Objective structured practical (clinical) exam - OSP(C)E is a method of evaluating the practical clinical competence of higher education applicants in a higher education medical institution based on objective testing through performing practical clinical tasks. OSP(C)E and - is an integral part of the State Certification of Higher Education Exercise - Master's degree in specialties 22 "Health Care".
The Department of Anesthesiology, Intensive Therapy, and Medicine of Emergency PGEF participates in OSP(C)E at the practical station, where students demonstrate the ability to carry out basic resuscitation measures using an automatic external defibrillator and an AMBU bag with a facial mask.
Entering the station, a student greets those present and introduces himself.
The person who will be his assistant announces the initial data of the scenario (for example, "We are in a shopping center, a middle-aged man was walking in front of us and suddenly falls and does not move".
The student performs a practical skill according to the algorithm below.
After the student demonstrates all the algorithm elements, the examiner stops the scenario with the words, "The ambulance has arrived. Stop scenario.".
An Algorithm of the practical skill /offline/
1
Safety assessment of the patient
Ask the one who read the input of the scenario, whether it is safe to approach and touch the patient.
2
Check the patient's consciousness
1) As you approach the patient, loudly say to the patient: "Do you hear me? Are you OK?".
2) When you approach the patient, shake him by the shoulders and repeat the question.
3
Call for help
1) Contact with a bystander (for example, "Boy in a Red T-shirt, I need your help").
2) Order an assistant to call an ambulance, indicate that he will use number 103, tell the operator where we are, the gender and approximate age of the patient, and the fact that the patient is unconscious.
4
Checking breathing
1) Open the airway by deflecting the head back. To do this, one palm should be placed on the patient's forehead and the other hand to support his lower jaw.
2) Lean over the patient's face and check the presence of breathing as a rule "I see, I hear, I feel" within 10 seconds (count them aloud).
5
The beginning of CPR, chest compression
1) Determine the point of compression by one of the methods.
2) Put your fingers in the lock, straighten your hands in the elbows, and put the base of the palm on the point of compression.
3) Start compressions with a frequency of 100-120 per minute with a depth of pressing on the sternum 5-6 cm.
6
Ensure the bringing of the AED and the AMBU bag
1) Ask the assistant whether he knows where is the nearest defibrillator and the AMUB bag.
2) If he does not know, order him to ask an ambulance operator.
3) Order to quickly bring the AED and the AMBU bag.
7
The use of AED
1) When the assistant brought AED, ask him if he can replace you with compression.
2) Order to replace you with compression and prepare the AED for work. To do this, take the following steps:
Switch on the AED,
Listening to its commands to impose electrodes,
Repeat its command "Do not touch the patient" while analyzing the rhythm, and trace the performance of this command by others and spread their hands to the sides.
Repeat its command "Do not touch the patient during the shock" loudly, and check the execution of this command while you press the shock button, and take your free hand to the side.
8
Resuscitation after shock
Immediately after shock, order the assistant to restore the compression of the chest, counting to himself up to 25, then counting up to 30 aloud.
9
Artificial respiration
1) Immediately, as the assistant restored compression, apply a mask on the patient's face, pressing it tightly to the face with the thumbs and index finger.
2) Immediately after the 30th compression, perform 2 artificial breaths, controlling the availability of a thoracic excursion.
3) After two breaths, order the assistant to hold the next 30 compressions.
10
Changing the roles of resuscitation
In 2 minutes after the shock, when the AED tells "Stop the resuscitation to assess the heart rate", order the assistant to change places with You.
When the station exam starts, a student introduces himself/herself with a demonstration of his/her ID card.
The person who will be his/her assistant connects to the conversation and announces the initial data of the scenario (for example, "I need your help! I am in a shopping center, a middle-aged man was walking in front of me and suddenly falls and does not move. What should I do?".
The student shows his/her practical skills /as an instructor/ according to the algorithm below.
After the student demonstrates all the algorithm elements, the examiner stops the scenario with the words, "The ambulance has arrived. Stop scenario.".
An Algorithm of the practical skill /online/
1
Safety assessment of the patient
Ask your contact: "Are you safe?".
2
Check the patient's consciousness
1) Ask your contact to ask the patient loudly: "Do you hear me? Are you OK?".
2) If the patient does not respond, let your contact shake him/her by the shoulders and repeat the question.
3
Call for help
Let your contact ask a bystander for help (for example, "Sir in a Red T-shirt, I need your help").
Ask your contact to order an assistant to call an ambulance, indicate that he/she will use number 103, tell the operator where they are, the gender and approximate age of the patient, and the fact that the patient is unconscious.
4
Check the patient's breathing
Say to your contact to open the airway by tilting the head back. Let your contact put his/her one hand on the patient's forehead and the other under his/her chin, and tilt.
Let your contact lean over the patient's face and check the presence of breathing as a rule "I see, I hear, I feel" within 10 seconds (count them aloud).
5
Start CPR, begin chest compressions
Tell your contact how to determine the point of compression by one of these methods (see the pictures below this algorithm).
Let your contact put his/her fingers in the lock, straighten their hands at the elbows, and put the base of the palm on the point of compression.
Tell your contact to begin compressions with a frequency of 100-120 per minute and a depth of 5-6 cm.
6
Bring the AED and the AMBU bag to the scene
Tell your contact to ask the assistant to bring an AED and the AMBU bag. If he/she does not know where those are, order him/her to ask an ambulance operator about it.
7
The use of AED
When the assistant brings the AED, ask if he/she can replace your contact with compression. When the assistant takes over compressions, your contact will prepare the AED for work following the next steps:
Turn on the AED,
Listening to its commands to place the electrodes,
Repeat aloud its command "Do not touch the patient" while AED is analyzing heart rhythm, and make sure that no one touches the patient
When the AED has charged and the shock button is flashing, repeat its command "Stay clear of the patient" loudly, make sure everybody (including the person operating the AED) stays clear of the patient, and only then press the shock button.
8
Resuscitation after shock
Immediately after shock, order the assistant to resume chest compressions, counting to himself up to 25, then counting up to 30 aloud.
9
Rescue breaths
1) Immediately, as the assistant restores compression, tell your contact to apply a mask on the patient's face, pressing it tightly to the face with the thumbs and index finger.
2) After the 30th compression, perform 2 rescue breaths, controlling the chest movement.
3) After two breaths, order the assistant to perform the next 30 compressions.
10
Changing the roles of resuscitation
In 2 minutes after the shock, when the AED says "Analyzing heart rhythm, do not touch the patient", order the assistant to change places with you.
How to determine the point for chest compression
LIfesaver (an interactive film) - https://life-saver.org.uk/