FREE CORE SURGERY INTERVIEW QUESTIONS: SAMPLE 2

I would treat this man according to ALS guidance.

If an AMPLE history was available I would get this from the nurses or paramedics who had already looked after the patient.
I would assess his airway and ensured he receives oxygen from a non re-breath mask set at 100%.

I would listen to his chest to ensure equal air entry and the heart for murmurs or irregularities.

I would get an ECG and place two large bore antecubital fossa cannulae and start IV fluids.

Analgesia would be given as required.

A full set of bloods plus a group and save would be set and an ABG/VBG could be done to check immediate gases and Hb’s in ED.

I would check his BM and ensure he was catheterised if required.

Once stabilisation had been performed a full history and examination would be appropriate.

Differentials are multiple and include pneumonia, MI, epigastric irritation or GI bleed.

This patient is exhibiting signs of stage 3 shock according to the below table.
This would indicate that there was occult blood loss if there were no signs of external haemorrhage.

A FAST scan could be used in ED to establish internal bleeding looking at the heart, spleen, kidneys and pelvis.

If this was not available and the patient was stable a CT would be helpful.

It is likely this patient with no history of trauma may have an upper GI bleed which his grade three shock would be a candidate for surgery. I would inform my senior colleagues, anaesthetist and the CPOD list and prepare the patient for theatre.