Our patient station below focusses on a patient who presents in casualty, accompanied by police. Test your understanding in this patient-focussed OSCE example.
A patient is accompanied by the police into the casualty department.
You Introduce yourself and he responds as follows:
“Hello doctor. I’m not quite right. Fright they nearly scared me to death. Grim reaper and the like. But I doughnut like you do I?”
It turns out the police are actually with him to take a statement from him because he was assaulted by a football hooligan in the city centre.
What problem is suggested?
- Formal Thought disorder
- Mood disorder
- Overvalued Idea
- None of the listed answers here
In the absence of alcohol or drugs what is his most likely diagnosis?
- Personality disorder
- Depression with psychosis
- Organic illness
You turn to write your initial clerking. When you turn round the patient is attempting to stab himself with a chest drain trochar that he has picked out of a sharps bin.
Security have removed it from him but the patient is shouting aggressively. They ask “what legal right do we have to restrain him?”
- Common Law
- Mental Health Act
- They have no legal right but in this situation its the right thing to do
- Organic illness
He struggles with security and you are concerned that he is at serious risk to himself as he attempts to bang his head repeatedly against the floor of the cubicle. A nurse holds a pillow under him whilst 3 security guards try and restrain him.
The A&E senior doctors are all dealing with a multiple trauma road traffic accident in the ED rescuscitation room.
Can you give an antipsychotic medication without either:
Sectioning him under the mental health act or Arranging a psychiatry opinion?
- It is illegal but in the circumstances probably in the patient’s best interests
What is the most appropriate route of administration for a rapid acting antipsychotic in this situation?
- Per Rectum
What is the most appropriate drug to administer in IM (intramuscular) form?