PHYSICAL AND MENTAL HEALTH |
|
ASSESSMENT ABCDE (CLICK HERE) Airway: clear? Breathing: Resp. rate, Sat % Circulation: Pulse, BP, Disability: level of consicousness ACVPU? BM? Pupil reaction? Exposure: skin appearance Other: hydration, bowel opening, sleep, weight, pain? Complete News2 Score + plan Score 3 in any parameter : Could this be sepsis? Agreggated score 5: Could this be sepsis? + Documentation... HANDOVER SBARD (CLICK HERE) Situation: Now... Background: Historical conditions, etc. Clozapin --> constipation Assessment: Vitals: Mental alertness, Temperature, Pulse, Resp., BP, Sats, (BM). Recomendation Decision MENTAL ALERTNESS ACVPU (CLICK HERE) Alert (fully alert) Confused Verbal (respond to verbal) Pain (respond to pain) Unresponsive Diabetic --> Insulin (Novorapid) Anaphylaxis (allergy) --> Adrenalin (epipen) Overdose --> Naloxon Asthma --> Salbutanol (asthma pump) Oxygen: Normal 15litres, for COPD 2 litres Asthma attack? 1 Sit up straight. 2 Take 1 puff every 30-60 seconds up to 10 puffs. 3 Call 999 if situation does not improve. 4 Repeat step 2 every 15 minutes Sources of infection? 50% Pneumonia. 20% Urinary tract. 15% Abdomen. 10% Skin |
S.E.P.S.I.S. (CLICK HERE) Shivering Extreme pain Pale Sleepy, confused "I feel like I might die" Shortness of breath STROKE? B.E. F.A.S.T. (CLICK HERE) Balance (loss of) Eye (blurred vision) Face (one side of face is dropping) Arm or leg weakness Speech Time 
| ||
|
|
| see_think_act_2010.pdf |
DRS ABCDE
Danger, Response (alert, confusion, response to voice, response to pain, unresponsive),
Shout for help
Airways, Breathing, CPR (circulation), Disability, Exposure
Danger, Response (alert, confusion, response to voice, response to pain, unresponsive),
Shout for help
Airways, Breathing, CPR (circulation), Disability, Exposure
|
|
|
Here is an OSCE-style sepsis scenario you can use for practice.
DISCLAIMER: OBTAINED WITH A.I. THEREFORE TO CONSIDER IT AS A SUGGESTION WITH POSSIBLE ERRORS
Station stemYou are the FY1 doctor on the medical ward. A nurse asks you to review a 68-year-old man, Mr Khan, who has become unwell over the last few hours. He has a fever, is confused, and looks very shaky. His observations are:
What the candidate should doABCDE assessment
Background:“He has a fever, confusion, and reduced urine output. He was previously stable earlier today.”
Assessment:“His observations are concerning: temp 38.8, HR 122, BP 88/54, RR 26, SpO2 92% on room air, and CRT is 4 seconds. He is drowsy and I am worried about septic shock.”
Recommendation:“I need urgent medical review now. Please attend immediately. I have started ABCDE assessment, and we need IV fluids, bloods, cultures, lactate, and antibiotics as soon as possible.”
Examiner promptsThe examiner may ask:
Would you like a longer OSCE script with candidate dialogue and examiner marking points?
Here is an OSCE-style sepsis scenario you can use for practice.
Station stemYou are the FY1 doctor on the medical ward. A nurse asks you to review a 68-year-old man, Mr Khan, who has become unwell over the last few hours. He has a fever, is confused, and looks very shaky. His observations are:
What the candidate should doABCDE assessment
Background:“He has a fever, confusion, and reduced urine output. He was previously stable earlier today.”
Assessment:“His observations are concerning: temp 38.8, HR 122, BP 88/54, RR 26, SpO2 92% on room air, and CRT is 4 seconds. He is drowsy and I am worried about septic shock.”
Recommendation:“I need urgent medical review now. Please attend immediately. I have started ABCDE assessment, and we need IV fluids, bloods, cultures, lactate, and antibiotics as soon as possible.”
