ABCDE Assessment | Sepsis | Emergency Simulation Scenario | OSCE Guide | UKMLA | CPSA

Geeky Medics
6 Sept 202314:09
EducationalLearning
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TLDRIn this medical scenario, junior doctor Leah assesses a 76-year-old patient, Rizal Linden, who has become acutely confused after a fall and physiotherapy. Examination reveals signs of pneumonia, hypoxia, and possible sepsis, prompting Leah to initiate sepsis protocol, administer oxygen and fluids, and consult with a senior doctor. The patient's condition is monitored closely, with plans to administer antibiotics and further tests as necessary.

Takeaways
  • 🏥 Patient Assessment: The script describes a detailed patient assessment conducted by a junior doctor named Leah on a 76-year-old man named Rizal Linden, who has become acutely confused after a fall and physiotherapy.
  • 📝 Medical History: Rizal has a history of hypertension and was on amlodipine, with no other significant medical conditions.
  • 💊 Medication Adjustment: Leah decides to stop Rizal's amlodipine due to his low blood pressure and confusion.
  • 🩺 Respiratory Concerns: Rizal exhibits symptoms of respiratory distress, with crackles at the right base of his chest and low oxygen saturation levels, indicative of possible pneumonia.
  • 📉 Vital Signs: Rizal's vital signs show a high respiratory rate (29), low blood pressure (89/63), and a high heart rate (140 bpm), along with a fever of 38.4°C.
  • 🩹 Diagnostic Tests: Leah orders an arterial blood gas test, chest x-ray, blood cultures, lactate test, ECG, and capillary blood sugar check to assess Rizal's condition.
  • 🚑 Sepsis Suspicion: Leah suspects Rizal has sepsis, likely originating from a chest infection, and initiates the sepsis six protocol.
  • 💡 Treatment Measures: Rizal is given 15 liters of oxygen via a rebreathe mask, fluids for hypotension, and broad-spectrum antibiotics for suspected sepsis.
  • 🔄 Fluid Balance: Leah starts a fluid balance chart for Rizal and plans to closely monitor his condition after fluid administration.
  • 🧠 Neurological Findings: Despite confusion, Rizal's neurological examination does not reveal any focal deficits.
  • 📞 Senior Consultation: Leah contacts Dr. Potter for a senior review of Rizal's case due to concerns about his potential deterioration.
Q & A

  • What was the initial concern about Rizal's condition?

    -The initial concern was that Rizal seemed more confused than usual after a fall and was waiting for physiotherapy.

  • What was Leah's role in the hospital?

    -Leah is one of the junior doctors working on the ward.

  • What were some of the symptoms Rizal was experiencing?

    -Rizal was feeling dreadful, had a high respiratory rate, low oxygen saturation, and was later found to have a fever.

  • What did Leah do as part of her assessment of Rizal's respiratory system?

    -Leah checked Rizal's oxygen SATs, respiratory rate, listened to his chest, and ordered an arterial blood gas test and a chest x-ray.

  • What did the chest x-ray reveal?

    -The chest x-ray showed haziness at the right base, which could indicate pneumonia.

  • What was the initial treatment for Rizal's low oxygen levels?

    -Rizal was given 15 liters of oxygen via a rebreathe mask.

  • How did Leah respond to Rizal's low blood pressure and high heart rate?

    -Leah administered 500 mL of fluids, suspended Rizal's amlodipine, and ordered another 500 mL of fluids if his blood pressure remained low after the first bag.

  • What was the outcome of Rizal's arterial blood gas test?

    -The arterial blood gas test indicated type 1 respiratory failure with acidosis.

  • What neurological findings did Leah observe in Rizal?

    -Leah found Rizal to be confused but without any focal deficits.

  • What was Leah's final assessment of Rizal's condition?

    -Leah was concerned that Rizal had sepsis, likely from a chest source, and initiated the sepsis six protocol, including broad-spectrum antibiotics.

  • What action did Leah take after completing her assessment?

    -Leah contacted Dr. Potter, the on-call senior doctor, to discuss Rizal's case and express her concern about his potential deterioration.

Outlines
00:00
🏥 Initial Patient Assessment

The first paragraph introduces a patient named Rizal who has fallen and is awaiting physiotherapy. Leah, a junior doctor, is concerned about Rizal's increased confusion and conducts a thorough assessment. She checks his personal details, performs a top-to-toe examination, and notes his respiratory rate and oxygen saturation levels. Leah identifies potential issues with Rizal's breathing and orders further tests, including an arterial blood gas test and a chest x-ray, suspecting possible pneumonia.

05:07
📈 Vital Signs and Circulation Examination

In the second paragraph, Leah continues her examination by checking the patient's vital signs, including blood pressure and heart rate, and notes that they are abnormally low and high, respectively. She also examines the patient's legs for swelling or pain and initiates a fluid balance chart. Leah orders additional tests, including a full blood count and blood cultures, and requests an ECG. The ECG results indicate sinus tachycardia, and Leah decides to administer fluids and suspends the patient's amlodipine medication. She also conducts a neurological assessment and checks the patient's temperature, which is slightly elevated.

