The Hands-on Guide for Junior Doctors E-Book

Anna Donald

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Hands-on Guides
• Sprache: Englisch

Seitenzahl: 517

Veröffentlichungsjahr: 2011

Beschreibung

Are you about to start the Foundation Programme? Do you know what to expect and how to thrive?

The Hands-on Guide for Junior Doctors, Fourth Edition, is the ultimate, practical guide for junior doctors and medical students. It helps you tackle the emotional, intellectual and physical demands of being a new doctor and allays common insecurities to help you make the most of your time in clinical practice.

This book tells you how to prepare for the daily rigours of hospital life, and will help you meet the required standard. It provides advice on getting started in placements, and helps you develop confidence, with tips on what to do as a junior member of the hospital team, and how to deal with common calls and emergencies. There is also an invaluable chapter on how to perform the practical procedures you’ll be assessed on.

With the Foundation Programme such a demanding process, both physically and emotionally, this book also provides the kind of information you don’t get at medical school, for example, how to look after yourself throughout your training.

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

Leseprobe

Contents

Introduction

How to use this book

Acknowledgements

Dedication

Abbreviations

Chapter 1 STARTING UP

Panic?

Other useful start-up information

Bibliography

Chapter 2 GETTING ORGANIZEDOR ‘THE FOLDER’

Personal folder and the lists

Keeping track of patients (List 1)

List of things todo (List 2)

Results sheet (List 3)

Data protection and confidentiality

Chapter 3 PAPERWORK AND ELECTRONIC MEDICAL RECORDS

Patient notes

Accident forms

Blood forms and requesting bloods

Consent

Death and cremation certificates

Discharge summaries (TTO/TTA)

Drug charts

Drug prescriptions

Handovers

Referral letters

Self-discharge

Sick notes

Chapter 4 ACCIDENT AND EMERGENCY

General

Admitting and allocating patients

Keeping track of patients

Medicine

Overdose

Surgery

Medical and surgical assessment units (MAUs and SAUs)

Fast-track patients

Chapter 5 BECOMING A BETTER DOCTOR

Foundation programmes(for UK readers)

Information technology

Keeping up with the literature

Evidence-based medicine

Clinical governance and paraclinical work

Courses

Professionalism

Confidentiality

Consent

Chapter 6 CARDIAC ARRESTS AND CRASH CALLS

Cardiac arrest calls

‘Do not resuscitate’ (DNR) orders

Chapter 7 COMMON CALLS

How to use this section

Considerations for all ward calls

Abdominal pain

Anaemia

Arrhythmia

Calcium

Chest pain

Confusion

Constipation

Diarrhoea

Electrocardiograms

Eye complaints

Falls

Fever

The immunocompromised patient with fever

Fits

Intravenous fluids

Upper gastrointestinal bleeds

Lower gastrointestinal bleeds

Glucose

Haematuria

Headaches

Hypertension

Hypotension

Insomnia

Itching

Major trauma

Minor trauma

The moribund patient

Nausea and vomiting

Oxygen therapy

Phlebitis

Potassium

Rashes and skin lesions

Shortness of breath

The sick patient

Sodium

Transfusions

Urine, low output (oliguria/anuria)

Basic emergency routine

Obstetrics and gynaecology calls

Chapter 8 DEATH AND DYING

Terminal care

Communication

Pain control

Symptom control

Prescribing for the dying

Support for the dying and for you

Death

What to do when a patient dies

Telling relatives about the patient’s death

Religious practices on death

Post mortems

Death certificates

Referring to the coroner (Scotland: procurator fiscal)

