Team Based Simulation

Question 1

What are the typical tasks in OSCE Sims?

Answer 1

Prepare the team for the arrival of a patient

Lead the team in the assessment and management of a patient

Lead the team in the resuscitation and stabilisation of a patient

Rapidly establish clinical priorities

Provide effective and timely interventions

Manage post-resuscitation care

Take a phone call to discuss referral at the end of the scenario

Question 2

What are some of the things that well performing candidates do?

Answer 2

Appeared to have practised running a team in simulation

Demonstrated a considered plan for medical management

Managed the immediate issue, then recognised the need for second line therapy

Managed the team well and gave clear instructions in a calm manner

Provided a succinct and clear summary after the 6-minute mark

Provided a wider differential diagnosis

Assumed leadership and gave clear directions for stepwise use of strategies to manage the patient’s airway and ventilation.

Were organised with clear plan but were flexible to incorporate new information

Used multiple strategies to improve the patient’s condition and adapted these strategies to the specifics of the patient.

Demonstrated a structured approach to the management of the patient

Showed a high standard of ALS/defibrillator/resuscitation care, including reversible causes

Able to work very well with their team, perhaps as a result of ‘human factors’ such as use of names and encouragement

Knew the drug doses for paediatric resuscitation and the specific therapies for the overdose

Question 3

Things to remember in a trauma simulation?

Answer 3

• Always check if the patient has a binder and apply it if not (unless clinically innapropriate)
• Check for external haemorrhage first and address this
• Apply Donway splint/CT7 to any femoral fractures
• DON’T forget the temperature and always request a blood warmer
• Request a VBG and assess/treat acidosis and hypocalcaemia
• Always consider a log roll (cautious if unstable) to assess for other injuries
• Consider early aeromedical transfer (if rural) if CT and laparotomy will cause delays or not help

Question 4

What is a way of quickly estimating the normal SBP in a child?

Answer 4

80 + (age x 2)

Ie 7 yo would be 80 + (7x2) = 94

3yo would be 80 + 6 = 86

Question 5

How should the drowned/soiled airway be approached?

Answer 5

• Noradrenaline +/- MTP prior to intubation
• 15L via NRB, NIV contraindicated
• Optimize positioning, ramping and ideally 45 degrees head up
• Consider prokinetics like Maxalon IV 10-20mg and Erythromycin IV 250mg if time allows (unlikely)
• Place an NG tube before induction (not if there is concern of BOS #)
• Encourage vomiting before induction (if coming from stomach and patient GCS 15 with protected airway)
• Consider NG placement before intubation to decompress stomach (not contradindicated in varices if critical) but dont delay intubation for this if needed
• Intubate directly after a vomit
• Avoid BVM if possible, if needing to ventilate to gentle and slow at 6-10bpm, consider doing this with an LMA in situ
• Direct pressure on any upper airway bleeding points
• Double suction set up (1-2 assistants with ducanto suckers) or SALAD (suction assisted

Question 6

How should facial bleeding with airway compromise from a high grade le forte fracture be managed?

Answer 6

• LF 1 the maxilla moves
• LF 2 the maxilla and nose move
• LF 3 the whole face (including orbits) move

Question 7

How is the leadership domain projected in the OSCE?

Answer 7

1- Know your environment
2- Anticipate and plan
3- Call for help appropriately
4- Prioritise
5- Allocate attention wisely and use all available information
6- Distribute workload and use all available resources
7- Communicate effectively

Question 8

What are the important points in the zero point survey for running a resus sim?

Answer 8

STEP UP
Self
Team
Environment
Patient
Updates (sign posting)
Priorities (goals and trajectory for resuscitation

Question 9

How does the ISBAR communication system differ between clinical handover and clinical deterioration?

Answer 9