Abdominal Pain including loin pain
The trainee will be able to assess a patient presenting with abdominal pain and loin pain 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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To outline the different classes of abdominal pain and how the history and clinical findings differ between the causes
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E, C, Mi, ACAT
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1
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To identify the possible surgical causes of abdominal pain, depending on site, details of history, acute or chronic including but not limited to peptic ulcer disease, pancreatitis, cholecystitis, cholangitis, biliary colic, bowel obstruction, diverticular disease, viscus perforation, acute appendicitis and ischaemic colitis, AAA, hernias, renal calculi, pyelonephritis, chronic inflammatory bowel disease, and volvulus
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E, C, Mi, ACAT
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1
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Know the common and serious causes of loin pain including renal colic, infection and obstruction of the urinary tract, abdominal aortic aneurysm
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E, C, Mi, ACAT
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1
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Know the medical causes of abdominal pain
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E, C, Mi, ACAT
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1
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To define the situations in which urgent surgical, urological or gynaecological opinion should be sought evaluation
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E, C, Mi, ACAT
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1
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Determine which first line investigations are required, depending on the likely diagnoses following evaluation using ECG, plain radiology, CT, ultrasound and blood tests.
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E, C, Mi, ACAT
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1
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Define the indications and contraindications for specialist investigation: ultrasound, CT, CT KUB,MRI, endoscopy, and IVU
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E, C, Mi, ACAT
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1
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Skills
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|
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To have an A, B, C, D approach ensuring identification of critical or life threatening illness
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Mi, C, D
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1
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Elicit signs of tenderness, guarding, and rebound tenderness and interpret appropriately
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Mi, C, D
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1
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Order, interpret and act on initial investigations appropriately: blood tests, x-rays, ECG and microbiology investigations,
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Mi, C
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1
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Initiate first line management: including effective fluid resuscitation, pain relief antibiotics and appropriate use of a nasogastric tube
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Mi, C
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1
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Interpret gross pathology on CT, CT KUB, IVU, including liver metastases and obstructed ureters with hydronephrosis
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Mi, C
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1
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Be able to identify those that require admission and those who may be safely discharged
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Mi, C
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1
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Behaviour
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|
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Exhibit timely intervention when abdominal pain is the manifestation of critical illness or is life-threatening, in conjunction with senior and appropriate specialists
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ACAT, C, Mi
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1
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Recognise the importance of a multi-disciplinary approach including early surgical/urological assessment when appropriate
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ACAT, C, Mi, M
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2, 3
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Display sympathy to physical and mental responses to pain
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ACAT, C, Mi, M
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3, 4
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Involve other specialties promptly when required
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ACAT, C, Mi
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2, 3
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Abdominal Swelling, Mass & Constipation
The trainee will be able to undertake assessment of a patient presenting with abdominal swelling, mass or constipation 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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Define the different types of abdominal mass in terms of site, aetiology and clinical characteristics
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E, C, Mi, ACAT
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1
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Recall the preponderance of functional causes of constipation including constipation with overflow and the investigation and management of faecal incontinence
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E, C, Mi, ACAT
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1
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Describe the appropriate investigations- radiological, surgical, endoscopy.
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E, C, Mi, ACAT
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1
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Identify the causes of hepatomegaly and splenomegaly, abdominal swelling and constipation
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E, C, Mi, ACAT
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1
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Recall abdominal wall pathology as possible causes of distension, including divarification of the recti
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E, C, Mi, ACAT
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1
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Know the pathophysiology of portal hypertension and bowel obstruction.
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E, C, Mi, ACAT
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1
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Know the important steps in diagnosing the cause of ascites, including imaging and the diagnosis of spontaneous bacterial peritonitis and malignancy
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E, C, Mi, ACAT
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1
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Skills
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|
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Elicit associated symptoms and risk factors for the presence of diseases presenting with abdominal mass, ascites and co existing signs. Elicit and interpret important physical findings to establish likely nature.
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Mi, C, D
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1
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Order and interpret appropriate diagnostic tests
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Mi, C
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1
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Practise safe management of ascites:, including the use of diuretics, fluid and salt restriction, and ascitic tap
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Mi, C, D
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1
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Select appropriate second line investigations of constipation when indicated: including blood tests imaging and endoscopy
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Mi, C
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2
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Following diagnosis of the cause of constipation prescribe bulk or osmotic laxatives or motility stimulants as necessary
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Mi, C
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1
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Provide review of medications in patients with constipation in the context of multisystem disease.
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Mi, C
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1
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Behaviour
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|
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Involve specialists promptly when appropriate: surgery, gastroenterology, radiology, palliative care
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ACAT, C, Mi
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3
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Discuss with patient likely outcomes and prognosis of condition
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ACAT, C, Mi
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3, 4
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Acute Back Pain
The trainee will be able to assess a patient with a new presentation of back pain 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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Know the causes of acute back pain including but not limited to – malignant, septic, musculoskeletal, urological, neurological, AAA.
