ACUTE &
CRITICAL
CARE
4TH YEAR MEDICINE
Indeera Shankla
, Table of Contents
Aims & Learning Objectives .................................................................................................................................. 3
Acute Medicine.................................................................................................................................................... 4
Important Areas............................................................................................................................................... 4
Clinical Presentations - Essential ....................................................................................................................... 5
Chest Pain ................................................................................................................................................................. 5
Shortness of Breath ................................................................................................................................................ 11
Limb Pain/Swelling ................................................................................................................................................. 12
Blood Glucose Disturbances ................................................................................................................................... 14
Substance Misuse ................................................................................................................................................... 16
Serious Infections ................................................................................................................................................... 20
Acute Kidney Injury ................................................................................................................................................ 21
Confusion & Delirium ............................................................................................................................................. 24
Clinical Presentations - Desirable .................................................................................................................... 25
Anaphylaxis ............................................................................................................................................................ 25
Unconscious Patient ............................................................................................................................................... 27
Acute Coronary Syndrome ..................................................................................................................................... 28
COPD - Acute Exacerbation .................................................................................................................................... 29
Subarachnoid Haemorrhage .................................................................................................................................. 30
Syncope .................................................................................................................................................................. 31
Electrolyte Disturbances ........................................................................................................................................ 32
Clinical Presentations - Enhanced Learning ..................................................................................................... 34
Chest Pain ............................................................................................................................................................... 34
Overdose ................................................................................................................................................................ 36
Acute Weakness ..................................................................................................................................................... 38
Asthma - Acute Exacerbation ................................................................................................................................. 41
Seizures .................................................................................................................................................................. 42
Skills - Essential .............................................................................................................................................. 44
ECG ......................................................................................................................................................................... 44
CXR ......................................................................................................................................................................... 46
ABG ......................................................................................................................................................................... 49
NEWS Score ............................................................................................................................................................ 50
IV Cannulation ........................................................................................................................................................ 51
Venepuncture ......................................................................................................................................................... 52
Oxygen Devices ...................................................................................................................................................... 53
Capillary Blood Glucose Sampling .......................................................................................................................... 54
Skills - Desirable ............................................................................................................................................. 55
Oxygen Prescribing ................................................................................................................................................. 55
Fluids ...................................................................................................................................................................... 56
Antibiotic Therapy .................................................................................................................................................. 58
Analgesia ................................................................................................................................................................ 61
ABG Sampling ......................................................................................................................................................... 62
Inhaler Technique................................................................................................................................................... 63
Nebuliser use .......................................................................................................................................................... 64
Skills - Enhanced Learning .............................................................................................................................. 65
Insulin Prescribing .................................................................................................................................................. 65
Alcohol Withdrawal ................................................................................................................................................ 66
Paracetamol Poisoning ........................................................................................................................................... 67
Anaesthesia ....................................................................................................................................................... 68
Learning Objectives........................................................................................................................................ 68
Curriculum ..................................................................................................................................................... 68
Knowledge .............................................................................................................................................................. 68
1
, Skills ...................................................................................................................................................................... 68
Attitude .................................................................................................................................................................. 68
Behaviour ............................................................................................................................................................... 68
Anaesthetic and Airway Equipment ................................................................................................................ 69
Airway Equipment .................................................................................................................................................. 69
Monitoring.............................................................................................................................................................. 71
Anaesthetic Drugs .......................................................................................................................................... 72
IV Induction Agents ................................................................................................................................................ 72
