Gersten Jonker

34   Chapter 2 TABLE 1: Elaborated entrustable professional activity on recognition and initial treatment of vitally threatened patients Title Recognition and initial treatment of patients with vital instability Description Evaluate patient with the ABCD approach; Measure and interpret vital signs; Based on the above, come to a clinical evaluation; In case of emergency: call directly for help/supervision; Initiate Basic Life Support, perform bag-mask-ventilation and airway maneuvers and start intravenous fluid therapy; Be a member of the resuscitation team; Discern limitations in capability. This EPA does not comprise: Provision of advanced cardiac/trauma life support, completely and/or indirectly supervised Care for pediatric patients with vital instability (< 16 years) Link to competency domains CanMEDS (Dutch KNMG version) Medical Expert: applies diagnostic, therapeutic, preventive repertoire (1.2) Communicator: reports adequately on a case, orally and in writing (2.4) Collaborator: consults others effectively (3.1), efficacious in interdisciplinary collaboration (3.4) Manager: works effectively within a system (6.2) Professional: discerns limits of competence (7.3) Required knowledge, skills, and attitudes (level of doctor in postgraduate year 1) Knowledge Knowledge of normal ranges for blood pressure, heart rate, respiratory rate, saturation and temperature; Knowledge of symptoms of threatened vital parameters Knowledge of Glasgow Coma Scale (GCS) and primary neurological survey; Knowledge of causes of disturbances in consciousness; Knowledge of Basic Life Support; Knowledge of principles of advanced cardiac and trauma life support; Knowledge of 4Hs, 4Ts, shock and no-shock algorithms; Knowledge of indications for and application of (Automatic) External Defibrillators; Knowledge of effective communication protocols to call for help (e.g. SBARR method); Knowledge of local protocols regarding acute intervention teams, emergency telephone number, resuscitation team etcetera; Knowledge of equipment and materials for basic interventions in ABC (e.g. infusion materials, AMBU-bag, non-rebreathing mask, Mayo tube) including (contra-) indications; Knowledge of levels of care on different wards (normal ward to ICU); Knowledge of indications to stop resuscitation efforts Skills Asks timely for help/supervision with an effective communication protocol (e.g. SBARR) and locally applicable emergency procedure; Performs and interprets a systematic physical exam according to ABCD and monitoring of vital signs; Clinical judgment based on ABCD and vital parameters; Provides probable diagnosis regarding the cause of the vital instability; Gives and receives orders/tasks and confirms the order/task and its execution; Proposes a management plan; Proposes orders regarding treatment; Initiates Basic Life Support; Performs Basic Life Support skills and part-tasks; Performs bag-mask ventilation and airway maneuvers (head tilt/chin lift, jaw thrust); Sites a peripheral intravenous catheter;