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Resuscitation and initial management of the acutely ill patient

This is an aggregate of the syllabus for all competencies in Domain 1. To view the syllabus for each competence click here.


Cardiac arrhythmias and the principles of their management (treatment algorithm):
Periarrest arrhythmias ((bradycardia, broad complex tachycardia, atrial fibrillation, narrow complex tachycardia)
VF and pulseless VT
Non-VF / VT rhythms (asystole / PEA)
Early warning signs of impending critical illness
Performance and interpretation of a primary and secondary survey
Organisational principles for the coordination and management of mass casualties
Causes of cardio-respiratory arrest, identification of patients at risk and corrective treatment of reversible causes
Environmental hazards & injuries: hypo- and hyperthermia, near-drowning, electrocution, radiations, chemical injuries, electrical safety/micro shock
Local major incident plan - the role of the ICU in hospital/community disaster plans
Clinical signs associated with critical illness, their relative importance and interpretation
Effects and acute complications of severe trauma on organs and organ systems:
Respiratory - thoracic trauma; acute lung injury; tension pneumothorax
Cardiovascular - hypovolaemic shock; cardiac tamponade
Renal - acute renal failure; rhabdomyolysis
Neurological - altered consciousness; traumatic brain injury; post-anoxic brain injury; coup and contra-coup injuries; intracranial haemorrhage and infarction; spinal cord injury
Gastrointestinal - abdominal trauma; abdominal tamponade; rupture of liver or spleen
Musculoskeletal system - soft tissue injury; short term complications of fractures; fat embolism; crush injury & compartment syndromes; maxillofacial injuries
Communication tasks and personal role in major incident / accident plan
Clinical severity of illness and indications when organ dysfunctions or failure are an immediate threat to life
Relevance of mechanism of injury to clinical presentation
Recognition of life threatening changes in physiological parameters
Cardiopulmonary resuscitation
Secondary insults that potentiate the primary injury
Pathophysiology and medical/surgical management of the phases of a burn injury
Triage methods in use locally
Measures of adequacy of tissue oxygenation
The modification of resuscitation techniques in the special circumstances of hypothermia, immersion and submersion, poisoning, pregnancy, electrocution, anaphylaxis, acute severe asthma and trauma
Immediate specific treatment of life-threatening injury
Calculation of area burned
Characteristics and clinical presentations associated with major incidents caused by natural or civilian disasters, infection epidemics or terrorist attack
Causes, recognition and management of:
     Acute chest pain
     Tachypnoea & dyspnoea
     Upper and lower airway obstruction
     Pulmonary oedema
     Pneumothorax (simple & tension)
     Shock states
     Anaphylactic and anaphylactoid reactions
     Hypertensive emergencies
     Acute confusional states and altered consciousness
     Acute seizures / convulsions
     Oliguria & anuria
     Acute disturbances in thermoregulation
Risks to the rescuer during resuscitation & methods to minimise these
Principles of calculation of fluid losses & fluid resuscitation in the burned patient
Treatment algorithms for common medical emergencies
Immediate management of acute coronary syndromes
Intraosseous cannulation
Decontamination procedures
Methods for securing vascular access rapidly
Principles of crisis management, conflict resolution, negotiation and debriefing
Indications, doses and actions of primary drugs used in the management of a cardiac arrest (inc. special precautions and contraindications)
Psychological support for patients and relatives
Techniques for effective fluid resuscitation
Principles of blood and blood component therapy; principles of massive transfusion
Tracheal route for drug administration: indications, contraindications, dosage
Management of public relations and information
Treatment strategies for abnormalities of fluid, electrolyte, acid-base and glucose balance
Indications, dosages and actions of drugs used in the peri-arrest period
Principles and application of therapeutic hypothermia
Principles of internal hospital communication
Indications for and methods of ventilatory support
Alternative forms of external communication
Respiratory complications of burn injuries (smoke inhalation, airway burns) - detection and management
Indications and methods of cardiac pacing in the peri-arrest setting
Management of cervical spine injuries
Effect of cardiorespiratory arrest on body systems
Indications for not starting resuscitation or ceasing an initiated attempt
Methods for assessing neurological function e.g. Glasgow Coma Scale
Audit of outcome after cardiac arrest
Relevance of prior health status in determining risk of critical illness and outcomes
Triage and management of competing priorities
Principles of management of closed head injury; coup and contra-coup injuries; methods of preventing 'secondary insult' to the brain; recognition and immediate management of raised intracranial pressure
Legal and ethical issues relating to the use of the recently dead for practical skills training, research and organ donation
Criteria for admission to, and discharge from ICU - factors influencing intensity and site of care (ward, high dependency unit (HDU), intensive care unit (ICU))
Principles, including indications, limitations and therapeutic modalities of basic radiological methods, CT scanning, MRI, ultrasound, angiography and radionucleotide studies in the critically ill patient
Recognition and management of acute disturbances in thermoregulation
Indications for and basic interpretation of chest radiographs: range of normal features on a chest x-ray; collapse, consolidation, infiltrates (including ALI/ARDS), pneumothorax, pleural effusion, pericardial effusion, position of cannulae, tubes or foreign bodies, airway compression, cardiac silhouette, mediastinal masses
The environmental control necessary for optimal care of the burned patient
Principles of outcome prediction / prognostic indicators and treatment intensity scales; limitations of scoring systems in predicting individual patient outcome
Prevention of infection in the burned patient
Burn-related compartment syndrome and escharotomy

