Transcript 6 months of EM in ACCS

Bringing it all together
The Major and Acute Presentations
Major presentations
 6 over 2 years
 2 in EM; 2 in AM; 2 in any module
 Septic patient ideally assessed during ICM
 Anaphylaxis assessment may be on a simulated patient
(e.g. during Anaesthetics)
1 Anaphylaxis
2 Cardiorespiratory Arrest (Valid ALS Certificate Mandatory)
3 Major Trauma
4 Septic Patient
5 Shocked Patient
6 Unconscious Patient
Forms required for Majors
 Use specific forms when available and generic forms
when not
 Ideally use the forms of the specialty to which you are
attached at the time of the assessment
 Major Presentation descriptors
 Mini-CEX - specific forms available for:
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Shock
Sepsis
Major Trauma
Cardiac Arrest
Anaphylaxis
Unconscious patient
 CBD
 Summative CBD (generic form)
Mini-CEX form for Shock
Expected knowledge, skills and behaviour being assessed:
Skills
from ACCS curriculum
Shocked Patient
The trainee will be able to identify a shocked
patient, assess their clinical state, produce a list of
appropriate differential diagnoses and initiate
immediate management
Knowledge
•Identify physiological perturbations that define
shock and understand the pathophysiology of its
cause
•Identify principle categories of shock
•Elucidate main causes of shock in each
category (e.g. MI, heart failure, PE, blood loss,
sepsis)
•Demonstrate knowledge of sepsis syndromes
•Demonstrate a knowledge of the roles and the
different types of monitoring required for the
shocked patient
•Understand the role of imaging in the diagnosis
of shock e.g. FAST scan, CT etc and be able to
interpret the fundamentals of this imaging
•Demonstrate a knowledge of the different fluids
fluids and drugs e.g. inotropes used in the
treatment of shock
•Recognise significance of major physiological
perturbations
•Perform immediate (physical) assessment (A,B,C)
•Institute immediate, simple resuscitation (oxygen, iv
access, fluid resuscitation)
•Arrange simple monitoring of relevant indices (oximetry,
arterial gas analysis) and vital signs (BP, pulse & respiratory
rate, temp, urine output)
•To be able to gain vascular access in the shocked
patient, including central venous (using Ultrasound),
arterial line, intra-osseous and cut down techniques
•Order, interpret and act on initial investigations
appropriately: ECG, blood cultures, blood count,
electrolytes, CVP measurements
•Recognition of the need for urgent surgical intervention
Behaviour
•Exhibit calm and methodical approach to assessing
critically ill patient
•Adopt leadership role where appropriate
•Involve senior and specialist (e.g. critical care outreach)
services promptly
Acute Presentations
 38 Acute Presentations
 Complete 10 AP in AM and 10 AP in EM:
 5 AP using specific mini-CEX/generic summative
CBD forms in EM
 5 AP using Formative CBD/Mini-CEX forms in AM
(ICM)
 5 AP in an ACAT for AM or EM
 Plus 8 -10 additional AP in AM and EM using:
 E-learning modules
 Audit and Teaching
 Reflective notes
 Additional ACATs
List of acute presentations
Mini-CEX form for Acute Presentation: Head injury
Expected Behaviour
in assessment of
Acute Presentation
5 Head Injury
Initial
approach
Ensures ABC are adequate and
that neck is immobilised in the
unconscious patient and those
with neck pain.
Ensures BM done.
Generic summative Mini-CEX form
for acute presentations
Summary: Sample CT1-2
CT1 first placement: EM
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2 Major presentations:
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Major Trauma: mini-CEX
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Shock: Summative CBD
5 Acute presentations (summative):
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Abdominal pain: CBD
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Head injury: Mini-CEX
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Breathlessness: Mini-CEX
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Mental Health: CBD
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Chest pain: Mini-CEX
5 AP: ACAT- EM:
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Cough
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Falls
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Syncope
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Traumatic limb injuries
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Acute Back pain
8 AP:
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E-learning modules: 5 on BMJ.com and Doctors.net (Pelvic pain, Wound assessment, Red eye, Rash,
Painful ear)
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Teaching (Vaginal bleeding)
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Audit (Pain management)
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Reflective notes: Fits/Seizure
CT1 second placement: Acute Medicine
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2 Major Presentations:
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Cardiac arrest: Mini-CEX
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Anaphylaxis: Mini-CEX
10 Acute presentations:
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Oliguric patient: CBD
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Palpitations: CBD
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Jaundice: CBD
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Headache: mini-CEX
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Blackout/Collapse: CBD
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1 ACAT- AM:
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Abdominal swelling
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Cyanosis
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Haematemesis & Melaena
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Dizziness & Vertigo
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Confusion
9 AP:
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2 ACAT-AM
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Neck pain
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Nausea and vomiting
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Stroke
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Poisoning
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Fever
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Disturbed behaviour
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Teaching: Diarrhoea
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E-learning: Sore throat, Atraumatic limb pain
Summary
CT2: 3rd placement: Anaesthetics
 No Major or Acute presentations required
CT2: 4th placement: ICM
 2 major presentations:
 Septic patient: Mini-CEX
 Unconscious patient: CBD
 1 Remaining acute presentation:
 Ventilatory support: Mini-CEX
 Not required if all completed during EM and AM
Done, until CT3 in your parent specialty!