Case 4: Acute care station
Jeff Samson, 55 years old, has been brought to the Emergency Department of your community hospital by his wife because of chest pain.
IN THE NEXT 14 MINUTES:
- ASSESS AND MANAGE THIS PATIENT.
An Emergency Department nurse is present in the room. Direct the nurse to order any tests or perform any procedures you believe are appropriate for this patient.
As you proceed with your initial assessment, EXPLAIN TO THE EXAMINER what you are doing and DESCRIBE ANY FINDINGS.
GIVE ONE (1) LABEL TO THE EXAMINER.
Candidate voiceover: Ok, this is an emergency situation, so I’ll need to make sure I manage my time well…and it’s a community hospital so that means that I might not have access to the same critical care services…His vitals are not given, so I’ll need to ask the nurse for them…
Nurse: Mr. Samson was just brought in. How would you like me to proceed?
Mr. Samson: My chest (pause for breath) hurts… I’m in a lot of pain…
Candidate: Ok, Mr. Samson, we’re going to figure out what’s going on. Nurse, can you give me his vitals?
Nurse: Yes. His blood pressure is 172/100, the pulse is 61 and regular, respiration rate 22 per minute. And the oxygen saturation is 87% on room air…
Candidate: Ok. Let’s get him on oxygen to start… (we can watch the nurse doing that as candidate’s voice continues, but fading), and then I’d like an IV, and do we have…
There are a few things to note in this station example:
- Time management is important in all stations, but particularly in acute care/management stations. While reading the candidate instructions, think about how to manage your time in the station, given what you know.
- The nurse is there to assist the candidate and will not do anything without the candidate’s direction. Do not assume that the nurse will take independent action as they would in a real clinical context.
- You can assume the equipment in the room is the same as in any standard emergency department
- Sometimes, orders such as diagnostic tests may not be available even if requested. In this case, the nurse will acknowledge the order, but indicate that it will take more time than the station allows. Do not interpret this to mean that the request was incorrect. Simply move on.
- You can ask the nurse to repeat information (for example, vital signs) at any time. Remember that you will not receive information that you do not ask for.
As you go about conducting your assessment of the patient, it is important for the examiner and the nurse to hear what you are thinking and seeing.