Examiner promptsThe examiner may ask:
Would you like a longer OSCE script with candidate dialogue and examiner marking points?
yesOSCE scriptHere is a longer OSCE-style script for sepsis, with candidate dialogue and examiner-style marking points.
Station prompt: You are the FY1 doctor asked to review a patient on the ward who is deteriorating and may have sepsis.
Opening:“Hello, I’m the doctor. I understand you’re feeling unwell. I’m going to check you from top to toe and then I’ll arrange urgent treatment.”
Candidate dialogueAirway“Can you tell me your name? Are you able to speak in full sentences?”
Circulation“I’m going to check your pulse and blood pressure.”
Disability“I’m going to check how alert you are and your blood sugar.”
Exposure“I need to look for a source of infection.”
What the candidate should say“I am concerned this patient may have sepsis with signs of shock. I would like urgent senior review now.”
Immediate actions
Background:“He was previously stable but now has fever, confusion, and reduced urine output.”
Assessment:“ABCDE shows tachycardia, hypotension, tachypnea, low oxygen saturation, delayed capillary refill, and drowsiness. I’m concerned about septic shock.”
Recommendation:“Please come to review immediately. We need urgent sepsis management, bloods, cultures, fluids, and antibiotics.”
Examiner marking points
Would you like me to turn this into a role-play exam with examiner questions and ideal answers?
Role-play examHere is a sepsis OSCE role-play with examiner questions and ideal answers.
Scenario: You are asked to review an unwell 68-year-old man on the ward. He is febrile, confused, hypotensive, and tachycardic. The nurse is concerned about sepsis.
Candidate starts“Hello, I’m the doctor. I understand you’re unwell, and I’m going to assess you urgently, check your breathing, circulation, and alertness, and then I’ll arrange treatment.”
Examiner questions and ideal answers1. What is your first approach?Ideal answer:“I would use the ABCDE approach to identify and treat any immediate life-threatening problems in order.”
2. What findings would make you worry about sepsis?Ideal answer:“Fever, low blood pressure, fast heart rate, fast breathing, confusion, poor perfusion, and reduced urine output would all raise concern for sepsis or septic shock.”
3. What would you check in the ABCDE assessment?Ideal answer:
5. What blood tests would you request?Ideal answer:“FBC, U&E, CRP, lactate, blood cultures, and any other tests guided by the likely source, such as LFTs or clotting if needed.”
6. Why is lactate important?Ideal answer:“Lactate helps assess tissue hypoperfusion and can indicate severity of sepsis or shock.”
7. How would you communicate to the senior doctor?Ideal answer:“I would use SBAR: situation, background, assessment, and recommendation, to clearly explain that the patient may have sepsis and needs urgent review.”
8. What would your SBAR sound like?Ideal answer:
10. What are common sources of sepsis?Ideal answer:“Urinary tract infection, pneumonia, abdominal infection, skin or soft tissue infection, and infected lines or catheters.”
Viva-style prompts
Common examiner expectations
Marked checklistHere is a quick sepsis OSCE checklist you can use for revision.
History and opening
Would you like a one-page OSCE summary sheet with the same content in ultra-short exam format?
One-page summarySepsis OSCE
Would you like a fully scripted spoken version for memorising in the exam?
Spoken OSCE scriptHere is a memorisable spoken version you can use in the exam:
“Hello, I’m the doctor. I understand this patient is unwell, and I’m going to assess them urgently using ABCDE.
First, I would check the airway to make sure it is patent. Then I would assess breathing by checking the respiratory rate, oxygen saturation, and work of breathing, and give oxygen if needed. Next I would assess circulation by checking the pulse, blood pressure, capillary refill, skin temperature, and urine output. I would then check disability by assessing the patient’s level of consciousness and blood glucose. Finally, I would expose the patient to look for a source of infection such as a chest, urinary, skin, or line source.