10:09
🚨 Sepsis Protocol and Senior Consultation

The third paragraph focuses on Leah's concern that the patient, Rizal, may have sepsis, possibly originating from a chest infection. She has completed the initial steps of the sepsis six protocol, including administering oxygen and fluids, and has taken blood cultures and lactate levels. Leah prescribes broad-spectrum antibiotics and requests a urine sample for analysis. She also contacts Dr. Potter for a senior review, detailing her findings and the steps taken thus far. Dr. Potter agrees to review the patient and provides further instructions for Leah to follow in the meantime.

Mindmap
Keywords
💡Physiotherapy
Physiotherapy refers to the treatment method that helps individuals restore movement and function when someone is affected by injury, illness, or disability. In the video, Rizal was waiting for physiotherapy after a fall, indicating that he had recently experienced an injury and was in the process of recovery.
💡Confusion
Confusion in a medical context often indicates a state of disorientation or impaired cognitive function, which could be due to various causes such as illness, injury, or medication side effects. In the video, Rizal's increased confusion in the morning raised concerns for the medical staff, prompting further assessment.
💡Respiratory Failure
Respiratory failure is a serious medical condition where the lungs are unable to maintain adequate oxygen levels in the blood or remove carbon dioxide effectively. It is categorized into Type 1 (hypoxemic) and Type 2 (hypercapnic). In the video, Rizal's arterial blood gas results indicate Type 1 respiratory failure, characterized by low oxygen levels and no excess carbon dioxide.
💡Pneumonia
Pneumonia is an infection of the lungs that can be caused by bacteria, viruses, or fungi. It leads to inflammation and often results in symptoms such as cough, fever, and difficulty breathing. In the video, Rizal's chest X-ray shows haziness at the right base, which is consistent with pneumonia, a possible source of his sepsis.
💡Sepsis
Sepsis is a life-threatening condition that occurs when the body's response to an infection injures its tissues and organs. It is characterized by a dysregulated immune response and can lead to tissue damage, organ failure, and even death if not treated promptly. In the video, Leah suspects Rizal has sepsis, likely originating from a chest infection.
💡Hypotension
Hypotension is a medical term for low blood pressure. It can be a sign of various conditions, including dehydration, bleeding, or a severe infection like sepsis. In the video, Rizal's blood pressure readings are low, which is one of the indicators that he might be septic.
💡Tachycardia
Tachycardia is a heart rate faster than the normal range, typically above 100 beats per minute for adults at rest. It can be a sign of various conditions, including stress, anxiety, or a medical emergency like sepsis. In the video, Leah notes that Rizal has sinus tachycardia with a heart rate of 142 beats per minute, which is concerning in the context of his overall presentation.
💡Neurological Assessment
A neurological assessment is a set of tests that evaluates the function of a patient's nervous system, including the brain, spinal cord, and nerves. It helps identify any abnormalities or deficits that may be present. In the video, Leah conducts a neurological assessment on Rizal to check for any focal deficits, which could indicate specific areas of concern in his brain function.
💡Fluid Balance
Fluid balance refers to the equilibrium between the intake and output of fluids in the body. In a hospital setting, it is closely monitored to ensure patients receive the right amount of fluids, especially in cases of illness or following surgery. In the video, Leah starts a fluid balance chart for Rizal to track his fluid status, which is crucial in managing his condition.
💡Blood Cultures
Blood cultures are tests done to detect the presence and identify the type of microorganisms causing an infection in the blood. They are essential in diagnosing conditions like sepsis. In the video, blood cultures are taken from Rizal as part of the sepsis protocol to identify the potential source and type of infection.
💡Antibiotics
Antibiotics are medications used to treat bacterial infections by either killing the bacteria or inhibiting their growth. In the context of sepsis, broad-spectrum antibiotics are often used initially to cover a wide range of potential pathogens until the specific causative organism is identified. In the video, Leah plans to start Rizal on broad-spectrum antibiotics due to her suspicion of sepsis.
Highlights

Katie the nurse expresses concern about the patient's increased confusion.

Leah, a junior doctor, introduces herself to the patient, Rasul.

Leah performs a comprehensive assessment on Rasul, checking his airway, breathing, and circulation.

Rasul's oxygen saturation is initially low, and he is placed on 15 liters of oxygen with a rebreathe mask.

Chest x-ray results suggest possible pneumonia at the right base.

Rasul exhibits signs of type 1 respiratory failure and acidosis based on arterial blood gas results.

Leah notes Rasul's hypotension and high heart rate, indicative of circulatory issues.

An ECG reveals sinus tachycardia with a heart rate of 142 beats per minute.

Neurological assessment finds Rasul confused but without focal deficits.

Leah reviews Rasul's medications and stops amlodipine due to low blood pressure.

Rasul's temperature is found to be elevated at 38.4 degrees Celsius.

Leah suspects sepsis as the primary concern and initiates the sepsis six protocol.

Broad-spectrum antibiotics are prescribed to treat the suspected sepsis.

The patient is catheterized and a urine sample is sent off for analysis.

Leah contacts Dr. Potter for a senior review due to concerns about Rasul's condition.

Dr. Potter agrees to review Rasul and provides instructions for further care in the interim.

The video concludes with a promotion for Geeky Medics' practice resources.

Transcripts

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