Medical Expertise

Prioritisation and Decision Making


Leadership and Management



A 21 year old female with a known history of asthma has been brought into the resus bay by ambulance. She is severely dyspnoeic and unable to speak. She has had a viral URTI for the last 3 days where she has been at home alone, there is no one to accompany her and she is unable to give further history. She has been on continuous nebulised salbutamol for 30 minutes without marked improvement. She has a single IV line and the nurses have drawn blood for a VBG and the patient has had a CXR of which the result is pending. It is unclear from the patient or the notes any further history of her asthma/PMG/Meds.

Observations are as follows:

P 140

Sats 93% 100% NRB

RR 36

Temperature 37.4

BP 130/90



  • Candidate
    • You are the senior doctor in a small ED called to see a new patient with asthma in the resus bay. The clinical scenario is as above. The patient will be a high fidelity mannequin. You will have a nurse and an RMO to assist you with procedures.
    • Assume that the patient is too breathless to give further history
    • You are required to
      • Assume clinical leadership
      • Assess the clinical situation
      • Describe and interpret any available investigations aloud to the team
        • If you request investigations the nurse will inform you when they are ready to view
      • Direct appropriate management for this patient
        • Ensure that you include doses and routes of administration
      • Please note:
        • Non Invasive Ventilation is not possible
        • You will not be assessed on advanced airway management



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