I am concerned this patient may have sepsis, possibly septic shock, because of the fever, tachycardia, hypotension, tachypnea, confusion, and poor perfusion. I would call for urgent senior help immediately, insert IV access, take bloods including lactate and cultures, send urine, start IV fluids if hypotensive, and give antibiotics as soon as possible according to local policy.
I would then escalate using SBAR: the situation is that the patient is deteriorating and may have sepsis; the background is that they were previously stable but have now become unwell; my assessment is that they are hypotensive, tachycardic, tachypneic, and confused; and my recommendation is for urgent review and immediate sepsis treatment.”
Shorter version“This patient is deteriorating and may have sepsis. I would use ABCDE, treat any immediate problems, take bloods and cultures, start fluids, give antibiotics, and escalate urgently with SBAR.”
Exam memory lineSepsis = fever, fast pulse, fast breathing, low BP, confusion, poor perfusion, and reduced urine output.
Would you like a simulated examiner-patient dialogue next?
Simulated dialogueDoctor: Hello, I’m the doctor. I understand you’re feeling very unwell. I’m going to assess you quickly and make sure you get the right treatment.
Patient: Okay.
Doctor: Can you tell me your name and date of birth?
Patient: My name is Mr Khan, 14 March 1958.
Doctor: Thank you. Are you able to speak in full sentences?
Patient: Yes, but I feel short of breath and shaky.
Doctor: I’m going to check your breathing, pulse, blood pressure, and temperature.
Nurse: His temperature is 38.8, respiratory rate 26, oxygen saturation 92% on room air, pulse 122, and blood pressure 88 over 54.
Doctor: Thank you. I’m concerned about sepsis. Has he been confused or passing less urine?
Nurse: Yes, he is drowsy and his urine output has dropped.
Doctor: Mr Khan, I’m going to give you oxygen, insert an IV line, take blood tests, and start fluids. We also need to look for the source of infection.
Patient: What’s wrong with me?
Doctor: You may have an infection that is affecting your whole body. We need to treat it urgently.
Doctor to nurse: Please can you call the registrar urgently? I’d like blood cultures, lactate, FBC, U&E, CRP, and urine sent now. Please prepare IV fluids and antibiotics as per the sepsis guideline.
Nurse: Okay.
Doctor: I will now hand over using SBAR.
Situation: I’m calling about a patient who is deteriorating and may have sepsis.
Background: He was previously stable but now has fever, confusion, and reduced urine output.
Assessment: He is tachycardic, hypotensive, tachypneic, and has poor perfusion, so I’m worried about septic shock.
Recommendation: He needs urgent senior review now, with immediate sepsis treatment, fluids, cultures, and antibiotics.
Key examiner points
Would you like a second dialogue version with more realistic patient answers and examiner interruptions?
Second dialogueDoctor: Hello, I’m the doctor. I’m here to assess you because you’re unwell. I’ll check you quickly and explain everything as I go.
Patient: I feel terrible. I’m hot and shaky.
Doctor: I’m going to start by checking your airway and breathing. Are you struggling to breathe?
Patient: A bit, yes.
Doctor: I can see you’re breathing faster than normal. I’m also checking your oxygen level.
Nurse: Oxygen saturation is 91% on room air, respiratory rate is 28.
Doctor: Thank you. I’m concerned. I’ll give oxygen and continue assessing your circulation. Have you been feeling dizzy or passing less urine?
Patient: Yes, I’ve barely passed urine today.
Doctor: That’s important. I’m checking your pulse and blood pressure now.
Nurse: Pulse is 128, blood pressure is 86 over 52, capillary refill is delayed.
Doctor: These observations suggest poor circulation. I’m worried about sepsis. I’d also like to know if you’ve been confused.
Patient: My daughter said I’ve been muddled.
Doctor: I’m going to check your blood sugar and do a quick neurological assessment as part of disability. Then I’ll look for the source of infection.
Nurse: Temperature is 39.1. Blood glucose is normal.
Doctor: Thank you. I’m going to examine your chest, abdomen, skin, and any lines or wounds for a source of infection.