Cremation forms and fees

Chapter 9 DRUGS

General

Prescribing drugs

Giving drugs

Specific drug topics

Miscellaneous tips

Chapter 10 HANDLE WITH CARE

Alcoholism

Children

Depression

Elderly patients

Haemophiliacs

HIV/AIDS

Jehovah’s Witnesses/Christian Scientists

Pregnant women

Sickle cell anaemia

The patient on steroids

Chapter 11 APPROACH TO THE MEDICAL PATIENT

History and examination

Clinical stalemate

Preparing patients for medical procedures

Specialist referrals and investigating the medical case

Chapter 12 PAIN

Pain control

Specific analgesics

Pain control by severity and underlying condition

Chapter 13 PRACTICAL PROCEDURES

General hints

Arterial blood gases

Bladder catheterization

Blood cultures

Venepuncture

Cannulation (Venflon/Line insertion)

Central lines

Chest drains

DC cardioversion

Electrocardiogram

Exercise stress test

Glucose tolerance test

Injections

Intercostal block

Joint aspiration/injection

Local anaesthesia (for any procedure)

Lumbar puncture

Mantoux test

Nasogastric tubes

Peritoneal tap (paracentesis)

Pleural aspiration

Pulsus paradoxus

Respiratory function tests

Sutures

Chapter 14 RADIOLOGY

Requesting investigations

Minimizing radiation

Common concerns about X-rays

Pregnancy

Plain films

Contrast studies

Ultrasound

Computed tomography

Arteriography

Magnetic resonance imaging

Radioisotope scanning

Chapter 15 SURGERY

Clerking: pre-admission clinic

Perioperative prescribing

Consent

Anaesthetics

Drawing up theatre lists

Marking patients for surgery

Post-operative care

Complicated patients

Day surgery

Oro-facio-maxillary surgery

Surgical protocol clerking sheet

Chapter 16 GENERAL PRACTICE

What you can and cannot do

Referral letters and note keeping

General points

Public health and health promotion

The hidden agenda and health beliefs

Follow-up

Home visits

Chapter 17 SELF-CARE

Accommodation

Alternative careers

Bleep

British Medical Association (BMA)

Car and insurance

Clothes (laundry/stains)

Contacting medical colleagues

Contract and conditions of service

Doctors’ mess

Drug representatives

European Working Time Directive

Insurance(room contents)

Jobs

Locums

Meals

Medical defence

Money

Needlestick injuries

Not coping

Part-time work (flexible training)

Representation of junior doctors

Sleep and on-call rooms

When things go wrong

Appendix USEFUL TESTS, NUMBERS AND OTHER INFORMATION

Addresses

Barthel score

Glasgow Coma Scale (GCS)

Mental Health Act

Mini-mental test score

Notifiable diseases

Results

Useful biochemical formulae

Index

Further Resources

Books

Websites

Advertisement

This edition first published 2011 © by A Donald, M Stein and C S HillPrevious editions published 1996, 2002, 2006

Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing program has been merged with Wiley’s global Scientific, Technical and Medical business to form Wiley-Blackwell.

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Library of Congress Cataloging-in-Publication Data

Donald, Anna.The hands-on guide for junior doctors / Anna Donald, Michael Stein, Ciaran Scott Hill. – 4th ed.p. ; cm.Includes bibliographical references and index.ISBN 978-1-4443-3466-1 (hardcover : alk. paper)1. Residents (Medicine)–Handbooks, manuals, etc. 2. Medicine–Handbooks, manuals, etc. I. Stein, Michael. II. Hill, Ciaran. III. Title.[DNLM: 1. Medical Staff, Hospital–organization & administration–Great Britain–Handbooks. 2. Clinical Competence–Great Britain–Handbooks. 3. Internship and Residency–organization & administration–Great Britain–Handbooks. 4. Medicine–Great Britain–Handbooks. WX 203]RA972.D66 2006610.92–dc222010039148

A catalogue record for this book is available from the British Library.

Introduction

Your junior doctor years are guaranteed to be one of the big experiences of your life. Free at last from rote learning and endless exams, your first job is intensely practical. The trouble is that the theoretical training in medical school does not usually prepare you for the physical and emotional rigours of hundreds of tasks being thrust upon you around the clock. Similarly, medical textbooks rarely deal with the practical know-how which makes all the difference between clumsy and elegant doctoring.

