Gersten Jonker

38   Chapter 2 TABLE 3: Elaborated entrustable professional activity on evaluation of circulatory compromised patients Title Evaluation and initial treatment of patients with circulatory insufficiency Description Rapid evaluation with the ABCD approach; Take a focused history of a patient with circulatory 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 circulatory 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 circulatory instability (< 16 years) Interpretation of advanced diagnostic tests (cardiac catheterization, echocardiography) 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. Crusade, Heartscore, TIMI, CHADS2VASC, SIRS-criteria, hypovolemic shock classification, NYHA classification); Knowledge of different types of shock and their treatments; Knowledge of levels of care on different wards (normal ward to 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 intravenous fluid therapy protocols; Knowledge of most important disorders leading to circulatory insufficiency (i.e. different types of shock); Knowledge of indications for echocardiography and of relevant reported findings; Knowledge of indications for cardiac catheterization (and percutaneous cardiac intervention) and of relevant reported findings; Knowledge of initial (pharmacological) treatment of different types of shock. Inotropes and vasoactive medications. 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 circulatory 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; Evaluates heart rhythm on telemetry monitor; Interprets 12-lead ECG : myocardial ischemia, rhythm- and conduction disorders; Writes an order for chest X-ray;