Patient: I’ve had a burning pain when passing urine.
Doctor: That could suggest a urinary infection. I will arrange urgent blood tests, cultures, fluids, and antibiotics.
Nurse: Should I call the registrar?
Doctor: Yes, please call urgently. This patient is unstable and may have septic shock. I’m giving an SBAR handover now.
Situation: This is a patient with suspected sepsis who is deteriorating.
Background: He has fever, urinary symptoms, confusion, and reduced urine output.
Assessment: He is hypotensive, tachycardic, tachypneic, and has poor perfusion.
Recommendation: He needs immediate senior review, IV fluids, cultures, antibiotics, and close monitoring.
Extra phrases for exam use
Common mistakes to avoid
DISCLAIMER: OBTAINED WITH A.I. THEREFORE TO CONSIDER IT AS A SUGGESTION WITH POSSIBLE ERRORS
Station stemYou are the FY1 doctor on the medical ward. A nurse asks you to review a 68-year-old man, Mr Khan, who has become unwell over the last few hours. He has a fever, is confused, and looks very shaky. His observations are:
- Temperature: 38.8°C
- Heart rate: 122 bpm
- Blood pressure: 88/54 mmHg
- Respiratory rate: 26/min
- Oxygen saturation: 92% on room air
- Capillary refill time: 4 seconds
- Urine output has reduced
- He is drowsy but rousable
What the candidate should doABCDE assessment
- Airway: Check if the airway is patent. The patient is talking, so the airway is currently open.
- Breathing: Count respiratory rate, look for distress, check chest expansion, give oxygen if needed, and assess SpO2.
- Circulation: Check pulse, blood pressure, capillary refill, skin temperature, urine output, and look for signs of shock.
- Disability: Assess consciousness using AVPU or GCS, check blood glucose, and note confusion or agitation.
- Exposure: Look for infection source, rash, wounds, catheter site infection, abdominal tenderness, or cellulitis.
- Call for urgent senior help.
- Give high-flow oxygen if indicated.
- Obtain IV access.
- Take bloods including FBC, U&E, CRP, lactate, blood cultures.
- Send urine sample and other cultures as appropriate.
- Start IV fluids urgently if hypotensive.
- Give antibiotics within the sepsis timeframe according to local protocol.
- Monitor observations closely and repeat ABCDE.
Background:“He has a fever, confusion, and reduced urine output. He was previously stable earlier today.”
Assessment:“His observations are concerning: temp 38.8, HR 122, BP 88/54, RR 26, SpO2 92% on room air, and CRT is 4 seconds. He is drowsy and I am worried about septic shock.”
Recommendation:“I need urgent medical review now. Please attend immediately. I have started ABCDE assessment, and we need IV fluids, bloods, cultures, lactate, and antibiotics as soon as possible.”
Examiner promptsThe examiner may ask:
- What are the red flags for sepsis?
- What investigations would you do?
- How would you communicate the urgency?
- What would you do if the blood pressure remains low after fluids?
- When would you escalate to critical care?
- Fever or hypothermia.
- Tachycardia.
- Hypotension.
- Tachypnea.
- Confusion or reduced alertness.
- Poor perfusion.
- Reduced urine output.
Would you like a longer OSCE script with candidate dialogue and examiner marking points?
Here is an OSCE-style sepsis scenario you can use for practice.
Station stemYou are the FY1 doctor on the medical ward. A nurse asks you to review a 68-year-old man, Mr Khan, who has become unwell over the last few hours. He has a fever, is confused, and looks very shaky. His observations are:
- Temperature: 38.8°C
- Heart rate: 122 bpm
- Blood pressure: 88/54 mmHg
- Respiratory rate: 26/min
- Oxygen saturation: 92% on room air
- Capillary refill time: 4 seconds
- Urine output has reduced
- He is drowsy but rousable
What the candidate should doABCDE assessment
- Airway: Check if the airway is patent. The patient is talking, so the airway is currently open.