Inhalation Anaesthetics .......................................................................................................................................... 73
Neuromuscular blockers ........................................................................................................................................ 74
Inotropic Agents ..................................................................................................................................................... 75
Local Anaesthetics .................................................................................................................................................. 76
Antiemetics and antacids ....................................................................................................................................... 78
Analgesic Agents .................................................................................................................................................... 79
Anaesthetic Management .............................................................................................................................. 83
Pre-operative Assessment...................................................................................................................................... 83
Preoperative management .................................................................................................................................... 87
Postoperative management ................................................................................................................................... 89
Other Related Topics...................................................................................................................................... 91
Regional Anaesthesia ............................................................................................................................................. 91
CEPOD classification ............................................................................................................................................... 93
Critical Care ....................................................................................................................................................... 94
Core Knowledge............................................................................................................................................. 94
General Principles of Critical Care .......................................................................................................................... 94
Shock, Cardiovascular Failure and Resuscitation ................................................................................................... 99
Respiratory Failure and Oxygen Therapy ............................................................................................................. 101
Renal Failure ......................................................................................................................................................... 104
Neurological Injuries & Trauma ........................................................................................................................... 105
Infection Control .................................................................................................................................................. 107
Post-critical Care .................................................................................................................................................. 107
Ethics, Law, Death & Donation ............................................................................................................................. 108
Practical Procedures..................................................................................................................................... 114
To Perform............................................................................................................................................................ 114
To Observe ........................................................................................................................................................... 114
Emergency Medicine ........................................................................................................................................ 115
Curriculum ................................................................................................................................................... 115
Presenting Complaints & Core Conditions ..................................................................................................... 116
Abdominal Pain .................................................................................................................................................... 116
Atraumatic Leg Pain ............................................................................................................................................. 131
Breathlessness...................................................................................................................................................... 136
Chest Pain ............................................................................................................................................................. 144
Collapse ................................................................................................................................................................ 149
Deliberate Self Harm ............................................................................................................................................ 164
Headache.............................................................................................................................................................. 168
Infection ............................................................................................................................................................... 173
MSK Problems ...................................................................................................................................................... 179
Palpitations/ Dysrhythmia.................................................................................................................................... 183
Shock .................................................................................................................................................................... 188
Trauma ................................................................................................................................................................. 193
Urinary Problems.................................................................................................................................................. 194
Acute Breathlessness ........................................................................................................................................... 199
OSCE................................................................................................................................................................ 200
OSCE Stations .............................................................................................................................................. 200
Pre-Op Assessment ...................................................................................................................................... 201
2
, Aims & Learning Objectives
Apply legal and ethical principles in the care of acutely ill/unconscious patients with (temporary) lack of
capacity
Appreciate (and have developed) a structured approach to the acutely ill or injured patient.
Appreciate the multi-faceted approach to recognizing an acutely unwell patient (clinical assessment,
deranged physiology and/or MEWS and use of nearside investigations)
Appreciate the patho-physiological changes that occur in acutely unwell or deteriorating patients and
recognise the importance of applying acute changes in a patient’s physiological status to their immediate
medical management.
Assess acutely ill patients, incorporating communication with patients, relatives and other clinical staff
Demonstrate competence in the simple interpretation of: blood gases, ECGs, CXRs, urinanalysis.
Demonstrate competence in: obtaining blood gases (arterial and venous), using cannula packs, obtaining
blood samples, basic airway management, checking baseline observations , calculating the MEWS score,
emergency use of oxygen, setting up intravenous fluid and resuscitation.
Demonstrate safe medicines management including decision making and supervised prescribing according to
the student formulary
Have reflected on the acute assessment and further management of patients with common acute
presentations such as: chest pain, breathlessness, collapse, reduced consciousness, sepsis, confusion,
abdominal pain, head injury, overdose and haemorrhage.
Understand basic principles of airway management, preoperative evaluation, peri- operative investigations,
fluid management, anaesthetic drugs, acute pain management and peri-operative oxygen delivery
Understand the need for early escalation of care to appropriate seniors/specialties, good communication
(including SBARR) and sound teamwork in the management of acutely unwell patients.
Understand the paramount importance of the placement is to recognise acutely ill or deteriorating patients
to ensure patient safety and reduce professional vulnerability in the clinical environment.
Understand the peri-operative anaesthetic care of the surgical patient.
Understand the principles of managing respiratory failure, shock and sepsis and VTE prophylaxis.
Understand the usefulness and limitations of “near-side” investigations, in guiding clinical decisions in the
resuscitation of acutely unwell patients.
