> "Safe and sensible" - Jana. The most fundamental approach to answering OSCE questions. > [!info]- LIPS-ED > > - Label scenario > - Issues > - Priorities > - Summarise or send for help > - Equipment > - Drugs > [!tip]- R RSI-DEAD > - **R**esus > - ABC, BSL, seizures, emergency antidotes > - **R**isk assessment > - Agent > - Dose > - Time > - Symptoms > - patient factors (b/g, PMx, etc) > - **S**upportive care > - **I**nvestigations > - ECG, BGL, HCG, paracetamol level, etc > - **D**econtamination > - **E**nhanced elimination > - **A**ntidotes > - **D**isposition > [!example]- Procedures > - if teaching, start with plan of what is being covered > - informed consent > - ensure pt comfortable > - departmental awareness > - right personnel helping > - indications/contraindications > - complications > - equipment > - PPE/sterility > - positioning > - technique > - trouble shoot common problems > - post-procedure care > - disposition > - give pt or student a chance to ask questions and answer appropriately > [!key points]- SPIKES - breaking bad news > - Setting > - Perception/perspective > - Invitation > - knowledge > - empathy/emotion > - summary/strategy > [!pearl]- LEADS (Emma West/Jonathan Papson) > see: [LEADS video](https://www.youtube.com/watch?v=rQfLgRSbkxA) > > - **Label** situation > - allow team to share your mental model ("verbalise your thinking" - Chung) > - If undifferentiated, it is ok to articulate this in your label as well > - eg "An arrested patient in a non-shockable rhythm" > - "peri-arrest shocked trauma patient" > - **Establish** your team roles and responsibilities > - who are team members? are they "confident and capable" to do tasks required? > - what team members do I need? > - **Assessment** of what is going on and acquire information > - Eg is airway patent and protected? > - are they perfusing/have a pulse? > - What am I concerned about? What are the *key issues*? > - receive suggestions > - **Direct** team > - address priorities and next steps (eg gain IV access, de-compress chest, give blood products) > - receive suggestions and feedback > - **Supervise** and **Summarise** > - Ensure priorities are being addressed > - summarise for team (explain labels, check on team) > - What is our definitive management > > Note that this is similar to LIPS above, and more applicable to real life team leadership than OSCE. Either LEADS or LIPS works fairly well in real life. One effective point that is more important for real life team leadership is the importance of summarising and re-iterating. I've found that cycling through ABCs in a critically unwell resuscitation can be helpful when checking in on the effects of the teams resuscitation efforts and re-establishing a shared mental model ## SCBD Any sick pt in SCBD: 1. Label with opening DDx 2. resus prep: 1. move to resus , full monitoring 2. assemble resus team, allocate roles, assume team leadership 3. call for specific help 3. concurrent assessment and treatment 1. "RDAS" 2. resus 3. definiitive 4. anticipate complications 5. disposition 6. supportive care ## Procedures Pre: - indications - contraindications - complications - consent during - situational - space/staff/stuff - position - PPE/sterility - actions post - post-procedure care - monitoring - documentation - interpretation of results - resources ## Bad News - intro - private area if appropriate - Current comfort - anyone you want to be here with you? - assess what is known thus far - "warning shot" > - Setting > - Perception/perspective > - Invitation > - knowledge > - empathy/emotion > - summary/strategy ## End of life discussion see also: [[palliative care|end of life care]] - intro - anyone else you would like to join - appropriate setting - check prior knowledge - gather information - health - baseline function - end of life care wishes, advanced care directive, etc - ensure care is based on the PATIENT and their wishes - explain very sick, suspect approaching end of life - explain end of life care → palliative care, medications - any spiritual beliefs? - check any questions? "I am worried we are not prolonging her life but actually prolonging her dying" "dementia is an illness with spectrum btwn mild and so severe to cause end of life. no cure." "Thank you for telling me about your dad's life; sounds like he is a very active person, and I don't think he would want this disability" see: [Cabrini OSCE 2019 - End of Life](x-devonthink-item://CAFAADEE-E2C2-413F-9284-88F799EB66BE) ## Open Disclosure see also: [[Complaints]] - intro - invite others who need to be there - clarify prior understanding open disclosure: explain there has been a complication, explain it and what steps will be done to correct it and/or insure patient is safe - factual account of what happened - apology - patient care → explain how they are being treated - give patient/family opportunity to share feelings "I want to talk you through how we will look into this error and steps we will take to prevent it from happening. but before I do, are there any concerns or questions you have for me?" - error management: investigation, audit, incident report, patient/family can file a complaint, implement improvements, follow up about steps we have taken - finish up: apology, summarise, clarify any other questions