Skills & Behaviours

Consult and take into account the views of referring clinicians; promote their participation in decision making where appropriate
Assess and communicates effectively the risks and benefits of intensive care admission
Discuss treatment options with a patient or relatives before ICU admission
Take decisions to admit, discharge or transfer patients
Determine when the patient's needs exceed local resources or specialist expertise (requirement for transfer)
Explain life-sustaining therapies, in clear language, and describe the expected outcome of such therapies in view of the patient's goals and wishes.
Considers legal and ethical issues: patient autonomy, appropriateness of resuscitation and ICU admission.
Conduct a primary survey: obtain relevant information rapidly and accurately
Recognise signs and symptoms of impending cardiac arrest
Assess conscious level, status of airway and cervical spine, and conduct careful systems review
Consider the need for stabilisation before transfer
Order and prioritise appropriate investigations
Check & assemble resuscitation equipment
Assess and document Glasgow Coma Scale (GCS)
Use emergency monitoring equipment
Demonstrate advanced life support skills (ALS standard or equivalent)
Monitor vital physiological functions as indicated
Recognise and rapidly respond to adverse trends in monitored parameters
Recognise and manage choking / obstructed airway
Assess burn severity and prescribe initial fluid resuscitation
Implement emergency airway management, oxygen therapy and ventilation as indicated
Estimate burn wound mortality from published data tables
Demonstrate emergency relief of tension pneumothorax
Prioritise the order of investigations and interventions for individual injuries according to their threat to life
Obtain vascular access sufficient to manage acute haemorrhage, rapid fluid infusion and monitor cardiovascular variables
Act appropriately as a member or leader of the team (according to skills & experience)
Describe the endpoints of burn resuscitation and preferred fluids
Initiate emergency cardiac pacing
Identify or describe risk factors for airway compromise in the burned patient
Respond to an emergency in a positive, organised and effective manner; able to direct the resuscitation team
Support relatives witnessing an attempted resuscitation
Identification and management of carbon monoxide poisoning
Participate in timely discussion and regular review of 'do not resuscitate' orders and treatment limitation decisions
Professional and reassuring approach - generates confidence and trust in patients and their relatives
Protect a potentially unstable cervical spine
Examine and plan care for the confused patient
Perform a comprehensive secondary survey; integrate history with clinical examination to form a differential diagnosis
Assess, predict and manage circulatory shock
Prescribe appropriate analgesia
Lead, delegate and supervise others appropriately according to experience and role
Recognise and manage emergencies; seek assistance appropriately


Rapid response and resuscitation
Appreciates the importance of timely institution of organ-system support
Recognises the need for supportive care for all organ systems whether failing / injured or not
Clear in explanations to patient, relatives and staff
Establishes trusting relationships with and demonstrates compassionate care of patients and their relatives
Patient safety is paramount
Determination to provide best and most appropriate care possible regardless of environment
Appreciate the importance of ensuring physiological safety as a primary aim
Recognises personal limitations, seeks and accepts assistance or supervision (knows how, when and who to ask)

Basic Sciences also underpin the competencies within this domain. These are presented in full in the Basic Sciences Syllabus.

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