Breathlessness
The trainee will be able to assess a patient presenting with breathlessness to produce a valid differential diagnosis, investigate appropriately, formulate and implement a management plan
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Knowledge
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Assessment Methods
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GMP Domains
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Recall the common and/or important cardio-respiratory conditions that present with breathlessness
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E, C, Mi, ACAT
|
1
|
Differentiate orthopnoea and paroxysmal nocturnal dyspnoea
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E, C, Mi, ACAT
|
1
|
Identify non cardio-respiratory factors that can contribute to or present with breathlessness e.g. acidosis
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E, C, Mi, ACAT
|
1
|
Define basic pathophysiology of breathlessness
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E, C, Mi, ACAT
|
1
|
List the causes of wheeze and stridor
|
E, C, Mi, ACAT
|
1
|
Demonstrate knowledge of the indications, contraindications and adverse effects of the drugs used to treat the causes of breathlessness
|
E, C
|
1
|
Outline indications for CT chest, CT pulmonary angiography, spirometry
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E, C, Mi, ACAT
|
1
|
Skills
|
|
|
Interpret history and clinical signs to list appropriate differential diagnoses: including but not limited to pneumonia, COPD, PE, pulmonary oedema, pneumothorax, asthma.
Know the relevant BTS guidelines for these conditions
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Mi, C, L
|
1
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Differentiate between stridor and wheeze
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Mi, C
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1
|
Order, interpret and act on initial investigations appropriately: routine blood tests, oxygen saturation, arterial blood gases, chest x-rays, ECG, Peak flow test, spirometry
|
Mi, C
|
1
|
Initiate treatment in relation to diagnosis, including safe oxygen therapy, early antibiotics for pneumonia
|
Mi, C
|
1
|
Perform chest aspiration and chest drain insertion
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D, L
|
1
|
Recognise disproportionate dyspnoea and hyperventilation
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Mi, C
|
1
|
Practice appropriate management of wheeze and stridor
|
Mi, C
|
1
|
Evaluate and advise on good inhaler technique
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Mi, C, D
|
1
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Recognise indications & contraindications for non-invasive ventilation (NIV), and the indications and contraindications for intubation and invasive ventilatory support
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Mi, C
|
1
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Behaviour
|
|
|
Exhibit timely assessment and treatment in the acute phase
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ACAT, C
|
1
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Recognise the distress caused by breathlessness and discuss with patient and carers
|
ACAT, C
|
2, 3
|
Recognise the impact of long term illness
|
ACAT, C
|
2
|
Consult senior when respiratory distress is evident
|
ACAT, C
|
2, 3
|
Involve Critical Care team promptly when indicated and recognise the need for care in an appropriate environment
|
ACAT, C
|
2
|
Exhibit non-judgemental attitudes to patients with a smoking history
|
ACAT, C, M
|
3, 4
|
Chest Pain
The trainee will be able to assess a patient with chest pain to produce a valid differential diagnosis, investigate appropriately, formulate and implement a management plan
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Knowledge
|
Assessment Methods
|
GMP Domains
|
Characterise the different types of chest pain, and outline other symptoms that may be present
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E, C, Mi, ACAT
|
1
|
List and distinguish between the common causes for each category of chest pain and associated features: cardio-respiratory, musculoskeletal, upper GI
|
E, C, Mi, ACAT
|
1
|
Define the pathophysiology of acute coronary syndrome and pulmonary embolus
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E, C, Mi, ACAT
|
1
|
Identify the indications for PCI and thrombolysis in ACS
|
E, C, Mi, ACAT
|
1
|
Identify the indications and limitations of cardiac biomarkers, d-dimer analysis, CTPA and V/Q scanning
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E, C, Mi, ACAT
|
1
|
Know emergency treatments for PE, ACS and aortic dissection
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E, C, Mi, ACAT
|
1
|
Outline the indications for further investigation in chest pain syndromes: CTPA, trans-oesophageal echocardiography and tread mill (stress) testing
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E, C, Mi, ACAT
|
1
|
Skills
|
|
|
Interpret history and clinical signs to list appropriate differential diagnoses: esp. for cardiac pain & pleuritic pain
|
Mi, C
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1
|
Order, interpret and act on initial investigations in the context of chest pain appropriately: such as ECG, blood gas analysis, blood tests, chest radiograph, cardiac biomarkers
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Mi, C
|
1
|
Commence initial emergency treatment including that for coronary syndromes, pulmonary embolus and aortic dissection
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Mi, C, D
