The Hands-on Guide to the Foundation Programme

ISBN-13: 9781118767467 / Angielski / Miękka / 2014 / 280 str.

Anna Donald

Opis

This is a career-focused practical guide for medical students and Foundation doctors, dealing with the challenges of the programme. With hints, tips, and practical advice on various aspects of the course, from self-care to prescribing, this guide provides invaluable support and guidance, with up-to-date information on postgraduate training and recruitment, practical management skills and career pathways to help build confidence, enabling you to hit the ground running.

Spis treści

Introduction xiii

How to use this book xiv

Acknowledgements xv

Abbreviations xvi

1 Starting up 1

Panic? 1

People to help you 1

Three basic tips 2

Other useful start–up information 2

Dress 2

Equipment 3

Geography 4

Ward rounds 4

Social rounds 5

Night rounds 5

Discharging patients 6

Work environment 6

Bibliography 6

2 Getting Organized or The Folder 8

Personal folder and the lists 8

How to make a personal folder 8

Keeping track of patients (List 1) 10

List of things to do (List 2) 10

Results sheet (List 3) 10

Data protection and confidentiality 11

3 Paperwork and electronic medical records 12

Patient notes 12

Incident forms 13

Blood forms and requesting

bloods tests 14

Discharge summaries (TTO/TTA) 15

Handovers 16

Referral letters 17

Self–discharge 17

Sick notes 17

4 Accident and emergency 19

General advice 19

Admitting and allocating patients 20

Keeping track of patients 21

Medicine 21

Medical and surgical assessment units 22

Fast–track patients 22

5 Becoming a better doctor 23

Foundation Programmes

(United Kingdom) 23

Academic Foundation Programmes 24

Assessments 24

Situational judgement tests 25

Moving on from the Foundation Programme 26

Information technology 26

The internet 27

Online medical databases 27

Keeping up with the literature 28

Evidence–based medicine 28

Clinical audit 29

Quality improvement projects 30

Case reports 30

Courses 30

Professionalism 31

Communication 31

Consultants and senior registrars 32

GPs 32

Nurses 33

Patients 34

Patients families 35

Confidentiality 36

Exceptions to keeping confidentiality 36

References 36

6 Emergencies 37

Acute coronary syndrome 37

Stroke 37

DVT and PE 40

Haematemesis 40

Acute asthma 41

Life–threatening asthma 42

Acute severe asthma 42

Brittle asthma 42

Acute pneumothorax 42

Anaphylaxis 43

Meningitis 43

Collapse or reduced mobility 45

Overdose 45

In general 46

Treating the patient 46

Surgery 48

7 Cardiac arrests and crash calls 49

Cardiac arrest calls 49

Do not resuscitate orders 52

8 Common calls 54

How to use this section 56

Considerations for all ward calls 56

Abdominal pain 57

Differential diagnoses 57

Anaemia 58

Arrhythmia 60

Calcium 62

Hypercalcaemia 64

Hypocalcaemia 64

Chest pain 65

Confusion 66

Differential diagnoses 66

Constipation 68

Differential diagnoses 68

Diarrhoea 69

Differential diagnoses 69

Electrocardiograms 70

Important ECG abnormalities to recognize 74

Eye complaints 74

The acute red eye 74

Sudden loss of vision in one or both eyes 75

Floaters 75

Falls 75

Differential diagnoses 75

Fever 76

Differential diagnosis 77

The immunocompromised

patient with fever 78

Fits 78

Differential diagnoses 78

Intravenous fluids 79

Upper gastrointestinal bleeds 81

Lower gastrointestinal bleeds 82

Glucose 82

Haematuria 83

Headaches 84

Differential diagnoses and key symptoms 84

Hypertension 85

Peri operative hypertension 86

Hypotension 86

Differential diagnoses 86

Insomnia 88

Differential diagnoses and suggested management 88

Management with benzodiazepines 88

Itching 88

Differential diagnoses (if no visible skin lesions or rash) 88

Major trauma 89

Minor trauma 90

The moribund patient 91

Nausea and vomiting 92

Differential diagnoses 92

Oxygen therapy 93

Methods of oxygen delivery 93

Pulse oximetry 94

Phlebitis 94

Management 94

Potassium 94

Hyperkalaemia 94

Hypokalaemia 95

Rashes and skin lesions 96

Disease categories 1 10 96

Shortness of breath 97

Differential diagnoses 97

The sick patient 98

Sodium 98

Hyponatraemia 98

Differential diagnoses 99

