Gersten Jonker

36   Chapter 2 TABLE 2: Elaborated entrustable professional activity on evaluation of respiratory compromised patients Title Evaluation and initial treatment of patients with respiratory insufficiency Description Rapid evaluation with the ABCD approach; Take a focused history of a patient with respiratory insufficiency in an Emergency Room, Coronary Care Unit, ward or urgent outpatient clinic (outside Operating Room and Intensive Care settings) ; Perform a physical exam, including ABCD and vital signs; Order and interpret basic diagnostic tests (blood, chest X-ray, ECG); Draft and rank a differential diagnosis in a patient with respiratory insufficiency; Start initial management and propose treatment plans. This EPA does not comprise: Care for the patient (nearly) in a cardiopulmonary resuscitation setting Care for pediatric patients with respiratory instability (< 16 years) Interpretation of advanced diagnostic tests (Ventilation-Perfusion scans, spirometry) Link to competency domains CanMEDS (Dutch KNMG version) Medical Expert: applies diagnostic, therapeutic, preventive repertoire (1.2) Communicator: creates effective therapeutic relationships (2.1), reports adequately on a case, orally and in writing (2.4) Collaborator: consults others effectively (3.1) Scholar: appraises medical information critically (4.1) Health Advocate: recognizes determinants of disease (5.1) Manager: works effectively within a system (6.2) Professional: adequate (inter-)professional conduct (7.2), 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 relevant criteria and scores (e.g. SIRS-criteria, Wells score; GOLD-criteria; Pneumonia Severity Index; Pneumonia Likelihood Ratio; AMBU-65 and CURB-65; ALI/ARDS); Knowledge of criteria for ventilation and admission to ward or ICU; Knowledge of (results of) relevant diagnostic tests (i.e. laboratory blood tests, blood gas analysis, chest X-ray and systematic interpretation, ECG); Knowledge of results of pleural fluid investigations (chemistry, microbiology); Knowledge of most important disorders leading to respiratory insufficiency; Knowledge of options in additional diagnostic testing (e.g. rapid PCR tests, viral, bacterial and fungal tests, CT scan, VP scan); Knowledge of indications for ventilation; Knowledge of indications and techniques of oxygen therapy (F i O 2 , nasal cannula, non-rebreathing mask, CPAP, Venturi, Optiflow); Knowledge of indications for chest drains; Knowledge of indications for bronchoscopy; Knowledge of initial pharmacological treatment of important disorders leading to respiratory insufficiency. Skills Performs and interprets a systematic physical exam according to ABCD and monitoring of vital signs; Asks timely for help/supervision; Takes a focused history and performs a focused physical exam in patients with respiratory insufficiency; Performs a blood gas analysis; Interprets result of a blood gas analysis; Connects patient to monitoring such as ECG/telemetry, non-invasive blood pressure, pulse oximetry, and interprets findings; Interprets 12-lead ECG: myocardial ischemia, rhythm- and conduction disorders;