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Abdominal OSCEs

Richard Taylor . Abdominal OSCEs. Aims. Acute illness management OSCEs Stomas Abdo exam tips . Things to remember. It’s about looking competent Inspiring trust Being systematic Being safe Having a bit of knowledge. Acute illness management.

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Abdominal OSCEs

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  1. Richard Taylor Abdominal OSCEs

  2. Aims • Acute illness management OSCEs • Stomas • Abdo exam tips • ...

  3. Things to remember... • It’s about looking competent • Inspiring trust • Being systematic • Being safe • Having a bit of knowledge

  4. Acute illness management • Mrs. Albert has presented to A and E with severe abdominal pain. • Assess the patient, take a focused history and present a plan

  5. What do you have to do? • Walk in and assess patient- stable or not • 3 minute history • Focused examination • Differential diagnosis • Basic, safe management plan • In 8 minutes...

  6. Assessing the patient 1 • ABC... • Is not enough! • Airway: • Maintained or not • Adjuncts • O2

  7. Assessing the patient 2 • Breathing • Work systematically • Start at the end of the bed, then hands etc. • RR, cyanosis, distress • Sats • Chest movements • (Auscultation) • (ABG)

  8. Assessing the patient 3 • Circulation • Start at the end of the bed again • Obvious bleeds/ pallor • Cap refill • BP • Venflon • Hydration status • Urine output

  9. Assessing the patient 4 • Disability • Keep it simple • AVPU • DEFG... • Pain relief • And move on- you have now passed...

  10. Focused history Signpost • Pain history • Associated symptoms • Menstrual history • Sexual history • Weight loss • PMHx • DHx

  11. Focused examination • Abdo exam • Examiner will tell you what you find • Expose the patient!

  12. Differentials • Give 3- you’ll be right most of the time • Consider your patient’s demographics • Don’t forget gynae causes

  13. Plan • Keep it simple • Bloods • Imaging • USS • AXR • CT • Analgesia • NBM • Fluids INFORM MY SENIOR

  14. Stomas • Will come up- have you gone through this already? • Know: • How to site • Types (and... and...) • Complications • How will you categorise them? • What kind of psychological problems?

  15. Categorise or die 1 • Or how to show that you’re competent • Don’t list things that come into your head • Categorise them • Early or late • Common or rare • By system • Specific or general • Give 2 or 3 examples • Then stop.

  16. Categorise or die 2 • The power of erm • The power of stopping

  17. Abdo exam 1 • This is real discriminator • Read Byrne, Hill... • Don’t waste time • First minute is: • Intro • Consent • General inspection • Hands • Face • And then the abdomen

  18. Abdo exam 2 • Use the phrase: “There are no stigmata of...” • Talk through what you are doing • Get to the end • Look at the renal angles for scars • Feel the hernial orifices • Name some scars • Know McBurney’s point and the mid-inguinal point

  19. Conclusion • Acute illness management will come up • Stomas will come up • Abdo may come up • It’s mainly communication skills • Competent • Trust • Safe • Knowledge

  20. Questions?

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