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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
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!
Sie lesen das E-Book in den Legimi-Apps auf:
Seitenzahl: 595
Veröffentlichungsjahr: 2014
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CONTENTS
Cover
Title page
Copyright page
Dedication
Introduction
How to use this book
Acknowledgements
Abbreviations
Chapter 1: STARTING UP
Panic?
Other useful start-up information
Bibliography
Chapter 2: GETTING ORGANIZED
OR
‘THE FOLDER’
Personal folder and the lists
Keeping track of patients (List 1)
List of things to do (List 2)
Results sheet (List 3)
Data protection and confidentiality
Chapter 3: PAPERWORK AND ELECTRONIC MEDICAL RECORDS
Patient notes
Incident forms
Blood forms and requesting blood tests
Discharge summaries (TTO/TTA)
Handovers
Referral letters
Self-discharge
Sick notes
Chapter 4: ACCIDENT AND EMERGENCY
General advice
Admitting and allocating patients
Keeping track of patients
Medicine
Medical and surgical assessment units
Fast-track patients
Chapter 5: BECOMING A BETTER DOCTOR
Foundation Programmes (United Kingdom)
Information technology
Keeping up with the literature
Evidence-based medicine
Courses
Professionalism
Confidentiality
References
Chapter 6: EMERGENCIES
Acute coronary syndrome
Stroke
DVT and PE
Haematemesis
Acute asthma
Acute pneumothorax
Anaphylaxis
Meningitis
Collapse or reduced mobility
Overdose
Surgery
Chapter 7: CARDIAC ARRESTS AND CRASH CALLS
Cardiac arrest calls
‘Do not resuscitate’ orders
Chapter 8: 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 9: 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
PMs
Death certificates
Referring to the coroner (Scotland: Procurator fiscal)
Cremation forms and fees
Further reading
Chapter 10: DRUGS
General
Prescribing drugs
Giving drugs
Prescribing drug infusions
Specific drug topics
Miscellaneous tips
Chapter 11: HANDLE WITH CARE
Alcoholism
Capacity
Children
Depression
Elderly patients
Haemophilia patients
HIV/AIDS
Jehovah’s Witnesses/Christian Scientists
Pregnant women
Sickle cell anaemia
The patient on steroids
Chapter 12: APPROACH TO THE MEDICAL PATIENT
History and examination
History and examination
Clinical stalemate
Preparing patients for medical procedures
Specialist referrals and investigating the medical case
Chapter 13: PRACTICAL PROCEDURES
General hints
Bladder catheterization
Blood cultures
Venepuncture
Cannulation (Venflon/line insertion)
Chest drains
DC cardioversion
Electrocardiogram
Exercise stress test
Injections
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
Ultrasound
Computed tomography
Radioisotope scanning
Chapter 15: APPROACH TO THE SURGICAL PATIENT
Introduction
Preoperative care
Clerking
Preoperative tests
Requesting blood preoperatively
Preoperative fasting
Consent
Marking
Booking theatre lists
WHO checklist
Perioperative prescribing
Anti-emetics
Analgesia
Laxatives
Bowel preparation
Thromboprophylaxis
Insulin infusion
Post-operative care
Wound checks
Stoma care
Enhanced recovery after surgery
Theatre
Further reading
Chapter 16: GENERAL PRACTICE
What you can and cannot do
Referral letters and note keeping
General points
Public health and health promotion
Smoking
Lifestyle advice
Notifiable diseases
Vaccinations
Breast screening
Cervical screening
Sexual health
The hidden agenda and health beliefs
Follow-up
Home visits
Chapter 17: SELF-CARE
Accommodation
Alternative careers
Bleep
British Medical Association
Car insurance
Clothes (laundry/stains)
Contract and conditions of service
Doctors’ mess
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 I: SCORING SYSTEMS
Cardiovascular
Barthel score
Appendix II: USEFUL TESTS, NUMBERS AND OTHER INFORMATION
Addresses
Mental Health Act
Notifiable diseases
Results
Useful biochemical formulae
Further Resources
Books
Websites
Index
End User License Agreement
List of Tables
Chapter 03
Table 3.1 Conditions for which it may be possible to fill out serial forms.
Chapter 08
Table 8.1 Differential diagnoses of anaemia.
Table 8.2a Managing supraventricular tachycardias. If the patient has SVT and signs of compromise (hypotension, heart failure, impaired consciousness, or a heart rate of >200 bpm), get help fast. The patient may require 100–200 J of synchronized direct current (DC) cardioversion.
Table 8.2b Management of ventricular tachycardias.
Table 8.3 Diagnosing infarction sites by ECG changes.
Table 8.4 Common post-operative causes of fever.
Table 8.5 Example of typical fluid chart.
Table 8.6 A rough guide to the electrolyte content and daily production of body fluids.
Table 8.7 Differential diagnoses of haematuria (consider the anatomy of the renal tract).
Table 8.8 Differential diagnoses to a moribund patient (acronym: CASH).
Table 8.9 Differential diagnoses of oliguria/anuria.
Chapter 10
Table 10.1 Abbreviations for prescribing drugs.
