Introduction
So, a consultant turns to you and says, “imagine you are the F1 on-call covering all the medical wards”. You already know that the next 5-10 minutes is going to be a lot of fumbling and waffle. No more! I’m going to be running through the key steps to take when approaching an acutely unwell patient all the way from “taking the phone call” to “managing the patient”.
On the Phone
The goal at this stage is to risk stratify. Essentially, you want to determine how worried you should be about the patient. Is it a “drop everything and run” kind of patient or is it a “see after finishing current tasks” kind of patient? This is arguably the most important step as it’ll determine the speed of your actions and so the final outcome. Always have a low threshold for going and assessing patients. If someone is worried enough at 1am to pick up the phone about a patient, then it’s likely that something’s going on.
Assessment
After getting all the basic facts about the patient and their observations, it’s time to head over and assess them fully. This is a must and there really is no substitute. We suggest 3 major steps to this process and explain the A-E approach.
History, Examinations & Investigations
After you’ve carried out a primary assessment and corrected any abnormalities, it’s time to dive deeper in with a full history and examination, whilst all the while thinking about what investigations you’d like done to narrow your differential diagnosis list.
Management
“How would you manage this patient?” Is a classic final question consultants use to end the grilling. Of course, the specific management plan will depend on the presenting complaint and likely diagnosis. But here are a few safe, sensible and general things to say.