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SCBD

MANAGEMENT

• LABEL + PRIORITIES
• PRE-AMBLE
• RSSAD
  • Resus
  • Specific
  • Supportive
  • Anticipate complications
  • Disposition

Label:

• Name the issue clearly and succinctly (e.g., “Severe sepsis likely secondary to pneumonia”).

Priorities:

• Identify the most significant and life-threatening pathologies.
• Outline the order of assessment and management.
  • Immediate threats to life first.
  • Structured A–E resuscitation - focussing on the scenario
  • Targeted management of underlying cause(s).

Pre-amble:

• Move to resuscitation bay; apply full cardiorespiratory monitoring.
• Assemble the team and allocate roles (you are the team leader).
• Alert relevant personnel:
  
  • ED (NUM, other consultant)
  • Wider hospital supports (ICU, theatre, IR, blood bank)
  • External services (retrieval, tertiary centre) if applicable

Then declare that you managements will be R-S-S-A-D
Tell them what you're going to tell them, then tell them

Resuscitation:

• Perform an A–E approach, prioritising life-threatening abnormalities.
• Tailor focus to the key threats relevant to the scenario (e.g., airway compromise, shock, arrhythmia).

Specific:

• Provide definitive, targeted treatment for the underlying problem(s):
  
  • Non-pharmacological: positioning, splinting
  • Pharmacological: drugs, doses, routes, timing
  • Procedural: intubation, chest decompression, surgical interventions
• State your desired end-points

Supportive:

• Analgesia: appropriate and titrated
• Fluids: guided by physiology and response
• Temperature management
• Family and social support: involve family, social worker, or pastoral care as indicated

Anticipate Complications:

• Identify what may go wrong next (e.g., deterioration, cardiac arrest, need for advanced airway).
• State what you are cognitively preparing for and any pre-emptive measures (e.g., prepare intubation drugs, ECMO on standby).
• You may well anticipate the next question in the station

Disposition:

• Consider the context (rural / remote / urban).
• Decide on definitive destination:
  
  • Operating theatre or interventional radiology for surgical conditions
  • ICU or HDU for ongoing critical care
  • Transfer if higher-level care or specialist services required
    

ASSESSMENT

• LABEL + PRIORITIES (based on DDx)
• Focussed History
• Obs / Vital Signs
• Examination
• Investigations (BBIS)
  • Bedside
  • Blood
  • Imaging
  • Special tests

• Tailor your assessment to the specific scenario.
  
  
• “My assessment will be concurrent with management, with the aim of identifying and treating life threats and establishing the differential diagnosis"
  
  
• State your differential diagnoses and that your assessment aims to rule-in or rule-out these possibilities.
  
  
• Emphasise that assessment is dynamic — it should be repeated whenever the patient’s condition changes.

History

• History of Presenting Complaint (HPC):
• Risk factors / Red flags: relevant to the presenting complaint
• Clues as to Differential Diagnosis
• Concise completion of background history:
  • Past Medical History (PMH)
  • Drug History (DHx)
  • Allergies
  • Social history (including occupational, family, substance use)
    

Observations (Vital Signs):

• State what is particularly important in relation to this scenario

Examination:

• Structured exam focusing on:
  • Life threats 
  • Clues to underlying cause of the presentation

Investigations (BBIS):

• Bedside:
  • Venous/arterial blood gas (VBG/ABG)
  • Blood glucose level (BSL)
  • ECG
  • Urinalysis, pregnancy test
    
    
• Bloods:
  • FBE, UEC, LFTs, CRP, lactate, coagulation studies
  • Specific markers as indicated (e.g., troponin, D-dimer, CK)
    
    
• Imaging:
  • Point-of-care ultrasound (FAST, lung, cardiac as appropriate)
  • X-rays or CT based on suspected pathology
    
    
• Special Tests:
  • Disease-specific investigations (e.g., LP, toxin screen)