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

Nataliia Lopina May 14, 2022

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

Result:

Total: 0 / 62

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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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

• Ideas, concerns, complications and expectations

Explore what the patient currently understands about increased INR

Ask if the patient has any concerns about warfarin

Ask if the patient is bleeding now or before counseling

Explore what the patient is hoping to get out of the consultation

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

Evaluate previous warfarin dosages

Evaluate the patient's earlier INR results

Assess the patient's apropriate INR target range

Evaluate the results of the current INR

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

Assess the presence of warfarin taking errors, low patient compliance, the complexity of the warfarin regimen for the patient

Assess any changes in the patient's clinical condition

Evaluate any changes in medication

Evaluate any changes in lifestyle

Evaluate changes in alcohol consumption

• Providing medical care to the patient if necessary

Assess the patient's bleeding and its severity if necessary

In case of active bleeding, provide immediate medical care after taking INR results

In the absence of bleeding adjust the dosage of warfarin

• Bleeding whilst taking warfarin

Explain that the main sidHow-take-warfarine effect of warfarin is bleeding more easily than normal

Explain the common types of ‘less serious bleeding’ and what to do if they experience them

Explain the rarer types of ‘serious bleeding’ and what to do if they experience them

• How to take warfarin

Explain that warfarin should be taken at the same time each day

Explain the different types of warfarin tablets

Explain what the patient should do if they forget a dose

Advise the patient to let medical professionals know that they take warfarin when they are being prescribed new medications

Advise the patient to let the team managing their anticoagulation know when they start taking a new medication

Advise the patient about the importance of effective contraception if taking warfarin (if relevant)

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

Estimate the required duration of administration of a concomitant drug that interacts with warfarin (temporary, chronic) as needed

Adjust warfarin dosage as needed

Withdraw warfarin if necessary

Evaluate the rationality and necessity of co-administration of antiplatelet agents and nonsteroidal anti-inflammatory drugs if necessary

• Lifestyle advice

Advise the patient about the impact of diet on the effect of warfarin

Advise the patient about the impact of alcohol on the effect of warfarin

Advise the patient about brushing teeth, shaving and dental procedures

• Yellow booklets and alert card

Provide the patient with information about the INR monitoring booklet and patient information booklet

Explain the importance of carrying the anticoagulant alert card with them at all times

• Closing the consultation

Summarise the key points back to the patient

Ask the patient if they have any questions or concerns that have not been addressed

Arrange appropriate follow-up

Thank the patient for their time

Dispose of PPE appropriately and wash your hands

• Key communication skills

Active listening

Summarising

Signposting

• Key clinical skills

Determining the target INR level depending on the clinical situation

Analysis of the factors that may affect the INR increase

Providing medical care to the patient with INR increase

Advice to the patient and explanations about lifestyle, diet

Total

Result:

Total: 0 / 50

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Categories: Acute coronary syndrome, Anesthesiology, Cardiology, Cardiology, Cardiology, Cardiology, Emergencies, Emergency, Interactive OSCE Checklists, Myocardial infarction, OSCE, OSCE Checklists

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

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…

Nataliia Lopina May 14, 2022

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

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

• 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

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• 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

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