- Breathing: Count respiratory rate, look for distress, check chest expansion, give oxygen if needed, and assess SpO2.
- Circulation: Check pulse, blood pressure, capillary refill, skin temperature, urine output, and look for signs of shock.
- Disability: Assess consciousness using AVPU or GCS, check blood glucose, and note confusion or agitation.
- Exposure: Look for infection source, rash, wounds, catheter site infection, abdominal tenderness, or cellulitis.
- Call for urgent senior help.
- Give high-flow oxygen if indicated.
- Obtain IV access.
- Take bloods including FBC, U&E, CRP, lactate, blood cultures.
- Send urine sample and other cultures as appropriate.
- Start IV fluids urgently if hypotensive.
- Give antibiotics within the sepsis timeframe according to local protocol.
- Monitor observations closely and repeat ABCDE.
Background:“He has a fever, confusion, and reduced urine output. He was previously stable earlier today.”
Assessment:“His observations are concerning: temp 38.8, HR 122, BP 88/54, RR 26, SpO2 92% on room air, and CRT is 4 seconds. He is drowsy and I am worried about septic shock.”
Recommendation:“I need urgent medical review now. Please attend immediately. I have started ABCDE assessment, and we need IV fluids, bloods, cultures, lactate, and antibiotics as soon as possible.”
Examiner promptsThe examiner may ask:
- What are the red flags for sepsis?
- What investigations would you do?
- How would you communicate the urgency?
- What would you do if the blood pressure remains low after fluids?
- When would you escalate to critical care?
- Fever or hypothermia.
- Tachycardia.
- Hypotension.
- Tachypnea.
- Confusion or reduced alertness.
- Poor perfusion.
- Reduced urine output.
Would you like a longer OSCE script with candidate dialogue and examiner marking points?
yesOSCE scriptHere is a longer OSCE-style script for sepsis, with candidate dialogue and examiner-style marking points.
Station prompt: You are the FY1 doctor asked to review a patient on the ward who is deteriorating and may have sepsis.
Opening:“Hello, I’m the doctor. I understand you’re feeling unwell. I’m going to check you from top to toe and then I’ll arrange urgent treatment.”
Candidate dialogueAirway“Can you tell me your name? Are you able to speak in full sentences?”
- If the patient is speaking, airway is patent.
- If there is concern, call for immediate help.
- Count respiratory rate.
- Look at chest movement and work of breathing.
- Check oxygen saturation.
- Listen for added signs of respiratory distress if appropriate.
- Give oxygen if sats are low or the patient is distressed.
Circulation“I’m going to check your pulse and blood pressure.”
- Measure pulse, BP, capillary refill, skin temperature, and peripheral perfusion.
- Look for dehydration or shock.
- Ask about urine output.
Disability“I’m going to check how alert you are and your blood sugar.”
- Assess AVPU or GCS.
- Check confusion, drowsiness, or agitation.
- Check glucose to rule out hypoglycaemia.
Exposure“I need to look for a source of infection.”
- Check temperature.
- Inspect skin, catheter sites, wounds, abdomen, chest, and legs.
- Look for rash, cellulitis, surgical site infection, or pneumonia signs.
What the candidate should say“I am concerned this patient may have sepsis with signs of shock. I would like urgent senior review now.”
Immediate actions
- Call for senior help and inform the nurse in charge.
- Start oxygen if needed.
- Insert IV access.
- Take bloods: FBC, U&E, CRP, lactate, blood cultures.
- Send urine for dip and culture.
- Consider chest x-ray or other source investigation.
- Start IV fluids urgently if hypotensive.
- Give IV antibiotics as per local sepsis guideline.
- Monitor urine output and repeat observations frequently.
Background:“He was previously stable but now has fever, confusion, and reduced urine output.”
Assessment:“ABCDE shows tachycardia, hypotension, tachypnea, low oxygen saturation, delayed capillary refill, and drowsiness. I’m concerned about septic shock.”
Recommendation:“Please come to review immediately. We need urgent sepsis management, bloods, cultures, fluids, and antibiotics.”
