PREFINAL OSCE

 

Osce questions

What is the criteria for weaning off patient from ventilator?

Subjective assessment:

     Adequate cough

     No neuromuscular blocking agents 

     Absence of excessive trachea bronchial secretions 

     Reversal of underlying cause of respiratory failure 

     No continuous infusion of sedatives

Objective assessment:

     Stable cardiovascular status

     Heart rate <140 beats/min

     No active myocardial ischemia 

     Adequate heamoglobin level >8g/dL

     Systolic blood pressure 90-160mmHg

    Temperature-afebrile 

 Adequate oxygenation:

      Tidal volume >5mL/kg

      Vital capacity >10mL/kg

      Proper Inspiratory effort 

      Respiratory rate <35/min

      PaO2 >60mmHg, PCO2 <60mmHg

      No significant respiratory acidosis 

      Peep (positive end respiratory acidosis) < 8 cmh2O

      O2 saturation >90% on FIO2 <0.4

How to differentiate between bronchial breath sounds and normal vesicular breath sounds?

Normal vesicular breath sounds have a soft and low pitch sound and 

Duration of Inspiratory phase is longer than expiratory phase 

No gap between both end of inspiration and in beginning of expiration

In bronchial breath sounds heard as loud and in high pitch and

Inspiration and expiration phases are mostly equal with slight longer expiration

Silent gap between inspiration and expiration

indications for dialysis ?

     plasma urea >180mg/dl

     hyperkalemaia >6mmol/l

     metabolic acidosis

     fluid overload and pulmonary edema

     Uremic encephalopathy

      creatinine levels >6.8.g/dl

Why there was a prolong action of midazolam though it is a short acting in this patient?

In the patient case there was low urine output with 

day3 1500 mL input and 300 output 

Day2  600 mL input and 200 output

 which show a drastic decrease in urine output due to impaired function of kidneys causing decreased elimination of the drugs Causing longer action of midazolam