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Home / Station 6: Fever with hypotension

NAC OSCE preparation

Station 6: Fever with hypotension

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Fever with hypotension

11 minutes

Discipline: Emergency & Clinical Safety
Station type: Emergency management
Setting: Emergency department

Your task

Assess the patient and explain immediate management. Findings are provided when requested.

Information available at entry

HR 126/minBP 82/48 mm HgRR 28/minSpO₂ 93%T 39.2°CCapillary refill 4 s

Coach prompt: Recognize septic shock and start time-sensitive care and source control.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 6 of 30

Standardized-patient profile

NameMs. Elena Petrova

Age64

Pronounsshe/her

RolePatient

Demeanour: Drowsy but arousable.

Opening statement: “I have fever and shaking chills and now feel very weak and confused.”

History and standardized-patient responses

Source

Candidate explores	Standardized-patient response
Urinary	Dysuria and right flank pain for two days.
Other sources	No cough, focal abdominal pain, rash or vascular device.

Severity

Candidate explores	Standardized-patient response
Mental state	Family noted confusion this morning.
Urine/intake	Very little urine and poor intake.

Background

Candidate explores	Standardized-patient response
Comorbidity	Type 2 diabetes and CKD stage 3.
Allergy	Severe immediate penicillin allergy.
Resistance risk	No recent antibiotics or known resistant organism.
Goals	Full resuscitation.

Physical findings

Warm peripheries, delayed refill and dry mucosa.
Right CVA tenderness.
No focal lung signs or meningism.

Examiner prompts

Diagnosis?

Septic shock, likely pyelonephritis/urosepsis.

First-hour care?

Resuscitation call, ABCs, monitoring, IV access, lactate/cultures, early allergy-appropriate broad-spectrum IV antibiotics, crystalloid with reassessment, urine output monitoring and source evaluation.

Persistent hypotension?

Start vasopressor support, usually norepinephrine, in critical care and pursue source control.

Differential diagnosis

Septic shock from pyelonephritis
Obstructed infected urinary tract
Pneumonia
Intra-abdominal sepsis
Adrenal crisis
Other shock

Investigations

CBC, electrolytes, renal/liver function and glucose
Lactate and blood gas
Blood cultures if they do not delay antibiotics
Urinalysis and culture
Renal imaging if obstruction suspected

Management

Immediate sepsis resuscitation
Prompt empiric IV antibiotics tailored to allergy/source
Crystalloid with dynamic reassessment
Vasopressor/critical-care escalation
Early drainage/source control if obstruction
Narrow therapy when data return

Communication behaviours

Use brief questions and collateral
Explain infection is affecting blood pressure and organs
Avoid outcome promises

Critical safety actions

Do not delay antibiotics or hemodynamic support
Reassess after interventions
Obstructed infection is a source-control emergency

Model closing summary

This 64-year-old woman has septic shock with encephalopathy and oliguria, likely from pyelonephritis and possibly an obstructed infected urinary system. I would activate resuscitation, obtain monitoring and IV access, draw lactate, cultures and organ-function tests, begin prompt allergy-appropriate IV antibiotics and crystalloid with frequent reassessment, and escalate to vasopressors/critical care if hypotension persists while urgently evaluating for obstruction.

Common pitfalls

Waiting for all results before antibiotics
Unlimited fluid without reassessment in CKD
Ignoring allergy details
No source-control plan

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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