This book is based on the collective experience of junior doctors who remember only too well the highs and lows of their first year. It contains information not readily available in standard texts that will help you to feel competent and confident despite sleepless nights and low blood sugars. It assumes minimal practical know-how. Subjects are listed in alphabetical order within each chapter. A detailed index is also provided for rapid reference.

Whatever you do, keep your head up and keep smiling. Hospitals are funny places. Lots of people love their first job; we hope you are one of them. Take care and good luck!

A.K.D.C.S.H.M.L.S.J.T.H.T.

How to use this book

This book is designed as a user-friendly manual. We recommend skimming through it when you first buy it, and then referring to relevant sections for particular problems that you come across.

This book provides standard algorithms for diagnosis and management of clinical problems that worked for us and our colleagues, in different settings throughout Britain. Please don’t follow our instructions slavishly. We realize that every firm has its own way of doing things and that there may be more appropriate algorithms for specialist wards or unusual situations. Like a recipe book, feel free to scrawl in the margins to make it more usable for you. We have included some blank pages at the back for extra notes.

We want to emphasize that this book is not the Oxford Textbook of Medicine, so please don’t expect to find the 337 causes of tropical swollen legs here!

To keep the book compact and maximally relevant to what you need, we have not attempted to replicate the British National Formulary. While we do suggest drugs where relevant, we realized from our own experience that the safest and most efficient way to prescribe drugs is to use the BNF in conjunction with your hospital’s drug formulary.

Finally, if you discover a better way of doing something, please let us know. If we can use your suggestion, you will be acknowledged in the next edition of the book.

Acknowledgements

This book is dedicated to Uncle Ivan Harris and to Bruce, Janet and Tom Donald, for the support and love that made writing this book possible.

Fifty per cent of the authors’ royalties for this book are donated to the University of Cape Town Medical School.

Dedication

The wonderful Anna Donald died during the preparation of this fourth edition of Hands-on Guide for Junior Doctors. For those who never had the privilege of meeting Anna, here is a little bit about an extraordinary friend and colleague (also see her obituary in the BMJ – 4 February 2009 – by Richard Smith and Sir Muir Gray):

Anna had a brilliant and inquisitive mind, receiving degrees from not one but three top-flight universities:

University of Sydney: Bachelor of Arts, majoring in history and preclinical medicine

University of Oxford: Bachelor of Medicine and Surgery degree (Rhodes Scholar)

Harvard University: Master’s degree in Public Policy

Anna worked as a doctor and lecturer in epidemiology and public policy at University College London, and was founding editor of the British Medical Journal’s Clinical Evidence, the journal of evidence-based health care and evidence-based health policy. Anna’s professional passion was the delivery of high-quality health care for everyone. Indeed, in 1998, as a pioneer in evidence-based health care, Anna founded Bazian, one of the first companies in the world to provide specialist evidence-based consulting and analysis to support the delivery of health care.

In 2007, Anna learned that her breast cancer, first diagnosed in 2003, had metastasized. Anna remained incredibly positive and said this: ‘When you discover you have metastatic cancer you think you’ve picked a black ball in the lottery. But I’ve discovered it’s a luminescent ball. I’m becoming the person I want to be. I’m not putting it off until I retire’.

Anna died two years later on 1 February 2009 having become the person she wanted to be. And she was always a person that everyone who met her, loved.

For more about Anna Donald, see her entry in Wikipedia.

Abbreviations

We include a long list of abbreviations to aid reading medical notes and for reference throughout this book.

