- basic template for answering FCICM exam questions on ‘clinical management’
- may or may not include assessment depending on need to confirm the diagnosis
- remember to address the condition, the cause and the complications
- History – features / risk factors / complications / Rx already given and response
- Examination – vitals / features / complications / +/- risk factors
- Investigations – Bedside / Laboratory / Imaging / Other (guided by history and examination)
Resuscitation (ABCDEFGH… if indicated)
- coordinated team-based approach in an appropriate setting involving simultaneous assessment and management while attending to immediate life threats
- IV/ O2 / Monitor
- Respiratory support (A&B) – NIV, mechanical ventilation, airway, adjucts
- Haemodynamic support (C) – fluid, inotropes, mechanical support
- Neurological support (D) – coma, seizures, ICP, naloxone, thiamine
- DEFG! (glucose)
- or H! (help)
Seek and treat
- underlying cause
- complications (of disease and treatments given)
Supportive care and monitoring
- House-keeping: FASTHUGS IN BED Please
- appropriate invasive monitoring and serial assessment
- correct metabolic and electrolyte disturbance if appropriate
Disposition and Followup (ABCDEx2)
- Admit or advise (admit ICU/HDU/OT/ward; advise appropriate ongoing management and follow up)
- Bus pass and bureaucracy (address social issues; audit/QA/bed state/ arrange transfer)
- Consult and communicate (appropriate specialties; GP, family, other services)
- Document and Debrief
- Educate and consider End Of Life Issues (educate staff and patient; consider DNR?)
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.