What this area covers
Interns and residents in Australian hospitals manage ward calls, fluids, prescribing and deteriorating patients, often overnight. This page is for interns, residents and IMGs starting their first Australian hospital job, and focuses on safe, practical decisions.
High-yield topics
| Topic | What to know |
|---|---|
| Recognition | Observation charts and MET criteria |
| ABCDE | Assess and treat in order |
| Escalation | ISBAR and graded assertiveness |
| Sepsis | Early antibiotics and fluids |
| Goals of care | Limits of treatment documented |
Worked example
Worked question · Escalation
A post-operative patient has a respiratory rate of 32 and SpO2 of 88%. What is first?
- A Call for help and give oxygen
- B Order a chest X-ray for the morning
- C Give oral paracetamol
- D Recheck in 4 hours
- E Document only
Show the reasoning
Answer A. These meet rapid response criteria. Start ABCDE, give oxygen and call a MET or senior.
A short study plan
| Week | Focus |
|---|---|
| 1 | Core principles |
| 2 | Common ward calls |
| 3 | Timed questions and review |
Do a short timed set most days and review every explanation, including the options you ruled out.
Common traps
- Acting without checking local protocols.
- Delaying escalation.
- Poor documentation.
Free sample deteriorating patient questions
Questions from our Junior Doctor bank. Choose your answer, then open the explanation.
Mr Hall, 78, is dizzy with HR 34, BP 78/50 and cool peripheries. ECG shows complete heart block. Atropine 600 micrograms IV has had no effect. What is the next step?
- ARepeat the ECG in 4 hours
- BTranscutaneous pacing or an adrenaline infusion
- CGive IV verapamil
- DIV amiodarone 300 mg over 20 minutes, then an infusion over 24 hours
- EOral metoprolol to stabilise the rhythm
Show answer and explanation
Answer B. Unstable bradycardia not responding to atropine (which often fails in complete heart block) needs transcutaneous pacing or a chronotropic infusion (adrenaline or isoprenaline) as a bridge to transvenous or permanent pacing. Call a rapid response and cardiology. What to do next: Attach pads, call the MET team and cardiology, review medicines (beta-blockers, digoxin, calcium channel blockers) and check potassium.
Learning point: Unstable bradycardia after atropine: transcutaneous pacing or adrenaline infusion; call MET and cardiology.
Ms Shaw, 22, has fever, severe headache, neck stiffness and a non-blanching rash. GCS 14. Blood cultures have been taken. What should happen next?
- AWait for a CT brain before antibiotics
- BIV ceftriaxone and dexamethasone now
- CGive paracetamol and observe for 4 hours
- DOral amoxicillin and review in the morning
- EPerform a lumbar puncture first, then decide on antibiotics
Show answer and explanation
Answer B. Suspected bacterial meningitis, especially with a non-blanching rash (meningococcal disease), needs antibiotics immediately. Give IV ceftriaxone 2 g (with dexamethasone before or with the first dose in adults) without waiting for CT or lumbar puncture. What to do next: Call the registrar and ICU, start droplet precautions, notify public health, and arrange contact prophylaxis.
Learning point: Suspected meningitis: IV ceftriaxone plus dexamethasone immediately; do not wait for CT or LP.
A 40-year-old man on the ward has a generalised tonic-clonic seizure that has lasted 6 minutes. He has a working IV cannula. What should be given?
- AIV phenytoin as the first drug
- BIV haloperidol 5 mg
- COral clonazepam drops
- DWait until 30 minutes before treating
- EIV midazolam or diazepam
Show answer and explanation
Answer E. A seizure lasting 5 minutes or more should be treated as status epilepticus. Give a benzodiazepine first (IV midazolam or diazepam, or IM or buccal midazolam if no IV access), check glucose, protect the airway, and give a second-line agent if it continues. What to do next: If seizures continue 5 minutes after a second benzodiazepine dose, give a second-line drug (levetiracetam, phenytoin or valproate) and call ICU/anaesthetics.
Learning point: Seizure lasting 5 minutes or more: benzodiazepine first, check glucose, then second-line if ongoing.
Practise more deteriorating patient questions free
Every deteriorating patient subtopic in our bank
The bank holds 50 deteriorating patient questions across 50 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- ABCDE1
- Acute angle-closure glaucoma1
- Acute limb ischaemia1
- Acute pulmonary oedema1
- Acute stroke1
- Adrenal crisis1
- Airway1
- Anaphylaxis1
- Anaphylaxis observation1
- Aortic dissection1
- Asthma attack1
- Bacterial meningitis1
- Cardiac arrest1
- Cardiac tamponade1
- Chest drain1
- Complete heart block1
- Delirium tremens1
- Escalation1
- GCS1
- Goals of care1
- Hyperkalaemia arrest risk1
- Hyperkalaemia in AKI1
- Hypoglycaemia unconscious1
- Hypothermia1
- Hypoxia1
- Lactate1
- Massive PE1
- Massive transfusion1
- MET call priorities1
- Neuroleptic malignant syndrome1
- Neutropenic sepsis1
- Opioid toxicity1
- Perforated viscus1
- Post-operative bleeding1
- Post-operative myocardial injury1
- Raised intracranial pressure1
- Rapid response criteria1
- Ruptured AAA1
- Seizure1
- Sepsis1
- Shockable rhythm1
- Snakebite1
- Spinal cord compression1
- Stable SVT1
- Status epilepticus1
- Tension pneumothorax1
- Thyroid storm1
- Unstable tachyarrhythmia1
- Upper airway swelling1
- Upper GI bleed1
Common questions
Is this relevant to IMGs?
Yes. Australian hospital systems, protocols and escalation pathways may differ from your previous experience.
Should I follow local protocols?
Always. This page explains principles; local policies apply.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.