Two teenagers, 1 boy and 1 girl, have been brought into the ED by a concerned parent. The boy seems aggressive and is yelling profanities, whilst holding a blood-soaked towel on his scalp. He seems sweating and is breathing heavily with a familiar boozy-smell of alcohol. He vomits a few times after arriving. The girl claims to be his girlfriend. She is giggling uncontrollably and sways restlessly in her chair. She won’t stop talking.
Instructions to actors:
Teenage boy (Jack):
- Jack has T1D and is suffering from Ketoacidosis as a result of Hypoglycaemia. He behaves as if intoxicated: aggressive, uncooperative, sweating profusely, covered in sweat and smells of alcohol.
- (Confusion) When asked about what happened, he gives no information other than blaming the girl next to him, pointing and saying “It’s all Stacey’s fault”. However, the girl’s name is actually Maddie.
- He is bleeding profusely from the scalp, just above his right eye. The towel is drenched in blood and blood is running down his face.
- He feels nauseous and vomits once a minute.
- He is extremely uncooperative and fights back if staff try to administer IV treatment before attempting to calm him down (IM injection will be required, or sedative)
- At 5 minutes, GCS drops to below 9
Teenage girl (Maddie):
- Maddie is actually drunk. She is hyperactive and keen to give information about what happened tonight. She is giddy and swaying back-and-forth restlessly in her chair. She flirts with any male staff.
- When asked how much they drank, she says: “Not much, just 1 or 10” whilst giggling.
- When asked how Jack got injured, she says: “He was hit in the head during a fight with another boy at the party, they were fighting over me.” But later, also adds “I think I saw him hit his head on the ground when he was vomiting.”
- When Jack gets her name wrong: she gets offended and says she’s breaking up with him. She starts to vomit.
Regrets serving alcohol at the house party. Is highly concerned about the legal implications of what has happened.
Instructions to Candidates
You are working in the emergency department when a middle-aged lady brings in a teenaged boy (Jack) and his girlfriend (Maddie). Jack is the patient, and both children appear to be intoxicated.
- Send for Help
- History – T1DM, drugs, alcohol
- Examination – head injury
- Initial investigations
- DKA management
- Intoxication management
- Viva Questions (usually 3) – e.g. complications of DKA
- Communication, leadership, teamwork and prioritisation of patient issues