3
CRITICAL
CARE
4TH YEAR MEDICINE
Indeera Shankla
, Table of Contents
Aims & Learning Objectives .................................................................................................................................. 3
Acute Medicine.................................................................................................................................................... 4
Important Areas............................................................................................................................................... 4
Clinical Presentations - Essential ....................................................................................................................... 5
Chest Pain ................................................................................................................................................................. 5
Shortness of Breath ................................................................................................................................................ 11
Limb Pain/Swelling ................................................................................................................................................. 12
Blood Glucose Disturbances ................................................................................................................................... 14
Substance Misuse ................................................................................................................................................... 16
Serious Infections ................................................................................................................................................... 20
Acute Kidney Injury ................................................................................................................................................ 21
Confusion & Delirium ............................................................................................................................................. 24
Clinical Presentations - Desirable .................................................................................................................... 25
Anaphylaxis ............................................................................................................................................................ 25
Unconscious Patient ............................................................................................................................................... 27
Acute Coronary Syndrome ..................................................................................................................................... 28
COPD - Acute Exacerbation .................................................................................................................................... 29
Subarachnoid Haemorrhage .................................................................................................................................. 30
Syncope .................................................................................................................................................................. 31
Electrolyte Disturbances ........................................................................................................................................ 32
Clinical Presentations - Enhanced Learning ..................................................................................................... 34
Chest Pain ............................................................................................................................................................... 34
Overdose ................................................................................................................................................................ 36
Acute Weakness ..................................................................................................................................................... 38
Asthma - Acute Exacerbation ................................................................................................................................. 41
Seizures .................................................................................................................................................................. 42
Skills - Essential .............................................................................................................................................. 44
ECG ......................................................................................................................................................................... 44
CXR ......................................................................................................................................................................... 46
ABG ......................................................................................................................................................................... 49
NEWS Score ............................................................................................................................................................ 50
IV Cannulation ........................................................................................................................................................ 51
Venepuncture ......................................................................................................................................................... 52
Oxygen Devices ...................................................................................................................................................... 53
Capillary Blood Glucose Sampling .......................................................................................................................... 54
Skills - Desirable ............................................................................................................................................. 55
Oxygen Prescribing ................................................................................................................................................. 55
Fluids ...................................................................................................................................................................... 56
Antibiotic Therapy .................................................................................................................................................. 58
Analgesia ................................................................................................................................................................ 61
ABG Sampling ......................................................................................................................................................... 62
Inhaler Technique................................................................................................................................................... 63
Nebuliser use .......................................................................................................................................................... 64
Skills - Enhanced Learning .............................................................................................................................. 65
Insulin Prescribing .................................................................................................................................................. 65
Alcohol Withdrawal ................................................................................................................................................ 66
Paracetamol Poisoning ........................................................................................................................................... 67
Anaesthesia ....................................................................................................................................................... 68
Learning Objectives........................................................................................................................................ 68
Curriculum ..................................................................................................................................................... 68
Knowledge .............................................................................................................................................................. 68
1
, Skills ...................................................................................................................................................................... 68
Attitude .................................................................................................................................................................. 68
Behaviour ............................................................................................................................................................... 68
Anaesthetic and Airway Equipment ................................................................................................................ 69
Airway Equipment .................................................................................................................................................. 69
Monitoring.............................................................................................................................................................. 71
Anaesthetic Drugs .......................................................................................................................................... 72
IV Induction Agents ................................................................................................................................................ 72
