How To Answer (HTA) Management

How To Answer gives you a structure to use for answering ‘Management’ type questions in the SAQ. This is a guide only and there are many ways to do this. Clinical judgement must be used at all times as to what is relevant to include and what is not. Not all headings will apply for every situation.

Domains

Resuscitation

Sometimes not needed, but must take precedence when vitals are given, or a situation clearly indicates the need for it. This domain includes measures such as IV normal saline 20mL/kg bolus stat, or defibrillation, for example.

Specific

Management pertaining to the case, such as reversal agents, antidotes, interventions. For example: hyperkalaemia’s specific management includes 10-30mL Calcium Gluconate 10% solution IV, whereas an aortic dissection’s specific management includes rate control to HR ~60 and SBP control to 100-110mmHg with IV beta blockade (esmolol, metoprolol, etc)

General

This means supportive care, such as fluids, analgesia, positioning, antiemetics, etc.

Complications & Communication

Management to avoid potential complications might go here, as well as communication with relevant specialties for particular interventions. Communication with the patient’s family might not go astray here either

Disposition

Management always includes a disposition. This may be cath lab, theatre or ICU, but make sure it’s there.

Miscellaneous

It’s worth noting the following

1. Treatment + disposition = management.

Therefore if you’re being asked for treatment… it doesn’t include disposition unless that is critical to the case (eg PCI)

2. “Steps” vs “priorities”

Steps represent the particular actions you take, rather than the overarching priorities. Priorities contain steps, sometimes you will be asked for one, rather than the other. Pay attention and above all read the question

If you’ve got another system, or you reckon there are better ways to do it, leave a comment below!