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More About This Title The Hands-on Guide to the Foundation Programme,5th Edition
English
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!
English
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
English
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