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1
|
Elect appropriate arena of care and degree of monitoring
|
Mi, C
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2
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Formulate initial discharge plan
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ACAT, C, AA
|
1
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Behaviour
|
|
|
Perform timely assessment and treatment of patients presenting with chest pain
|
ACAT, C
|
1
|
Involve senior when chest pain heralds critical illness or when cause of chest pain is unclear
|
ACAT, C
|
3
|
Recognise the contribution and expertise of specialist cardiology nurses and technicians
|
ACAT, C
|
3
|
Recommend appropriate secondary prevention treatments and lifestyle changes on discharge
|
ACAT, C
|
2, 3
|
Communicate in a timely and thoughtful way with patients and relatives
|
ACAT, C, M
|
3, 4
|
Confusion, Acute/Delirium
The trainee will be able to assess an acutely confused/delirious patient to formulate a valid differential diagnosis, investigate appropriately, formulate and implement a management plan
|
Knowledge
|
Assessment Methods
|
GMP Domains
|
List the common and serious causes for acute confusion/delirium
|
E, C, Mi, ACAT
|
1
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Outline important initial investigations, including electrolytes, cultures, full blood count, ECG, blood gases, thyroid function tests
|
E, C, Mi, ACAT
|
1
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Recognise the factors that can exacerbate acute confusion/delirium e.g. change in environment, infection
|
E, C, Mi, ACAT
|
1
|
List the pre-existing factors that pre-dispose to acute confusion/delirium
|
E, C, Mi, ACAT
|
1
|
Outline indications for further investigation including head CT, lumbar puncture. Describe the indications, contraindications and side effects of drugs used in acute psychosis including, but not limited to: Haloperidol, Benzodiazepines, Clonidine
|
E, C, Mi, ACAT
|
1
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Skills
|
|
|
Examine to elicit cause of acute confusion/delirium
|
Mi, D
|
1
|
Perform mental state examinations (abbreviated mental test and mini-mental test and Confusional Assessment method for ICU (CAM-ICU)) to assess severity and progress of cognitive impairment
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Mi, C, D
|
1
|
Recognise pre-disposing factors: cognitive impairment, psychiatric disease
|
C
|
1
|
Understand and act on the results of initial investigations e.g. CT head, LP
|
E, C
|
1
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Interpret and recognise pathology evident on CT head/MRI Brain
|
E, C
|
1
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Behaviour
|
|
|
Recognise that the cause of acute confusion/delirium is often multi-factorial
|
ACAT, C
|
2, 3
|
Contributes to multidisciplinary team management including appropriate use of local physical restraint policy
|
ACAT, C, M
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3, 4
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Recognise the effects of acutely confused/delirious patient on other patients and staff in the ward environment
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ACAT, C
|
2, 3
|
Cough
The trainee will be able to assess a patient presenting with cough to produce a valid differential diagnosis, investigate appropriately, formulate and implement a management plan
|
Knowledge
|
Assessment Methods
|
GMP Domains
|
List the common and serious causes of cough
|
E, C, Mi, ACAT
|
1
|
Identify risk factors relevant to each aetiology including precipitating drugs
|
E, C, Mi, ACAT
|
1
|
Outline the different classes of cough and how the history and clinical findings differ between them
|
E, C, Mi, ACAT
|
1
|
State which first line investigations are required, depending on the likely diagnoses following evaluation
|
E, C, Mi, ACAT
|
1
|
Skills
|
|
|
Order, interpret and act on initial investigations appropriately: blood tests, chest x-rays and PFT’s
|
E, C
|
1
|
Awareness of management for common causes of cough
|
E, C
|
1
|
Behaviour
|
|
|
Contribute to patients understanding of their illness
|
ACAT, C
|
3, 4
|
Exhibit non-judgmental attitudes to patients with a history of smoking
|
ACAT, C, M
|
3, 4
|
Consult seniors promptly when indicated
|
ACAT, C
|
2, 3
|
Recognise the importance of a multi-disciplinary approach
|
ACAT, C, M
|
2
|
Cyanosis
The trainee will be able to assess a patient presenting with cyanosis to produce a valid differential diagnosis, investigate appropriately, formulate and implement a management plan
|
Knowledge
|
Assessment Methods
|
GMP Domains
|
Know the causes of cyanosis, cardiac & respiratory
|
E, C, Mi, ACAT
|
1
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Know how to formulate a differential diagnosis and be able to differentiate from methaemaglobinaemia
|
E, C, Mi, ACAT
|
1
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Skills
|
|
|
Perform a full clinical examination differentiating between the various causes of cyanosis
|
E, C, D
|
1
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Be able to perform and interpret the appropriate tests, e.g. x-rays and ECG
|
E, C, D
|
1
|
Understand the safe prescribing of oxygen therapy
|
E, C
|
1
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Behaviour
|
|
|
Involve senior promptly in event of significant airway compromise
|
ACAT, C
|
2
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Involve specialist team as appropriate
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ACAT, C
|
2
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