Transfusions 99

Blood transfusions 99

Platelet transfusions 100

Urine: Low output (oliguria/anuria) 101

Basic emergency routine 102

Obstetrics and gynaecology calls 103

Talking to the patient 103

Gynaecological examination 103

Obstetric examination 104

Being a male 104

Common gynaecological calls 105

Termination of pregnancy 106

9 Death and dying 107

Terminal care 107

Communication 107

Breaking bad news 107

Ongoing communication

with dying patients 108

Pain control 110

Symptom control 110

Prescribing for the dying 110

Support for the dying and for you 111

Death 111

What to do when a patient dies 111

Telling relatives about the patient s death 112

Religious practices on death 112

PMs 112

Death certificates 113

Writing the death certificate 113

Referring to the coroner (Scotland: Procurator fiscal) 114

Cremation forms and fees 114

To check for pacemakers 114

Further reading 114

10 Drugs 116

General 116

Prescribing drugs 116

Drug charts 116

Writing prescriptions 117

Controlled drugs 117

Verbals 118

Giving drugs 118

Drug infusions 119

Prescribing drug infusions 119

Intravenous drugs 120

Specific drug topics 122

Antibiotics 122

Anticoagulation 122

Digoxin 125

Therapeutic drug levels 126

Miscellaneous tips 126

11 Handle with care 134

Alcoholism 134

Alcohol withdrawal 135

Capacity 136

Children 137

Depression 137

Elderly patients 138

Haemophilia patients 139

Taking blood 139

For theatre 139

HIV/AIDS 140

Taking blood 140

HIV testing 140

Jehovah s Witnesses/Christian Scientists 141

Pregnant women 141

Sickle cell anaemia 142

The patient on steroids 142

Side effects of steroids 142

Managing ill patients on steroids 143

Treating common side effects 143

Withdrawing steroid therapy 143

Haematological and oncological emergencies 144

Spinal cord compression 144

Superior vena cava obstruction and airway compromise 144

Raised intracranial pressure 145

Tumour lysis syndrome 145

Hyperviscosity 145

12 Approach to the medical patient 147

History and examination 147

Getting to know the disease 148

History and examination 151

Clinical stalemate 151

Preparing patients for medical procedures 151

Cardiac catheterization 152

Elective DC cardioversion 152

Upper gastrointestinal endoscopy 153

Colonoscopy 154

Flexible sigmoidoscopy 154

Liver biopsy 155

Pacemaker insertion 155

Renal biopsy 156

Specialist referrals and investigating the medical case 156

Cardiology 157

Gastroenterology 158

Haematology 159

Neurology 160

Renal medicine 161

Respiratory medicine 161

Rheumatology 162

13 Practical procedures 163

General hints 163

Interpreting ABGs 165

Bladder catheterization 167

Men 168

Women 169

Blood cultures 169

Venepuncture 169

Cannulation

(Venflon/line insertion) 170

Problems with temporary and tunnelled central lines 173

Using central lines 173

Chest drains 173

Managing a chest drain 174

How to remove a drain 175

DC cardioversion 175

Electrocardiogram 176

Exercise stress test 176

Relative contraindications (discuss with senior) 176

The procedure 176

Injections 177

Subcutaneous 177

Intramuscular 178

Joint aspiration/injection 179

Aspiration 179

Injecting joints 180

Local anaesthesia (for any procedure) 180

Lumbar puncture 181

Contraindications (get help) 181

Mantoux test 184

Nasogastric tubes 184

Peritoneal tap (paracentesis) 185

Pleural aspiration 185

Indications 185

Pulsus paradoxus 188

Respiratory function tests 188

Spirometry 188

Peak expiratory flow rate 189

Sutures 190

14 Radiology 191

Requesting investigations 191

Minimizing radiation 192

Common concerns about X–rays 192

Pregnancy 193

Plain films 193

Chest X–rays 193

Abdominal films 194

Ultrasound 194

Computed tomography 195

General 195

CT head Some emergency indications 195

Radioisotope scanning 196

15 Approach to the surgical patient 198

Introduction 198

Preoperative care 198

Clerking 198

Preoperative tests 199

Requesting blood preoperatively 200

Preoperative fasting 200

Consent 201

Marking 203

Booking theatre lists 203

WHO checklist 205

Perioperative prescribing 205

Anti–emetics 205

Analgesia 205

Laxatives 205

Bowel preparation 205

Thromboprophylaxis 207

Insulin infusion 207

