OSCE Checklist | ABCDE Approach

Initial steps
1 Introduce yourself to whoever has requested a review of the patient and listen carefully to Intro
their handover FULL NAME & ROLE

2 Ensure the patient’s notes, observation chart and prescription chart are easily accessible Prep
1 3
3 Ask for another clinical member of staff to assist you if possible

4 Introduce yourself to the patient (including your name and role) and confirm patient details Obtain CONSENT

5 Ask how the patient is feeling (if conscious) Pt. interation

2
6 If the patient is unconscious and there are no signs of life, start basic life support CPR

WASH HANDS Airway Patient can talk = airway patient > move on

E 7 Check the patency of the airway (look for signs of airway compromise, listen for abnormal
airway noises, inspect inside the mouth) Angioedema, cyanosis, paradoical (see saw) breathing — stridor,
Look snoring, gurgling — secretions (blood, vomit), foreign object.

T
8 If required: perform basic airway manoeuvres (head-tilt chin-lift, jaw thrust) and consider
inserting an airway adjunct (OP/NP) Seek URGENT (IMMEDIATE) Expert Help - MET Call (anaesthetics)

R 9 Re-assess the patient after any intervention

Breathing
V 10 Review respiratory rate and oxygen saturation

11 Inspect for signs of respiratory problem (cyanosis, increased work of breathing, cough,
Kussmaul’s respiration) 1. Well/unwell, 2. Colour (pale, cyanosis), 3. ? Dyspnea
E
Use of accessory muscles, diminished breath sounds, added sounds.
12 Assess tracheal position

IPPA 13 Perform brief respiratory assessment: chest expansion, percussion, auscultation Posterior first + R M
1. 2.
I 14 Request an ABG and portable chest X-ray if indicated ABG - not indicated if O2 sats normal > 94% RA
Other - 3). sputum culture. 4). Nasopharageal swab?
1).
15 Administer oxygen if indicated
T 2).
16 Initiate appropriate management for specific respiratory problems (e.g. nebulised salbutamol
for asthma) Analgesia (if required)

R 17 Re-assess the patient after any intervention 3 — Re-check vitals, inspect, re-auscultate.

Circulation + Volume Status

18 Review heart rate and blood pressure

V 19 Review the fluid balance chart and calculate the patient’s fluid balance; consider
catheterisation to monitor urine output IV fluids?
20 Inspect for signs of a circulatory problem (pallor, oedema)
? Perip. cyanosis
21 Assess temperature and measure capillary refill time Temp - warm/well-perfused peripheries
Moist mucus membranes? Hands

E =6 22 Assess the radial/brachial pulse

rate (fast/slow), rhythm (regular/irregular) +
character (strong, thready)
23 Briefly inspect for a significantly raised JVP + Mucous membranes, tissue turgor (hydration stat) -
Location of apex beat (in hypervolemia)
24 Briefly auscultate for heart sounds
 E 25 Inspect the ankles and sacrum for oedema

26 Insert at least one wide-bore intravenous cannula and take appropriate blood tests 14G/16G
4 I +/- urinary catheter -
27 Consider continuous cardiac monitoring and perform a 12-lead ECG if indicated assess fluid balance

28 Administer intravenous fluid bolus if hypovolaemic

T
29 Initiate appropriate management for specific circulatory problems (e.g. control bleeding,
treat acute coronary syndrome, start sepsis six) Analgesia

R 30 Re-assess the patient after any intervention Vitals (HR/BP), inspect, periph temp, cap refil, pulse

Disability + Drugs/documentation
V 31 Assess level of consciousness using ACVPU or GCS

32 Assess the pupils Size, symmetry, reactive to light?

E
33 Perform a brief neurological assessment (ask patient to move their limbs if able)

34 Review the drug chart for relevant medications (e.g. opioids, sedatives, anxiolytics)
DOCUMENTATION- past medical hist, medication
I 35 Measure capillary blood glucose

36 Request CT head if intracranial pathology suspected (e.g. stroke)

T 37 Initiate appropriate management for specific causes of reduced consciousness (e.g.

naloxone) Analgesia
R 38 Re-assess the patient after any intervention LOC, pupils (opening eyes, size/symmetry, reactivity), brief neuro

Exposure
39 Exposure the patient as appropriate and inspect for relevant clinical signs (e.g. rashes,
cellulitis, infected surgical wound, swollen calf) “Rashes, infection, bleeding/bruising, scars, ”
E “Injuries, bleeding, infection”
40 Briefly palpate the abdomen for any tenderness/distension ? peritonism

41 Palpate the calves for tenderness Peripheral oedema - DVT

V 42 Review the patient’s temperature

I 43 Request swabs/samples to be taken from any potential infective sources Sample for CULTURE

T
44 Initiate appropriate management for identified problems (e.g. warming for hypothermia, treat
infection, control bleeding) Analgesia +/- urinary cathertisation
R 45 Re-assess the patient after any intervention Temp, pain, swelling levels

Escalation and handover

46 Seek appropriate advice from a senior clinician or specialist team

47 Use an effective SBAR handover to communicate key information

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F - phone a friend G = Glucose H - Handover

GCS < 8 — call anaesthetics airway support

No signs of life (at any point) > Crash call > Start CPR