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OSCE/Viva Key Terms:Words

Updated: Apr 17, 2022



Acute pain case

Assess:

Pain

  • Each site of pain graded

  • Mechanism of pain

  • Temporal factors

  • Etiology

Function

  • Ambulate

  • ADLs

  • ROM

  • Breathing/Coughing

Psychosocial issues

  • Patient distress

  • Supports

  • Psychiatric history

  • Patient/family knowledge and understanding

  • Barriers - cultural/language

Acute Lignocaine overdose



Acute ketamine overdose




Opioid overdose

  • Acute emergency scenario

  • Ensure no danger such as sharps

  • Call for help

  • Check for response and breathing

  • If suspect opioid intoxication such as miosis though normal pupils does not exclude intoxication, IM Naloxone 400 mg bolus (2 mg if cardiac arrest)

  • Ask team to prepare for infusion


  • A - Check airway patent and secure with guedel if required, head tilt and chin thrust,

  • B - Provide 100% oxygen 15 L via NRB mask and/or bag/mask ventilation, respiratory rate and saturations

  • C - Ensure monitoring including HR, BP, and IV access 2 large bore 16 G cannulas, ECG monitoring - 500mL boluses of NSaline +/- inotropes +/- atropine/pacing

  • D - Temperature

  • E - Check for other signs of injury and secondary survey

  • DEFG - Check for BSL

  • Draw bloods including drug screen, serum paracetamol level, ELFTs


  • Naloxone half life of 30 minutes

  • Target of naloxone is adequate ventilation NOT arousal

  • IV route is best though IM is fine

  • Can cause significant agitation on waking

  • Manage pain with PCA if required following arousal and naloxone has worn off

  • Needs significant monitoring


Differentials for unconsciousness:

  • Alcohol/Acidosis

  • Environmental (hypothermia), Electrolytes, Endocrine

  • Infection

  • Overdose / Oxygen deficiency

  • Uraemia

  • Trauma/Tumour (e.g. brain)

  • Insulin (diabetes)

  • Psychogenic / Poisons

  • Stroke / Shock


Respiratory depression/suppression case

  • Naloxone

Epidural complications



Why not long acting?

N&V Treatments

  • Ondansetron

  • Droperidol

  • Dexamethasone

  • Cyclizine


Substance use disorder case

DSM5 Criteria (three levels of severity)

  • Impaired control

  • Social problems

  • Risky use

  • Physical dependence


  • ***** use disorder (e.g. Alcohol, cannabis)

  • Intoxication

  • Withdrawal


Acute pain in substance use disorder / OST

Confirm dose and route with pharmacist/prescriber

Assess other prescribed medications

Medical comorbidities

Psychiatric comorbidities

Social factors



Opioid case

  • OIVI

  • Opioid naive

  • Incomplete cross-tolerance

  • Breakthrough pain

  • OIH

  • Tolerance

  • Dependence

  • Substance use disorder

  • 5A's

  • COMM/ORT

Procedures



Headache/Facial pain



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