DrMKZ

PSF (PROBLEM-SOLVING FRAMEWORK) – CLINICAL REASONING

🔴 1. PROBLEM REPRESENTATION
(1–2 line summary of the case)
Format:
[Age] [gender] with [key symptoms] for [duration] + [key findings]
Example:
65-year-old male with fever, productive cough 3 days, hypotensive and tachycardic

🟡 2. PROBLEM LIST
(List all active issues)
Hypotension
Fever
Productive cough
Tachycardia
👉 Always separate:
Acute problems
Chronic comorbidities

🔵 3. DIFFERENTIAL DIAGNOSIS
(Structured + prioritised)
Most Likely
Septic shock secondary to pneumonia
Must Not Miss
Cardiogenic shock
Pulmonary embolism
Others
Hypovolemia
Adrenal crisis

🟣 4. WORKING DIAGNOSIS
(Commit to ONE main diagnosis)
Septic shock secondary to community-acquired pneumonia
🟠 5. PLAN

(Split into Investigations + Management)
🧪 Investigations
Baseline:
FBC
Urea & electrolytes
LFT
CRP
Targeted:
Blood cultures
ABG
CXR
💉 Management
Immediate (Resus):
Oxygen
IV fluids (bolus)
IV antibiotics (early)
Definitive:
Source control
Tailor antibiotics
Supportive:
Monitoring (vitals, urine output)

🟢 6. REASSESSMENT / REVIEW
Monitor:
BP response
Lactate trend
Urine output
If not improving:
Start vasopressor

s
Escalate to ICU
⚡ ULTRA-SHORT PSF (EXAM / ON-CALL)
PR → PL → DDx → WD → Plan → Review
Problem representation
Problem list
Differentials
Working diagnosis
Plan
Reassessment