CSA case Abdo pain done well
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- Опубліковано 21 гру 2011
- A great example of a CSA case handled well. Compare this using the CSA scoring download with the same scenario done badly. What made one better than the other? Using the consultation spotting download which consultation skills were used?
Things to look for include; open Q, active listening, cue handling, exploration of thoughts, fears and hopes (ICE), summarising, respecting patient autonomy and intergrating ICE into the management plan.
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you can tell why he smashed it.illustrates the game very well.not just getting alcohol..saying diagnosis and recommending admission but getting her ideas,taking time to persuade
She might be the funniest and most charming alcoholic I've ever seen!
Could also relay it back to her initial expectation that she had wrote down that her golfer friend had told her to ask for....
"Now I know you mentioned THIS would help, however after my examination findings and from what you've told me I feel this this this..... How do you feel about that?"
Some differentials on what else it could be as others mention?
Great ! However that lady is a good actor
Clinical history should be done before jumping to social aspect
Why would anyone ask 'who's at home with you' before exploring the abdo pain???
'I would like to get you admitted to hospital' - a classic example of shared management and negotiation. Where was the warning shot??
Cud you pls tell me how it should be done ? Having plab 2 exam in coming month...
Sounds like she's significantly hypotensive...not one for shared management....time to call 999
tell me abt it! i was thinking the same thing
Why leave it until 4min50secs to actually take a medical Hx about the PC?
because he was followingthe traffic light system
Yes would be good to say what hospital might do ie endoscope / USS / bloods.
Also this BP thats low - what value was it - sound quality not very good so maybe I missed the vlaue being said - low low low is all I hear so the patient won;t actually ever know whats low and whats ok/"safe".
Could the hypotension not be secondary to a perforated ulcer? Her pain had after all increased prior to attendance though there is no mention of peritonism; alcoholic gastritis or GD/DD are perfectly reasonable alternatives to acute pancreatitis and could have been mentioned to the patient also...
edit: I was wondering, would a patient present this well and then need admission? this lady doesnt look like someone who would have guarding on examination or severe hypotension (presumably severe, did not hear numbers)
very good video, the lady talks a lot but somehow this was still 11 minutes so thats great. I didnt think of pancreatitis, but i did think it could easily be perforated ulcer due to hypotension, either way does not change plan to arrange admission. also great that he added to call ambulance - lots of people forget that you cant just drive yourself to A+E with chest pain or hypotension etc
I think CAGE should have been explored in this scenario. Otherwise, good job.
What is CAGE ?
@@chemmutk1 CAGE is a tool used to explore for alcohol abuse. you'll ask
C- have you ever felt you needed to Cut down on your drinking?
A-Have people Annoyed you by criticising by your drinking?
G- have you ever felt Guilty about drinking?
E- Have you ever felt you needed a drink first thing in the morning to steady your nerves or get rid of a hangover?( alcohol as an Eye opener)
Why Pancreatitis? Why not Alcoholic gastritis? Why Chest pain radaiting to epigastrium was not a DD?
It was just scaring the woman.. in the last few minutes. What happens in the hospital - no explanation to the woman?
Is this a good example of CSA consultation?
What's a stool, doctor?
Voice is too low
I wouldnt straight forward say pancreatitis, could be perf peptic ulcer . And also dr doesnt explain the reason for admission clearly what she would expect in hospital & i dont think he broke the news nicely , he didnt look worried at all.
No where near to real patient- and it sounds odd to ask ICE first in real life scenarios- he managed to get it done on time as he didn't have to examine her !
Two minutes in and this is hardly a 'good' example of consultation done well! It's messy, unfocused and reliant on the actor to provide all the pertinent information...I would've failed for this :')