Reviewer comments
CT1 Anaesthetics/ACCS Standardised RecruitmentCLINICAL INTERVIEW StationCandidate attributes to be assessed by interview:Working under pressure (decision making and self control)Teamwork (capacity to work effectively with others & demonstrate leadership)Clinical judgement & Decision making (prioritising, monitoring situation & generating functional outcomes)Clinical vignette to open the question:You are the orthopaedic F2. It is nightime. You are called to see a 68 year old lady who has had a DHS for fractured neck of femur under spinal anaesthesia during the afternoon trauma list. She is confused and agitated and calling for individual not known to you or the nursing staff. She is mildly hypotensive (95/60) and tachycardic at 120 bpm.How would you assess the situation? (CJ)Suggested positive response to initial question:Attempt to reassure patientMeasure saturation and apply high flow oxygenTry to obtain corroborative information as to baseline mental state from nursing staff (and relatives if possible)As nursing staff when analgesia last given, and what it wasCheck if any drains, look for haematoma, consider FBC and U+EFluid bolus 12 lead ECG?Consider haloperidolYou give 500ml of colloid and initially the blood pressure improves. Her mental state improves with fluid and oxygen (and haloperidol if mentioned by candidate). At 3am you are called back. She is obviously short of breath. She appears clammy. Her oxygen saturation is 89% on high flow oxygen. Her blood pressure is 80/50.What actions would you take? (CJ, WUP)How would you decide what to do first? (CJ)Who would you get to help you? (TW)How would you get them to help you? (TW)Who else in the hospital might be able to help? (TW)If the senior you call is busy, how would you impress upon them that this is an urgent situation?What would you do whilst you wait for help to arrive? (CJ)What would you do when the senior doctor is reviewing the patient? (TW)Further questions for follow-up and probing:Have you been involved in a similar type of situation?Have you developed any techniques to get the most out of the team in similar situations? ................
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