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VAQ Question 5 2013.2 practice exam

VAQ Question 5 2013.2 practice exam . A/Prof Pam Rosengarten Peninsula Health, Emergency Department.

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VAQ Question 5 2013.2 practice exam

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  1. VAQ Question 5 2013.2 practice exam A/Prof Pam Rosengarten Peninsula Health, Emergency Department

  2. A 19 month old girl presents to your emergency department 8 days after having her forehead laceration glued. Her parents describe medical staff struggling after and finally accepted the result after 3 attempts. After 8 days her local GP removed the steristrips covering the wound and advised the patient to present • PASS criteria • 2cm Transverse wound to mid / left forehead with clean base • 0.5cm wound separation / gaping / dehisced • No signs infection – wound clean, no surrounding erythema • Interpretation: Many answers no interpretation! • (although this may have appeared in part b it is requested in part A ) • Dehisced wound( or words to that effect) of forehead of small child • will result in significant scarring / poor cosmetic result if left to heal as is by 2nd intention( or words to that effect) Describe and INTERPRET photograph 30%

  3. This wound cannot just be sutured/ glued close 2 options for closure are to heal by secondary intention and await cosmetic result with and review of scar at later date OR debridement of wound edges and closure ( this is not an ED procedure ) Therefore would NOT sedate and suture in ED ( consensus of FACEMS on this especially as it was result of inadequate treatment in first place) this response = fail B ) Outline your management 70%

  4. Management of child and wound as present today 2 issues must be mentioned • management of child’s wound today • refer to plastics surgery for operative repair / opinion – and options of primary closure or delayed repair • Management in respect to first presentation and treatment – • STEM notes struggling and 3 attempts • ie READ THE STEM Outline your management

  5. expected some form of discussion of open disclosure and review/ action upon of the 1st presentation eg • open disclosure, apologise and investigate • Investigate initial attendance – • gather information from parents • Gather information from treating clinicians and review notes • Identify individual or system issues related to child and wound management – eg Technique of the staff involved in wound management –consideration of procedural sedation • Educate individual staff and dept education to nursing and medical staff wrt the glue of wound and Techniques and options for support and cooperation for children during procedures • Resolve system issues identified , review / audit • Feedback to parents Outline your management

  6. No interpretation and consideration of the issues with this wound • suture in ED with procedural sedation • no mention of the issues with first attendance • Note: • Not a lot of detail was required for this answer to pass but coverage / acknowledgement of the major issues was required • The issue of whether wound should have been glued in first instance was discussed by some – this was not pass / fail although I feel it was amenable to glue provided done under appropriate conditions Failed answers

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