Post–operative care 207

Wound checks 208

Stoma care 209

Enhanced recovery after surgery 209

Theatre 210

Further reading 210

16 General practice 212

What you can and cannot do 212

You can 212

You cannot 212

Referral letters and note keeping 212

General points 212

Public health and health promotion 213

Risks 213

Benefits 213

Condoms 214

Intrauterine system 214

Intrauterine device 214

Contraceptive injection 214

Contraceptive implants 214

Smoking 215

Lifestyle advice 215

Notifiable diseases 215

Vaccinations 215

Breast screening 215

Cervical screening 215

Sexual health 216

The hidden agenda and health beliefs 216

Follow–up 216

Home visits 217

17 Self–care 218

Accommodation 218

Alternative careers 218

Bleep 219

British Medical Association 219

Car insurance 219

Clothes (laundry/stains) 220

Contacting medical colleagues 220

Contract and conditions of service 220

What you need to know about your contract 220

Doctors mess 225

Making money for the mess 225

Insurance (room contents) 225

Jobs 225

Curriculum vitae 225

The interview 226

Consultant career prospects 226

Locums 226

Meals 227

Medical defence 227

Money 228

Income protection if long–term sick or disabled 228

Student debt 228

Mortgages 228

Payslip deductions 228

Pensions 229

Tax 229

Telephone and online banking 230

Needlestick injuries 230

If the patient is known to be HIV positive 231

If the patient is known to be hepatitis positive 231

Not coping 231

Part–time work (flexible training) 232

Representation of junior doctors 232

Sleep and on–call rooms 232

When things go wrong 233

Bullying and psychological stress 233

Whistle–blowing 233

Appendix I: Scoring systems 235

Cardiovascular 235

CHA2DS2 VASc 235

HASBLED score 235

GRACE score 235

TIMI Risk Index 236

NYHA scoring system (New York Heart Failure Association Scoring System) 236

Neurology 236

TIA–ABCD2 scoring 236

AMTS (abbreviated

mental test score) 237

AVPU score 237

(GCS) Glasgow Coma score 237

Anaesthetics 237

Mallampatti classification for intubation 237

BMI 238

Calculating anion gap 238

Calculating serum osmolality 238

Respiratory 238

Gastroenterology 239

Child Pugh classification 240

Renal 241

Trauma 241

Barthel score 242

Bathing 242

Bladder 242

Bowels 242

Dressing 242

Feeding 242

Grooming 242

Mobility 242

Stairs 242

Toilet 242

Transfer 242

Appendix 11: Useful tests, numbers and other information 243

Addresses 243

Mental Health Act 243

Notifiable diseases 244

Results 244

Haematology 244

Biochemistry 245

Useful biochemical formulae 245

Fitness to drive 246

Further resources 248

Index 249

O autorze

Anna Donald, late of Bazian Ltd, London

Michael Stein is Chief Medical Officer, Map of Medicine, London, and Medical Advisor, Hearst Business Media, Hearst Corporation, New York

Ciaran Scott Hill is Neurosurgery Registrar, The Royal London Hospital, Honorary Senior Lecture in Neuroscience, Univesity College London, and Prehospital Care Physician, London Air Ambulance

Selina Chavda is NIHR Academic Clinical Fellow in Haemato–Oncology, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research

Blurb

About to start the Foundation Programme?
Making the transition from medical school to professional life?

The Hands–on Guide to the Foundation Programme, Fifth Edition is a practical guide for medical students and foundation doctors, dealing with the many challenges of the programme. With hints, tips and realistic advice on various aspects of the course, from self–care to prescribing, this guide provides invaluable support, with up–to–date information on postgraduate training and recruitment, practical management skills and career pathways to help build confidence, enabling you to hit the ground running.

This edition features newly expanded sections on emergencies, psychiatric evaluation, the Situational Judgement Test, and the common calls and conditions you will encounter on a daily basis. The Hands–on Guide to the Foundation Programme is a perfect companion to assist the junior doctor in preparing for the intellectual and emotional challenges of the foundation years.

Take the stress out of the Foundation Programme with The Hands–on Guide!