Tuesday, 11 March 2014

Tutorial 10 March 2014

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10 March 2014

10 March 2014
1. How to prepare. Picking a course.
2. Roleplay: how to introduce oneself.
3. Labour ward scenario 1.
4. Labour ward scenario 2.
5. Roleplay: Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. She is healthy. Her brother has cystic fibrosis

Labour Ward Scenario 1.

Sunday 13.00 hours.

You are given 15 minutes to prepare and you then have a viva with an examiner. Your instructions are to prioritise the patients and allocate staff to go to see them.

Mrs JH
Primigravida. T+8. In labour. 6 cms.
Mrs AH
Primigravida at T. In labour. 5 cms.
Mrs. BH
Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3.
Mrs SB
Primigravida. 32/52 gestation. Admitted 30 minutes ago. Abdominal pain + 200 ml. bleeding. Nephrostomy tube in situ - not draining since this morning. Low placenta on 20 week scan.
Mrs KW
Para 1. In labour. Cx. 5 cm. Ceph at spines.
Mrs KT
Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor.
Mrs TB
Para 1. T+4. Clinically big baby. Cx fully dilated for 1 hour. Type 1 decelerations.
Mrs RJ
Primigravida. Epidural. RIF pain. Cx fully dilated for 1 hour. Shallow late decelerations. OT position. Distressed ++. BP /105. ++ protein. Urine output 50 ml in past 4 hours.
Mrs KC
Transfer from ICU. 13 days after delivery of 32 week twins. Laparotomy on day 7 for pelvic pain and fever. Infected endometriotic cyst removed. IV antibiotics changed to oral.

Gynaecology ward.

8 major post operative cases who have been seen on the morning ward round and are stable. Husband of patient who has had Wertheim's hysterectomy asking to see a doctor for a report on the operation.

Mrs JB
10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding.
19 years old. Nulliparous. Just admitted with left iliac fossa pain. Scan shows unilocular 5 cm. ovarian cyst.

Medical staff:

Consultant at home. Registrar - you.
Senior House Officer with 12 months experience.
Registrar in Anaesthesia.
Consultant Anaesthetist on call at home.

Midwifery staff:
Senior Sister.           Trained to take theatre cases. Able to site IV infusions and suture episiotomies and tears.
3 staff midwives. 1 trained to take theatre cases. Two able to site IV infusions.
1 Community midwife looking after Mrs. KW.
2 Pupil Midwives.

Scenario 2.

Monday. 0900 hours.  You have just come on duty.

Mrs A
Para 0+0
25 yrs
41 weeks. In labour 12 hours. Cx 8 cm. No progress for 4 hours. "Dips" reported on CTG
Mrs B
Para 1+2
31 yrs
28 weeks. Just admitted. "Show" + contractions
Mrs C
Para 5+3
40 yrs
In labour 8 hours. Cx 6 cm. dilated
Mrs D
Para 1+3
27 yrs
37 weeks. Diabetes. Admitted ½ hour previously. Previous Caesarean section.
Mrs E
Para 1+2
32 yrs
40 weeks. Previous 9 lb. baby. In the second stage for 1 ½ hours.
Miss F
Para 0+0
15 yrs
34 weeks. Concealed pregnancy. In labour. Just admitted. Breech presentation
Mrs G
Para 1+2

26 weeks. Admitted with severe abdominal pain
Mrs H
Para 2+1

39 weeks. In early labour.
Mrs I
Para 1+0

Delivered two hours previously by Caesarean section for severe pre-eclampsia. Diastolic BP / 110. Urine output 50 ml. since delivery
Mrs J
Para 1+0

Normal delivery + PPH >1,500 ml. one hour ago

Medical staff:

Consultant:               in his Rooms.
You:                            Registrar.
Foundation Year 2  six months’ experience.
Registrar in anaesthetics.

Midwifery staff:

Senior Sister.
Two staff midwives.
One community midwife.
Two student midwives.

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