TEALE FENNING

Hopeful · Joined: 03 May 2007 Posts: 49

A poor woman immediately post op after laparotomy for ovarian cyst proven to be endomitrioma who woke up with a burn on her left thigh

how do u approach this

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 918

hi hopeful,

this is one from my OSCE. Rolling Eyes

the question actually read as --- day 1 post laparotomy for bilateral ov cystectomy for endometriosis. she is a lecturer electrician at the local college. has a large burn on her left thigh where the cautery pad was attached. she has not been seen post op by any doctor yet. you were not the operating surgeon nor have assisted the operation. she wants some explaination about the procedure and findings and the burn and also needs a day 1 post op check.

operative notes were supplied where the burn had not been mentioned. nor was it mentioned on the anaesthetic chart but was noted in the notes of the nursing staff from the night shift.

this was a role play station and you had to speak to the actress, conduct the day 1 check -- findings supplied by the examiner on asking. explain the op findings, discuss the burn and make further plan of care.

all of the above was on the info sheets pre station and it was a prep station if i am not wrong.

gosh -- is it scary or sad that i remember it in so much details? Evil or Very Mad

having said that this was the station i started my osce with.

come on guys have a go...... Wink

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region

Xerxes I · Posted: Thu Apr 10, 2008 8:27 am Post subject:

Easy,

Blame the surgeon and the theatre staff, say it's got nothing to do with me. say I am always careful with these things, you just can't get the staff these days.

But seriously, there is one interesting point int his, and that is her profession. I'd probably try to acknowledge this to her somehow. She may wnat to ask very technical questions in which case you should be tactful if you don't know the answer, don't bu***it or you will fail.

salihabduallah · Joined: 04 Sep 2007 Posts: 94

day 1 check :

- ask about any symptoms like : abdominal pain, chest pain, fever, sweating, cough, urine retention.

- check vital signs : PR, Bd presure & T and general condition.

-check dressing.

salihabduallah · Joined: 04 Sep 2007 Posts: 94

explain the op findings

We review operative notes
Tell her about nature of disease found intraoperatively and what procedure is done, discuss with her future fertility, discuss follow up plan, tell her about when the histopathological examination result will be available.

salihabduallah · Joined: 04 Sep 2007 Posts: 94

discuss the burn and make further plan of care.

deal with her with sympathy
tell her that it is her right to know how this happened
Knows her attittude toword the burn and what she thinks about it
Explain that this error occurs rarly and the calf electric plate might displaced from below her leg without noticing of staff

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 918

hi salihabduallah,

good attempt.

the cautery pad is placed on the thigh and not calf. please read the question well in your exam. if the actress has instructions to get angry at discrepancies during explanation it'll make things unnecessarily stressful.

do you want to give the cautery burn bit a second try?

also where is your follow up care plan?

do practice all ocse with a friend so you can take turns to play the actor and the candidate. that's how we studied.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region

salihabduallah · Joined: 04 Sep 2007 Posts: 94

salihabduallah · Joined: 04 Sep 2007 Posts: 94

Few to add :

- follow our unit plan to deal with such circumstances
- talk with empathy to the patient and her family
- sincer appology with explanation
- This can be fixed up.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 918

that's much better now. just practice saying that out loud. also check out this link in the forum ....

http://www.tealefenning.co.uk/phpBB2/question-structured-viva-diathermy-t157,highlight,diathermy.html
will help you with details bout diathermy.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region