the door-balloon time (the choice of further reperfusion strategy aimed as soon as possible to restore the coronary blood flow in the infarct-dependent artery)

Primary PCI

Hospital thrombolysis followed by PCI

• Call the nearest reperfusion center

Activation of the intervention team of the reperfusion center

• P2Y12 receptor inhibitor prescription depending on the chosen strategy of reperfusion therapy

Choice of P2Y12 inhibitor for medical care

• Carrying out thrombolytic therapy as needed

Criteria for selecting patients for thrombolytic therapy

Evaluation of success criteria for fibrinolytic therapy

Choice of the drug for thrombolysis

Assessment of absolute contraindications for thrombolysis

Assessment of relative contraindications for thrombolysis

• Transportation to the nearest reperfusion center

Analysis of delays in the medical care of a patient with acute coronary syndrome

Monitoring of vital signs during the transfer

Pain management as needed

Reporting in the emergency department of the hospital during the patient's hospitalization

Total

Additional materials: https://clincasequest.hospital/chest-pain-history-taking/ https://clincasequest.hospital/pericarditis/ https://clincasequest.hospital/stephen-smiths-formula/ https://clincasequest.hospital/wellens-syndrome/ https://clincasequest.hospital/aslangers-pattern/ Register on our website right…

Interactive OSCE Checklist – Counseling a Patient with an increased INR level

Interactive OSCE Checklist “Chest Pain History Taking”

Сообщение Interactive OSCE Checklist – Counseling a patient who is taking warfarin появились сначала на ClinCaseQuest.

Interactive OSCE Checklist “Chest Pain History Taking”

Elena Shevchenko — Tue, 11 Jan 2022 14:18:09 +0000

Email (indicate if you want the results to be sent to your email)

Date

Student name

Group, faculty

• Opening the consultation

Wash your hands and don PPE if appropriate

Introduce yourself to the patient including your name and role

Confirm the patient's name and date of birth

Explain that you'd like to take a history from the patient

Gain consent to proceed with taking a history

• Presenting complaint

Use open questioning to explore the patient’s presenting complaint

• History of presenting complaint

Site: ask where the pain is

Onset: clarify when the pain first started and if it came on suddenly or gradually

Character: ask the patient to describe how the pain feels

Radiation: ask if the pain moves anywhere else

Associated symptoms: ask if there are any other associated symptoms

Time course: ask how the pain has changed over time

Exacerbating or relieving factors: ask if anything makes the pain worse or better

Severity: ask how severe the pain is on a scale of 0-10

Explore the patient's ideas, concerns and expectations

Summarise the patient’s presenting complaint

• Systemic enquiry

Screen for relevant symptoms in other body systems

• Past medical history

Screen for conditions that may be associated with chest pain

Ask about other medical diagnoses and previous surgical history

Ask if the patient has any allergies and if so, clarify what kind of reaction they had to the substance

• Drug history

Ask if the patient is currently taking any prescribed medications or over-the-counter remedies

Ask if the patient if they’re experiencing any side effects from their medication

• Family history

Ask if there is any family history of diseases relevant to chest pain and clarify at what age the disease(s) developed (e.g. cardiovascular disease, thromboembolic disease)

• Social history

Explore the patient’s general social context (accommodation, who the patient lives with, how the patient manages with activities of daily living, care needs)

Take a smoking history

Take an alcohol history

Ask about recreational drug use

Ask about problematic gambling

Ask about diet and exercise

Ask about the patient’s occupation

Ask if the patient drives

• Closing the consultation

Summarise the salient points of the history back to the patient and ask if they feel that you’ve missed anything

Thank the patient for their time

Dispose of PPE appropriately and wash your hands

• Key communication skills

Active listening

Summarising

Signposting

Total

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Interactive OSCE Checklists – ClinCaseQuest

Checklist – Counseling “Explain a bone marrow aspiration”

Interactive OSCE Checklist – Emergency care of a patient with chest pain – Acute Coronary Syndrome with ST-segment elevation and equivalents

• Opening the consultation

• Availability of a defibrillator

• Presenting complaint

• History of presenting complaint

• Past medical history

• Drug history

• Physical examination

• Intravenous access

• Registration of a 12-channel ECG

• Express test for the determination of cardiac troponin, myoglobin, creatine phosphokinase-MB, if possible

• Making preliminary diagnosis

• Drug therapy (basic)

• Evaluation of the door-balloon time (the choice of further reperfusion strategy aimed as soon as possible to restore the coronary blood flow in the infarct-dependent artery)

• Call the nearest reperfusion center

• P2Y12 receptor inhibitor prescription depending on the chosen strategy of reperfusion therapy

• Carrying out thrombolytic therapy as needed

• Transportation to the nearest reperfusion center

Interactive OSCE Checklist – Counseling a patient who is taking warfarin

• Opening the consultation

• Ideas, concerns and expectations

• How warfarin works

• INR

• How to take warfarin

• Bleeding whilst taking warfarin

• Other side effects of warfarin

• Lifestyle advice

• Yellow booklets and alert card

• Closing the consultation

• Key communication skills

• Opening the consultation

• Availability of a defibrillator

• Presenting complaint

• History of presenting complaint

• Past medical history

• Drug history

• Physical examination

• Intravenous access

• Registration of a 12-channel ECG

• Express test for the determination of cardiac troponin, myoglobin, creatine phosphokinase-MB, if possible

• Making preliminary diagnosis

• Drug therapy (basic)

• Evaluation of the door-balloon time (the choice of further reperfusion strategy aimed as soon as possible to restore the coronary blood flow in the infarct-dependent artery)

• Call the nearest reperfusion center

• P2Y12 receptor inhibitor prescription depending on the chosen strategy of reperfusion therapy

• Carrying out thrombolytic therapy as needed

• Transportation to the nearest reperfusion center

• Opening the consultation

• Ideas, concerns, complications and expectations

• Analysis of earlier, current INR results, apropriate INR target range and current warfarin dosing

• Analysis of the factors that may affect the increased INR level

• Providing medical care to the patient if necessary

• Bleeding whilst taking warfarin

• How to take warfarin

• Tips for further warfarin dosing according to the analysis of the reasons that led to the INR levels increase

• Lifestyle advice

• Yellow booklets and alert card

• Closing the consultation

• Key communication skills

• Key clinical skills

• Opening the consultation

• Presenting complaint

• History of presenting complaint

• Systemic enquiry

• Past medical history

• Drug history

• Family history

• Social history

• Closing the consultation

• Key communication skills

Interactive OSCE Checklist “Chest Pain History Taking”

• Opening the consultation

• Presenting complaint

• History of presenting complaint

• Systemic enquiry

• Past medical history

• Drug history

• Family history