Examiner marking points
- Recognizes sepsis as a medical emergency.
- Uses a structured ABCDE approach.
- Identifies abnormal vital signs.
- Escalates appropriately.
- Communicates clearly using SBAR.
- Mentions urgent fluids, cultures, antibiotics, and monitoring.
- Considers source of infection and need for senior review.
- Focusing on one symptom and missing shock.
- Delaying escalation.
- Forgetting blood glucose.
- Not asking about urine output or source of infection.
- Not stating urgency clearly in SBAR.
Would you like me to turn this into a role-play exam with examiner questions and ideal answers?
Role-play examHere is a sepsis OSCE role-play with examiner questions and ideal answers.
Scenario: You are asked to review an unwell 68-year-old man on the ward. He is febrile, confused, hypotensive, and tachycardic. The nurse is concerned about sepsis.
Candidate starts“Hello, I’m the doctor. I understand you’re unwell, and I’m going to assess you urgently, check your breathing, circulation, and alertness, and then I’ll arrange treatment.”
Examiner questions and ideal answers1. What is your first approach?Ideal answer:“I would use the ABCDE approach to identify and treat any immediate life-threatening problems in order.”
2. What findings would make you worry about sepsis?Ideal answer:“Fever, low blood pressure, fast heart rate, fast breathing, confusion, poor perfusion, and reduced urine output would all raise concern for sepsis or septic shock.”
3. What would you check in the ABCDE assessment?Ideal answer:
- Airway: Is the patient speaking or obstructed?
- Breathing: Respiratory rate, oxygen saturation, work of breathing.
- Circulation: Pulse, BP, capillary refill, skin temperature, urine output.
- Disability: Conscious level, AVPU/GCS, blood glucose, confusion.
- Exposure: Temperature, infection source, rash, wounds, catheter sites.
5. What blood tests would you request?Ideal answer:“FBC, U&E, CRP, lactate, blood cultures, and any other tests guided by the likely source, such as LFTs or clotting if needed.”
6. Why is lactate important?Ideal answer:“Lactate helps assess tissue hypoperfusion and can indicate severity of sepsis or shock.”
7. How would you communicate to the senior doctor?Ideal answer:“I would use SBAR: situation, background, assessment, and recommendation, to clearly explain that the patient may have sepsis and needs urgent review.”
8. What would your SBAR sound like?Ideal answer:
- Situation: “This is a deteriorating patient with suspected sepsis.”
- Background: “He was previously stable but now has fever and confusion.”
- Assessment: “He is hypotensive, tachycardic, tachypneic, and has poor perfusion.”
- Recommendation: “Please review urgently; I think he needs immediate sepsis management, fluids, cultures, and antibiotics.”
10. What are common sources of sepsis?Ideal answer:“Urinary tract infection, pneumonia, abdominal infection, skin or soft tissue infection, and infected lines or catheters.”
Viva-style prompts
- What is septic shock?
- When would you start antibiotics?
- Why should you repeat observations?
- How do you assess reduced consciousness?
- What signs suggest poor peripheral perfusion?
Common examiner expectations
- Clear structure.
- Recognition of sepsis as an emergency.
- Early escalation.
- Practical management steps.
- Good communication with SBAR.
Marked checklistHere is a quick sepsis OSCE checklist you can use for revision.
History and opening
- Introduces self and confirms patient identity.
- Explains assessment clearly.
- Recognizes the patient may be unwell and needs urgent review.
- Checks Airway is patent.
- Assesses Breathing: respiratory rate, SpO2, work of breathing.
- Assesses Circulation: pulse, BP, capillary refill, skin temperature, urine output.
- Assesses Disability: AVPU/GCS, confusion, blood glucose.
- Assesses Exposure: temperature and likely source of infection.
- Fever or hypothermia.
- Tachycardia.
- Hypotension.
- Tachypnea.
- Confusion or reduced consciousness.
- Poor perfusion.
- Reduced urine output.
