LIFE FAST LANE: FACEM SCE
STRUCTURED CLINICAL EXAM
AND LIFL TOXICOLOGY | 253
QUESTIONS | WITH ACTUAL
ANSWERS!!
FACEM
Evatee 10/23/24 FACEM
,LIFE FAST LANE: FACEM SCE STRUCTURED
CLINICAL EXAM AND LIFL TOXICOLOGY | 253
QUESTIONS | WITH ACTUAL ANSWERS!!
A middle aged pt with chest pain. The patient becomes hypotensive with a
systolic BP of 80mmHg before investigations have been performed.
Resuscitation is commenced.
How will you investigate this unstable patient? Answer - 1. ECG: arrhythmia,
MI.
2. CXR: pulmonary pathology, dissection.
3. Bedside echo: tamponade, RV or IVC dilatation, or decreased RV suggesting
hypovolaemic.
4. Blood gas: Hb, A-a gradient, lactate.
5. ?D-dimer: delay in result.
The patient with chest pain remains persistently hypotensive despite initial
fluid resuscitation. Bedside echo shows features of massive pulmonary
embolism (PE).
Outline your management of this patient. Answer - 1. High flow oxygen.
2. Fluid bolus.
3. +/- vasopressors
4. Thrombolysis. Catheter embolectomy.
5. Heparin/LMWH
6. ICU referral or transfer.
,The patient stabilised and was admitted. It is brought to your attention that the
patient was seen in your ED 2 days ago with chest pain and admitted to CCU
under Cardiology. He was discharged after a negative exercise stress test.
Describe your response to this Answer - Possible critical incident.
Need to report this.
Joint cardiology and ED investigation.
Inform ED director and hospital legal team.
Any system errors.
Any individual errors.
Clinical governance - risk management, quality improvement.
Teaching/education opportunity.
Open disclosure, liase with patient and family.
What does clinical governance mean. Name 4 elements of clinical governance.
Answer - Clinical governance is a systematic approach to maintaining and
improving the quality of patient care within a health system.
Elements of clinical governance:
Education and Training
Clinical audit
Clinical effectiveness
Research and development
Openness
Risk management
Information Management
A 30 year-old man was working at a Silicon Chip factory when hydrofluoric acid
was spilt onto a hot surface and "exploded". He has suffered chemical burns to
, his arms and chest. Decontamination was performed at the scene and he has
been brought in by ambulance, complaining of severe pain.
What are the important features in your history and examination?
What are the symptoms of systemic toxicity. Answer - Risk of dermal necrosis
and soft tissue necrosis:
- Concentration of HF, how long contact with HF, how long til decontaminated,
what PPE.
- Local symptoms: pain, where, joint or tendon involvement, eyes, inhalation.
Risk of systemic toxicity:
- Greater than 10% BSA high risk.
Hydrofluoric acid burn:
The patient has moderate hypocalcaemia and approximately 10% BSA
cutaneous burns involving his arms and chest. There are no other injuries.
Outline your management. Answer - Cardiac monitoring.
Give IV calcium (+/- magnesium if assx hypomagnesia)
- Titrate to normal QTc and calcium and magnesium levels.
Refractory pain may require subcut, intra-arterial or regional calcium
gluconate:
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