μg

micrograms

−ve

negative

+ve

positive

A&E

accident and emergency

ABC

airway, breathing, circulation

ABG

arterial blood gases

ac

ante cibum (before food)

ACE

angiotensin-converting enzyme

ACTH

adrenocorticotrophic hormone

ADH

antidiuretic hormone

AF

atrial fibrillation

AFB

acid-fast bacillus

AIDS

acquired immunodeficiency syndrome

ALP (alkphos)

alkaline phosphatase

ALS

Advanced Life Support

ALT

alanine aminotransferase

ANA

antinuclear antigen

ANCA

antineutrophil cytoplasmic antigen

ANF

antinuclear factor

APTT

activated partial thromboplastin time

ARC

AIDS-related complex

ARDS

adult respiratory distress syndrome

ARF

acute renal failure

ASAP

as soon as possible

ASD

atrial septal defect

ASOT

antistreptolysin O titre

AST

aspartate transaminase

ATN

acute tubular necrosis

AV

atrioventricular

AVCs

additional voluntary contributions

AXR

abdominal X-ray (plain)

Ba

barium

BBB

bundle branch block

bd

bis die (twice per day)

bHCG

beta-human chorionic gonadotrophin

BMA

British Medical Association

BMJ

British Medical Journal

BNF

British National Formulary

BP

blood pressure

bpm

beats/minute

Ca

carcinoma

Ca

calcium

CABG

coronary artery bypass graft

CBD

common bile duct

CCF

congestive cardiac failure

CCU

coronary care unit

CEA

carcino-embryonic antigen

CFC

complement fixation test

CI

contraindications

CK

creatinine kinase

CK-MB

creatine kinase cardiac isoenzyme

CLL

chronic lymphocytic leukaemia

CML

chronic myeloid leukaemia

CMV

cytomegalovirus

CNS

central nervous system

COAD

chronic obstructive airways disease

COPD

Chronic Obstructive Pulmonary Disease

CPR

cardiopulmonary resuscitation

CRF

chronic renal failure

CRP

C-reactive protein

CSF

cerebrospinal fluid

CT

computed tomography

CTG

cardiotocography

CV

curriculum vitae

CVA

cerebrovascular accident

CVP

central venous pressure

CVS

cardiovascular system

CXR

chest X-ray

D&V

diarrhoea and vomiting

DDAVP

desmopressin

DIC

disseminated intravascular coagulation

DIP

distal interphalangeal

DKA

diabetic ketoacidosis

dl

decilitre(s)

DM

diabetes mellitus

DNR

do not resuscitate

DOA

date of admission

DOB

date of birth

DOD

date of death

DoH

Department of Health

DVLC

Driver and Vehicle Licensing Centre

DVT

deep venous thrombosis

DXT

radiotherapy

EBV

Epstein–Barr virus

ECG

electrocardiogram

ECHO

echocardiography

EDTA

ethylene diamine tetra-acetic acid

EEG

electroencephalogram

ELISA

enzyme-linked immunosorbent assay

EM

electron microscope

ENT

ear, nose and throat

EPC

early pregnancy clinic

ERCP

endoscopic retrograde cholangiopancreatography

ESR

erythrocyte sedimentation rate

FBC

full blood count

FDP

fibrin degradation product

FEVl

forced expiratory volume in first second

FFP

fresh frozen plasma

FOB

faecal occult blood

FSH

follicle stimulating hormone

FVC

forced vital capacity

Fx

family

FY1

Foundation Year 1

FY2

Foundation Year 2

g

gram(s)

G&S

group and save

G6PD

glucose-6-phosphate dehydrogenase

GBM

glomerular basement membrane

GCS

Glasgow Coma Scale

GFR

glomerular filtration rate

GGT

gamma-glutamyl transferase

GH

growth hormone

GI (GIT)

gastrointestinal

GKI

glucose, potassium and insulin

GMC

General Medical Council

GN

glomerulonephritis

GP

general practitioner

GT

glutamyl transferase

GTN

glyceryl trinitrate

GTT

glucose tolerance test

GU

genito-urinary

HB

heart block

Hb

haemoglobin

HBsAg

hepatitis B surface antigen

Hct

haematocrit

HDL

high density lipoprotein

HDU

high dependency unit

Hep

hepatitis

HiB

Haemophilus influenzae B vaccine

HIV

human immunodeficiency virus

HLA

human leukocyte antigen

HO

House Officer

HOCM

hypertrophic obstructive cardiomyopathy