Clinical Management Template

OVERVIEW

• 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

TEMPLATE

Assessment

• 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)

Specific therapy

• Pharmacological
• Physical
• Psychological
• Procedural

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?)