Inhalation Anaesthetics .......................................................................................................................................... 73
Neuromuscular blockers ........................................................................................................................................ 74
Inotropic Agents ..................................................................................................................................................... 75
Local Anaesthetics .................................................................................................................................................. 76
Antiemetics and antacids ....................................................................................................................................... 78
Analgesic Agents .................................................................................................................................................... 79
Anaesthetic Management .............................................................................................................................. 83
Pre-operative Assessment...................................................................................................................................... 83
Preoperative management .................................................................................................................................... 87
Postoperative management ................................................................................................................................... 89
Other Related Topics...................................................................................................................................... 91
Regional Anaesthesia ............................................................................................................................................. 91
CEPOD classification ............................................................................................................................................... 93
Critical Care ....................................................................................................................................................... 94
Core Knowledge............................................................................................................................................. 94
General Principles of Critical Care .......................................................................................................................... 94
Shock, Cardiovascular Failure and Resuscitation ................................................................................................... 99
Respiratory Failure and Oxygen Therapy ............................................................................................................. 101
Renal Failure ......................................................................................................................................................... 104
Neurological Injuries & Trauma ........................................................................................................................... 105
Infection Control .................................................................................................................................................. 107
Post-critical Care .................................................................................................................................................. 107
Ethics, Law, Death & Donation ............................................................................................................................. 108
Practical Procedures..................................................................................................................................... 114
To Perform............................................................................................................................................................ 114
To Observe ........................................................................................................................................................... 114
Emergency Medicine ........................................................................................................................................ 115
Curriculum ................................................................................................................................................... 115
Presenting Complaints & Core Conditions ..................................................................................................... 116
Abdominal Pain .................................................................................................................................................... 116
Atraumatic Leg Pain ............................................................................................................................................. 131
Breathlessness...................................................................................................................................................... 136
Chest Pain ............................................................................................................................................................. 144
Collapse ................................................................................................................................................................ 149
Deliberate Self Harm ............................................................................................................................................ 164
Headache.............................................................................................................................................................. 168
Infection ............................................................................................................................................................... 173
MSK Problems ...................................................................................................................................................... 179
Palpitations/ Dysrhythmia.................................................................................................................................... 183
Shock .................................................................................................................................................................... 188
Trauma ................................................................................................................................................................. 193
Urinary Problems.................................................................................................................................................. 194
Acute Breathlessness ........................................................................................................................................... 199
OSCE................................................................................................................................................................ 200
OSCE Stations .............................................................................................................................................. 200
Pre-Op Assessment ...................................................................................................................................... 201
2
, Aims & Learning Objectives
Apply legal and ethical principles in the care of acutely ill/unconscious patients with (temporary) lack of
capacity
Appreciate (and have developed) a structured approach to the acutely ill or injured patient.
Appreciate the multi-faceted approach to recognizing an acutely unwell patient (clinical assessment,
deranged physiology and/or MEWS and use of nearside investigations)
Appreciate the patho-physiological changes that occur in acutely unwell or deteriorating patients and
recognise the importance of applying acute changes in a patient’s physiological status to their immediate
medical management.
Assess acutely ill patients, incorporating communication with patients, relatives and other clinical staff
Demonstrate competence in the simple interpretation of: blood gases, ECGs, CXRs, urinanalysis.
Demonstrate competence in: obtaining blood gases (arterial and venous), using cannula packs, obtaining
blood samples, basic airway management, checking baseline observations , calculating the MEWS score,
emergency use of oxygen, setting up intravenous fluid and resuscitation.
Demonstrate safe medicines management including decision making and supervised prescribing according to
the student formulary
Have reflected on the acute assessment and further management of patients with common acute
presentations such as: chest pain, breathlessness, collapse, reduced consciousness, sepsis, confusion,
abdominal pain, head injury, overdose and haemorrhage.
Understand basic principles of airway management, preoperative evaluation, peri- operative investigations,
fluid management, anaesthetic drugs, acute pain management and peri-operative oxygen delivery
Understand the need for early escalation of care to appropriate seniors/specialties, good communication
(including SBARR) and sound teamwork in the management of acutely unwell patients.
Understand the paramount importance of the placement is to recognise acutely ill or deteriorating patients
to ensure patient safety and reduce professional vulnerability in the clinical environment.
Understand the peri-operative anaesthetic care of the surgical patient.
Understand the principles of managing respiratory failure, shock and sepsis and VTE prophylaxis.
Understand the usefulness and limitations of “near-side” investigations, in guiding clinical decisions in the
resuscitation of acutely unwell patients.
3
