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Domain 3 : Disease management
Diagnostic accuracy determines therapeutic specificity. Although in the early phases of managing an acutely ill patient, physiological safety and support are the main issues, making the correct diagnosis and providing the right treatment will determine the patient's outcome. Disease management therefore requires skills in integrating clinical information with laboratory data, and applying 'best practice' guidelines promptly and effectively. It also involves regular clinical review with revision of diagnostic possibilities and modification of treatment according to patient response.

Acute disease: 

By the end of specialist training, the trainee...

3.1 Manages the care of the critically ill patient with specific acute medical conditions
NB. Specific and relevant conditions should be defined according to national case mix but may include: Respiratory disorders; Cardiovascular disorders; Shock syndromes; Hypo / hyperthermia; Haematological, Oncological, Immunologic and Rheumatologic disorders; Metabolic & Endocrine disorders; Infections; Gastrointestinal disorders; Neurological disorders; Neuromuscular disorders; Renal disorders; Hepato-biliary disorders.

Co-morbid disease:

By the end of specialist training, the trainee...

3.2 Identifies the implications of chronic and co-morbid disease in the acutely ill patient
NB. Chronic co-morbid disease may include, for example: diabetes; COPD; CHF; cirrhosis, malignancy, previous solid organ transplantation.

Organ system failure:

By the end of specialist training, the trainee...

3.3 Recognises and manages the patient with circulatory failure
3.4 Recognises and manages the patient with, or at risk of, acute renal failure
3.5 Recognises and manages the patient with, or at risk of, acute liver failure
3.6 Recognises and manages the patient with neurological impairment
3.7 Recognises and manages the patient with acute gastrointestinal failure
3.8 Recognises and manages the patient with acute lung injury syndromes (ALI / ARDS)
3.9 Recognises and manages the septic patient
3.10 Recognises and manages the patient following intoxication with drugs or environmental toxins
3.11 Recognises life-threatening maternal peripartum complications and manages care under supervision

Features of competent performance

  • Recognition of presenting signs and symptoms
  • Identification and rapid response to life-threatening complications
  • Prioritise investigations and monitoring - appropriate; timely
  • Appropriate differential diagnosis
  • Clear decision making and immediate management strategies (including application of relevant protocols / guidelines / care bundles)
  • Interpret data in the clinical context
  • Accurate differential diagnosis on basis of information available
  • Effective team-working & leadership - clear communication & instructions
  • Appropriate referral / consultation LI>
  • Recognition of limitations (self and others)
  • Attention to patient safety
All competencies
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Note that the "Resources" that are included in this page, have not been updated in the recent years. An updated collection of useful resources will be available soon as part of the ESICM Academy (for more details, see www.esicm.org).

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