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INSTRUCTIONS FOR THE DOCTOR

This is a short case about a new patient.

Please manage this medical emergency.

Scenario

Catriona Chryssides is a 29-year-old arts coordinator. You have been asked to see her as an emergency because of dizziness and palpitations on a Saturday morning.

You are doing a locum in a remote Aboriginal community. The clinic has a treatment room with emergency equipment and medication. The nearest hospital is 300 km away and patients requiring urgent hospital care are evacuated by the RFDS plane. Hospital specialists provide telephone advice if needed. An Aboriginal Health Practitioner is also working in the clinic.

The facilitator will give you the physical examination findings and the results of initial investigations when specifically requested.

INSTRUCTIONS FOR THE PATIENT, CATRIONA CHRYSSIDES

You have just moved to the area as an arts coordinator. You wanted a change of scene and to travel before your 30th birthday next month. It has been a major upheaval leaving your friends and family in the city. You are finding the work challenging and chaotic, and wonder if you will ever be able to make a worthwhile contribution.

It’s Saturday morning. You started the day with a strong coffee and got up to go for a walk and felt fine. Suddenly you experienced a jolt in your heart and it feels as if it has gone haywire as it is pounding rapidly. You feel dizzy, unwell, a bit nauseated and frightened. You told your housemate how you felt and she promptly drove you down to the clinic.

You have never experienced anything like this before. You have no significant past medical history.

You smoke 10 cigarettes per day but do not consume alcohol or take recreational drugs.

Before leaving the city you made sure that you were up-to-date with your vaccinations and cervical screening test. You have a subcutaneous etonogestrel (Implanon) contraceptive implant.

You will suddenly feel well again when the doctor gives you the second injection.

INSTRUCTIONS FOR THE FACILITATOR

This scenario can be changed to assess the doctor’s emergency skills in their own clinical setting, for example, the venue could be a small rural hospital or a suburban general practice.

The observations are:

  • temperature normal (37.0°C)

  • pulse 180 beats per minute, regularly regular rhythm by palpation

  • 16 breaths a minute, no evidence of cyanosis

  • BP 92/64 mmHg, sitting. JVP normal

  • orientated to time, place and person.

Please show the candidate the ECG recording once the monitor is attached. (Refer to Figure 5) (Note: an ECG is given rather than just rhythm strip to enable the candidate to proceed with definitive treatment in the time available for the case.)

Ask the candidate for their diagnosis ...

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