This book provides a structured approach to the initial assessment, resuscitation, differential diagnosis and short-term management of common on-call problems. It also provides an overall guide to hospital practice and acute clinical skills. It is designed to help junior doctors and senior medical students acquire a logical, practical and efficient approach, which is essential for problem-based learning and acute management.
Clinical problem-solving is an essential skill for the doctor on call. Traditionally, the diagnosis and management of a patient's problems are approached with an ordered, structured and sequential system (e.g. history-taking, physical examination, and review of available investigations) before formulating the provisional and differential diagnoses and the management plan.
In an emergency, doctors proceed concurrently with resuscitation, history, examination, investigation and definitive treatment. Stabilisation of the airway, breathing, circulation and neurological disability must occur in the first few minutes to avoid death and disability.
A 'complete history and physical examination' can take 60 minutes or more to complete. However, while on call this is not possible, as unnecessary time spent on a patient with a relatively minor complaint may deny adequate treatment time to patients who may require resuscitation.
This book provides a focused approach to many clinical problems in order to increase efficiency and improve time management.