Be able to outline features that raise concerns as to a sinister cause (red flags) and those that lead to a consideration of chronic causes (yellow flags).
Understand and recognise the Cauda Equina Syndrome.
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E, C, Mi, ACAT
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1
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Specify abdominal pathology that may present with back pain
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E, C, Mi, ACAT
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1
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Recall the indications of an urgent MRI of spine
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E, C, Mi, ACAT
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1
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Outline indications for hospital admission
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E, C, Mi, ACAT
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1
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Outline secondary prevention measures in osteoporosis
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E, C, Mi, ACAT
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1
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Skills
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|
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Perform examination and elicit signs of spinal cord/cauda equina compromise
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Mi, C, D
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1
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Practise safe prescribing of analgesics/anxiolytics to provide symptomatic relief
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Mi, C
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1
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Order, interpret and act on initial investigations appropriately: blood tests and x-rays
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Mi, C
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1
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Behaviour
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|
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Involve neurosurgical unit promptly in event of neurological symptoms or signs
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ACAT, C, Mi
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2
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Ask for senior help when critical abdominal pathology is suspected
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ACAT, C, Mi
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2, 3
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Recognise the socio-economic impact of chronic lower back pain
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ACAT, C, Mi
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2, 3
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Participate in multi-disciplinary approach: physio, OT
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C, M
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3, 4
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Recognise impact of osteoporosis and encourage bone protection in all patients at risk
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C
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1
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Aggressive/disturbed behaviour
The trainee will be competent in predicting and preventing aggressive and disturbed behaviour, use safe physical restraint and chemical sedation, investigate appropriately and liaise with the mental health team.
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Knowledge
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Assessment Methods
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GMP Domains
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Know the factors that predict aggressive behaviour: personal history, alcohol and substance abuse, delirium.
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E, C, Mi, ACAT
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1
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Define and characterize psychosis and know the common causes
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E, C, Mi, ACAT
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1
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Know the indications, contraindications and side effects of tranquillisers.
Know de-escalation techniques that can be used o prevent violent behaviour
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E, C, Mi, ACAT
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1
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Know the legal framework for authorizing interventions in the management of the disturbed or violent patient.
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E, C, Mi, ACAT
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1
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Skills
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|
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Ensure appropriate environment and support staff.
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C
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1
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Assess fully including mental state examination and produce valid differential diagnosis
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Mi, C, D
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1
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Undertake and interpret appropriate investigations.
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C
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1
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Produce safe rapid tranquillisation if indicated as defined in national guidelines with appropriate monitoring.
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Mi, C
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1
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Behaviour
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|
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Treat acutely disturbed patient with respect and the dignity they deserve
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ACAT, M
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2, 4
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Liaise promptly with psychiatric services
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ACAT, M
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3
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Blackout/Collapse
The trainee will be able to assess a patient presenting with a collapse to produce a valid differential diagnosis, investigate appropriately, formulate and implement a management plan (see also ‘Syncope’ and ‘Falls’)
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Knowledge
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Assessment Methods
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GMP Domains
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Recall the causes for blackout and collapse (including syncopal causes vasovagal, cough, effort, micturition, carotid sinus hypersensitivity).
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E, C, Mi, ACAT
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1
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Differentiate the causes depending on the situation of blackout +/or collapse, associated symptoms and signs, and eye witness reports
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E, C, Mi, ACAT
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1
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Outline the indications for temporary and permanent pacing systems
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E, C, Mi, ACAT
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1
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Define indications for investigations: ECHO, ambulatory ECG monitoring, neuroimaging
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E, C, Mi, ACAT
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1
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Skills
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|
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Elucidate history to establish whether event was LOC, fall without LOC, vertigo (with eye witness account if possible)
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Mi, C
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1
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Assess patient in terms of ABC and degree of consciousness and manage appropriately
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Mi, C, D
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1
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Perform examination to elicit signs of cardiovascular or neurological disease and to distinguish epileptic disorder from other causes
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Mi, C, D
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1
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Order, interpret and act on initial investigations appropriately: ECG, blood tests inc. glucose, brain imaging (CT and MRI)
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Mi. C
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1
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Manage arrhythmias appropriately as per ALS guidelines
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C, L
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1
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Detect orthostatic hypotension
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Mi, C, D
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1
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Institute external pacing systems when appropriate
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Mi, C, D, L
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1
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Behaviour
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|
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Ensures the follow up pathways for these patients e.g. syncope clinics, falls clinics
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ACAT, C
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2,3
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Recognise impact episodes can have on lifestyle particularly in the elderly
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ACAT, C
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2, 3
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Recognise recommendations regarding fitness to drive in relation to undiagnosed blackouts
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ACAT, C
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2, 3
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