- Calls for senior help early.
- Gives oxygen if needed.
- Obtains IV access.
- Takes bloods, including lactate and cultures.
- Sends urine and other relevant samples.
- Starts IV fluids if hypotensive.
- Gives antibiotics promptly according to local policy.
- Repeats observations and reassesses.
- Situation: says the patient is deteriorating and may have sepsis.
- Background: gives relevant history and recent change.
- Assessment: states abnormal observations and concern for septic shock.
- Recommendation: asks for urgent review and treatment.
- Mentions likely source of infection.
- Mentions escalation to critical care if not improving.
- Mentions monitoring urine output and ongoing reassessment.
Would you like a one-page OSCE summary sheet with the same content in ultra-short exam format?
One-page summarySepsis OSCE
- Introduce yourself and confirm the patient’s identity.
- State that you are concerned about deterioration and will assess urgently.
- Use ABCDE:
- A: Airway patent?
- B: Respiratory rate, oxygen saturation, work of breathing.
- C: Pulse, blood pressure, capillary refill, skin temperature, urine output.
- D: Conscious level, confusion, blood glucose.
- E: Temperature, examine for infection source.
- Fever or hypothermia.
- Tachycardia.
- Hypotension.
- Tachypnea.
- Confusion or reduced alertness.
- Poor perfusion.
- Reduced urine output.
- Call for senior help early.
- Give oxygen if needed.
- Insert IV access.
- Send bloods: FBC, U&E, CRP, lactate, blood cultures.
- Send urine and other relevant samples.
- Start IV fluids if hypotensive.
- Give antibiotics promptly as per local protocol.
- Reassess and repeat observations.
- Situation: “This patient is deteriorating and may have sepsis.”
- Background: “They were previously stable, but now have fever and confusion.”
- Assessment: “Observations show hypotension, tachycardia, tachypnea, and poor perfusion.”
- Recommendation: “Please review urgently; they need immediate sepsis management.”
Would you like a fully scripted spoken version for memorising in the exam?
Spoken OSCE scriptHere is a memorisable spoken version you can use in the exam:
“Hello, I’m the doctor. I understand this patient is unwell, and I’m going to assess them urgently using ABCDE.
First, I would check the airway to make sure it is patent. Then I would assess breathing by checking the respiratory rate, oxygen saturation, and work of breathing, and give oxygen if needed. Next I would assess circulation by checking the pulse, blood pressure, capillary refill, skin temperature, and urine output. I would then check disability by assessing the patient’s level of consciousness and blood glucose. Finally, I would expose the patient to look for a source of infection such as a chest, urinary, skin, or line source.
I am concerned this patient may have sepsis, possibly septic shock, because of the fever, tachycardia, hypotension, tachypnea, confusion, and poor perfusion. I would call for urgent senior help immediately, insert IV access, take bloods including lactate and cultures, send urine, start IV fluids if hypotensive, and give antibiotics as soon as possible according to local policy.
I would then escalate using SBAR: the situation is that the patient is deteriorating and may have sepsis; the background is that they were previously stable but have now become unwell; my assessment is that they are hypotensive, tachycardic, tachypneic, and confused; and my recommendation is for urgent review and immediate sepsis treatment.”
Shorter version“This patient is deteriorating and may have sepsis. I would use ABCDE, treat any immediate problems, take bloods and cultures, start fluids, give antibiotics, and escalate urgently with SBAR.”
Exam memory lineSepsis = fever, fast pulse, fast breathing, low BP, confusion, poor perfusion, and reduced urine output.
Would you like a simulated examiner-patient dialogue next?
Simulated dialogueDoctor: Hello, I’m the doctor. I understand you’re feeling very unwell. I’m going to assess you quickly and make sure you get the right treatment.
Patient: Okay.
Doctor: Can you tell me your name and date of birth?
Patient: My name is Mr Khan, 14 March 1958.
Doctor: Thank you. Are you able to speak in full sentences?
Patient: Yes, but I feel short of breath and shaky.
