The worst intern in the department

A good tip for ensuring your answers are CLEAR, is to imagine you are giving instructions to the worst intern in the department.

Consider a case of lower limb necrotising fasciitis (in septic shock) and the following SAQ: Outline your approach to the management of this patient

Unclear answer

  1. Broad-spectrum – IV Abs
  2. IVF challenge
  3. Analgesia
  4. Surgical Review

Could the worst intern in your department execute your plan accurately?

Better answer

  1. Meropenum 1g IV, Clindamycin 600mg IV, Vancomycin 30mg/kg IV
  2. IV Hartmanns bolus with target MAP >65mmHg, up to 30mg/kg, then if MAP remains <65 noradrenaline infusion (4mg in 100mL) to achieve same target
  3. Titrated aliquots of fentanyl, 50mcg initially then 25mcg q15min until pain controlled
  4. Emergent Surgical Review so as to organise debridement +/- amputation as source control

Take Home points

Writing clear answers will demonstrate your knowledge and consultant-level communication. It will also help you significantly on the floor at work.

I hope the ‘worst intern in the department’ concept is helpful!