<?xml version="1.0" encoding="UTF-8"?>
<opml version="2.0">
  <head>
    <title>063-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Undifferentiated acute illness: foundations">
      <outline text="Orientation">
        <outline text="Undifferentiated symptoms are not diagnoses"/>
        <outline text="Benign self-limited illness to time-critical failure">
          <outline text="Circulation, respiration, brain, metabolism, host defence"/>
        </outline>
        <outline text="Stabilise, define, find danger, build mechanism differential"/>
        <outline text="Repeat examination and treatment response revise probability"/>
      </outline>
      <outline text="Universal first assessment">
        <outline text="Observe before questioning">
          <outline text="Airway, breathing, perfusion, temperature, consciousness, glucose"/>
        </outline>
        <outline text="Early electrocardiogram">
          <outline text="Collapse, dizziness, chest symptoms, palpitations, older age"/>
        </outline>
        <outline text="Pregnancy testing alters almost every differential"/>
        <outline text="Treat immediate threats while investigating">
          <outline text="Hypoglycaemia, hypoxia, anaphylaxis, seizure, shock, sepsis"/>
        </outline>
        <outline text="Normal observations after transient illness do not prove safety">
          <outline text="Pre-arrival events, recovery, baseline, recurrence risk"/>
        </outline>
      </outline>
      <outline text="Fever and temperature">
        <outline text="Fever: regulated rise in hypothalamic set point"/>
        <outline text="Hyperthermia: unregulated heat accumulation">
          <outline text="No response to antipyretics"/>
        </outline>
        <outline text="Chills suggest rapid rise, not necessarily bacteraemia"/>
        <outline text="Serious infection without high fever">
          <outline text="Older, frail, pregnant, immune-suppressed, medicated"/>
        </outline>
        <outline text="History, exposures, full examination">
          <outline text="Avoid indiscriminate cultures from colonised sites"/>
        </outline>
        <outline text="Sepsis: organ dysfunction from dysregulated response">
          <outline text="Cultures without delaying antibiotics"/>
          <outline text="Restore perfusion, oxygen, source control"/>
        </outline>
        <outline text="Non-infectious fever">
          <outline text="Drug fever may lack rash or eosinophilia"/>
        </outline>
        <outline text="Hyperthermia syndromes need rapid cooling"/>
        <outline text="Persistent fever: reassess, not automatic broadening"/>
      </outline>
      <outline text="Collapse and transient loss of consciousness">
        <outline text="Clarify what collapse meant"/>
        <outline text="Syncope: transient global cerebral hypoperfusion">
          <outline text="Rapid onset, brief, spontaneous complete recovery"/>
        </outline>
        <outline text="Patient and witness accounts"/>
        <outline text="Reflex syncope: pain, fear, heat, standing, visceral"/>
        <outline text="Orthostatic syncope: inadequate compensation to standing">
          <outline text="Asymptomatic drop, normal test not exclusive"/>
        </outline>
        <outline text="Cardiac syncope: arrhythmia, obstruction, embolism, pump">
          <outline text="Exertional, supine, no prodrome, family sudden death"/>
          <outline text="Monitoring duration matches event frequency"/>
        </outline>
        <outline text="Seizure features: aura, tonic then clonic, lateral tongue bite">
          <outline text="Brief jerks also occur in syncope"/>
        </outline>
        <outline text="Psychogenic non-epileptic events need positive diagnosis"/>
        <outline text="Collapse without loss of consciousness">
          <outline text="Older adults: multiple contributors, injury, safeguarding"/>
        </outline>
      </outline>
      <outline text="Dizziness and vertigo">
        <outline text="Descriptive words are inconsistent"/>
        <outline text="Classify by timing and triggers">
          <outline text="Episodic triggered, spontaneous episodic, continuous acute"/>
        </outline>
        <outline text="Brief positional vertigo: benign paroxysmal positional vertigo"/>
        <outline text="Spontaneous episodes: migraine, Meniere, dysrhythmia, panic"/>
        <outline text="Continuous vertigo: neuritis or posterior-circulation stroke"/>
        <outline text="Head-impulse, nystagmus, skew testing">
          <outline text="Only continuous syndrome with nystagmus, trained hands"/>
        </outline>
        <outline text="Stroke concern features">
          <outline text="Headache, focal signs, vertical nystagmus, cannot stand"/>
        </outline>
        <outline text="Early CT and MRI can miss posterior fossa ischaemia"/>
      </outline>
      <outline text="Generalised weakness and fatigue">
        <outline text="Weakness, fatigue, sleepiness differ"/>
        <outline text="Sudden focal weakness is stroke until assessed"/>
        <outline text="Ascending, bulbar, respiratory: emergency monitoring"/>
        <outline text="Localise by examination">
          <outline text="Pain and poor comprehension mimic weakness"/>
        </outline>
        <outline text="Guillain-Barre: ascending symmetrical, reduced reflexes">
          <outline text="Serial forced vital capacity; saturation falls late"/>
        </outline>
        <outline text="Myasthenia: fluctuating, sensation preserved"/>
        <outline text="Botulism: descending, autonomic and pupil features"/>
        <outline text="Potassium, phosphate, magnesium disorders cause paralysis"/>
        <outline text="Fatigue without objective weakness">
          <outline text="Select tests from history"/>
          <outline text="Validate disability, avoid false certainty"/>
        </outline>
      </outline>
      <outline text="Targeted investigations">
        <outline text="Baseline tests according to syndrome"/>
        <outline text="Add tests only to answer a clinical question"/>
        <outline text="Interpret with pretest probability">
          <outline text="Mild abnormalities distract"/>
          <outline text="Wrong-time troponin, early scan cannot close differential"/>
        </outline>
        <outline text="Indiscriminate testing causes incidental findings and cascades"/>
        <outline text="Document why disposition is safe"/>
      </outline>
      <outline text="Treatment, observation, safety net">
        <outline text="Treat threat while preserving diagnostic information"/>
        <outline text="Fluids when depleted, not reflex boluses"/>
        <outline text="Hold contributing medicines with restart criteria"/>
        <outline text="Observation is an active diagnostic strategy">
          <outline text="Duration, repeat checks, escalation thresholds"/>
        </outline>
        <outline text="Discharge checks: baseline, function, follow-up owner"/>
        <outline text="Explain uncertainty, give specific return triggers"/>
      </outline>
    </outline>
  </body>
</opml>