Doctor: I’m going to check your breathing, pulse, blood pressure, and temperature.
Nurse: His temperature is 38.8, respiratory rate 26, oxygen saturation 92% on room air, pulse 122, and blood pressure 88 over 54.
Doctor: Thank you. I’m concerned about sepsis. Has he been confused or passing less urine?
Nurse: Yes, he is drowsy and his urine output has dropped.
Doctor: Mr Khan, I’m going to give you oxygen, insert an IV line, take blood tests, and start fluids. We also need to look for the source of infection.
Patient: What’s wrong with me?
Doctor: You may have an infection that is affecting your whole body. We need to treat it urgently.
Doctor to nurse: Please can you call the registrar urgently? I’d like blood cultures, lactate, FBC, U&E, CRP, and urine sent now. Please prepare IV fluids and antibiotics as per the sepsis guideline.
Nurse: Okay.
Doctor: I will now hand over using SBAR.
Situation: I’m calling about a patient who is deteriorating and may have sepsis.
Background: He was previously stable but now has fever, confusion, and reduced urine output.
Assessment: He is tachycardic, hypotensive, tachypneic, and has poor perfusion, so I’m worried about septic shock.
Recommendation: He needs urgent senior review now, with immediate sepsis treatment, fluids, cultures, and antibiotics.
Key examiner points
- Introduce yourself and confirm identity.
- Use a structured ABCDE approach.
- Recognize sepsis as an emergency.
- Escalate early.
- Communicate clearly with SBAR.
- Mention fluids, cultures, antibiotics, and senior help.
Would you like a second dialogue version with more realistic patient answers and examiner interruptions?
Second dialogueDoctor: Hello, I’m the doctor. I’m here to assess you because you’re unwell. I’ll check you quickly and explain everything as I go.
Patient: I feel terrible. I’m hot and shaky.
Doctor: I’m going to start by checking your airway and breathing. Are you struggling to breathe?
Patient: A bit, yes.
Doctor: I can see you’re breathing faster than normal. I’m also checking your oxygen level.
Nurse: Oxygen saturation is 91% on room air, respiratory rate is 28.
Doctor: Thank you. I’m concerned. I’ll give oxygen and continue assessing your circulation. Have you been feeling dizzy or passing less urine?
Patient: Yes, I’ve barely passed urine today.
Doctor: That’s important. I’m checking your pulse and blood pressure now.
Nurse: Pulse is 128, blood pressure is 86 over 52, capillary refill is delayed.
Doctor: These observations suggest poor circulation. I’m worried about sepsis. I’d also like to know if you’ve been confused.
Patient: My daughter said I’ve been muddled.
Doctor: I’m going to check your blood sugar and do a quick neurological assessment as part of disability. Then I’ll look for the source of infection.
Nurse: Temperature is 39.1. Blood glucose is normal.
Doctor: Thank you. I’m going to examine your chest, abdomen, skin, and any lines or wounds for a source of infection.
Patient: I’ve had a burning pain when passing urine.
Doctor: That could suggest a urinary infection. I will arrange urgent blood tests, cultures, fluids, and antibiotics.
Nurse: Should I call the registrar?
Doctor: Yes, please call urgently. This patient is unstable and may have septic shock. I’m giving an SBAR handover now.
Situation: This is a patient with suspected sepsis who is deteriorating.
Background: He has fever, urinary symptoms, confusion, and reduced urine output.
Assessment: He is hypotensive, tachycardic, tachypneic, and has poor perfusion.
Recommendation: He needs immediate senior review, IV fluids, cultures, antibiotics, and close monitoring.
Extra phrases for exam use
- “I am concerned about septic shock.”
- “I would like urgent senior review now.”
- “Please prepare sepsis bloods, cultures, fluids, and antibiotics.”
- “I will reassess after initial treatment.”
Common mistakes to avoid
- Not noticing reduced urine output.
- Forgetting blood glucose.
- Delaying escalation.
- Missing SBAR structure.
- Failing to state urgency clearly.