Table 10.2 Standard treatments for common infections (please refer to the protocols in your local trust for more information as regional variations exist).
Table 10.3 INR and warfarin dosing.
Table 10.4 Therapeutic drug levels and sampling times.
Table 10.5 75 commonly used drugs.
Chapter 11
Table 11.1 Prescribing chlordiazepoxide.
Table 11.2 Anti-inflammatory steroid equivalent doses.
Chapter 13
Table 13.1 Normal ABG values.
Table 13.2 Interpreting acid–base disorders.
Table 13.3 Cannula sizes.
Table 13.4 Expected values for FEV
1
(litre).
Table 13.5 Expected normal values for FVC (litre).
Table 13.6 Predicted values for PEFR (l/minute).
Table 13.7 When to remove sutures.
Chapter 14
Table 14.1 Radiation doses of radiological investigations.
Chapter 15
Table 15.1 Preoperative marking verification checklist
Table 15.2 Surgical protocols for people with diabetes.
Chapter 17
Table 17.1 New Deal hours.
Table 17.2 European Working Time Directive.
Table 17.3 Banding.
List of Illustrations
Chapter 02
Figure 2.1 Essential telephone numbers.
Chapter 06
Figure 6.1 Acute MI (new ST elevation or new LBBB).
Figure 6.2 Acute coronary syndrome without ST elevation.
Figure 6.3 Management of acute pneumothorax as per BTS Guidelines.
Figure 6.4 Treatment nomogram for paracetamol overdose as per MFRA guidelines.
Chapter 07
Figure 7.1 Protocol for (a) basic life support and (b) advanced life support (adults).
Chapter 08
Figure 8.1 Determining the axis for ECG examination.
Chapter 10
Figure 10.1 Preparing powdered drugs.
Chapter 12
Figure 12.1 Approach to history taking.
Figure 12.2 Approach to examination.
Chapter 13
Figure 13.1 Radial arterial puncture.
Figure 13.2 Femoral arterial puncture: inguinal canal anatomy may be remembered using the mnemonic ‘NAVY’ – nerve, artery, vein and Y-fronts (!).
Figure 13.3 Cannulating a vein.
Figure 13.4 Cross section through chest cage to illustrate chest drain.
Figure 13.5 ECG chest lead placement.
Figure 13.6 Site for intramuscular injections: (a) lateral view. (b) Posterior view.
Figure 13.7 (a) Patient position for lumbar puncture, (b) approaches for lumbar puncture. (c) Close-up of lumbar puncture.
Figure 13.8 Site for tapping ascites.
Figure 13.9 Pleural aspiration (diagram shows an oblique section).
Chapter 14
Figure 14.1 Anatomy of a chest X-ray.
Figure 14.2 CT head pathology.
Chapter 15
Figure 15.1
Guide
Cover
Table of Contents
Begin Reading
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The Hands-on Guide to the Foundation Programme
Fifth Edition
ANNA DONALD
BA (Sydney), BM, BCh (Oxon), MPP (Harvard)
Late of Bazian Ltd, London, UK
MICHAEL STEIN
MB ChB, BSc (Hons) (UCT), DPhil (Oxon)
Chief Medical Officer, Map of Medicine, London, UK
and Medical Advisor, Hearst Business Media
Hearst Corporation, New York, NY, USA
CIARAN SCOTT HILL
BSc (Hons), MSc (Clin. Neuro.), MBBS, MCSP, MRCS, MRCP, DMCC, DOHNS
Neurosurgery Registrar, The Royal London Hospital
Honorary Senior Lecturer, in Neuroscience, University College London,
and Prehospital Care Physician, London Air Ambulance, London, UK
SELINA J CHAVDA
MBBS, BSc (Hons), MRCP
NIHR Academic Clinical Fellow in Haemato-Oncology
The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
This edition first published 2015 © 2015 by John Wiley & Sons Ltd.Previous editions published 1996, 2002, 2006, 2011
Registered OfficeJohn Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
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The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.
Library of Congress Cataloging-in-Publication Data
Donald, Anna, author. The hands-on guide to the Foundation Programme / Anna Donald, Michael Stein, Ciaran Scott Hill, Selina Chavda. – Fifth edition. 1 online resource. Preceded by The hands-on guide for junior doctors / Anna Donald, Michael Stein, Ciaran Scott Hill. 4th ed. 2011. Includes bibliographical references and index. Description based on print version record and CIP data provided by publisher; resource not viewed.
ISBN 978-1-118-76744-3 (Adobe PDF) – ISBN 978-1-118-76745-0 (ePub) – ISBN 978-1-118-76746-7 (pbk.)I. Stein, Michael, 1963 May 25– , author. II. Hill, Ciaran, author. III. Chavda, Selina, author. IV. Title. [DNLM: 1. Foundation Programme (Great Britain. National Health Service) 2. Medical Staff, Hospital–organization & administration–Great Britain–Handbooks. 3. Clinical Competence–Great Britain–Handbooks. 4. Internship and Residency–organization & administration–Great Britain–Handbooks. 5. Medicine–Great Britain–Handbooks. WX 203] RA972 616–dc23
2014028668
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Cover image: Hand MRI © kemie /iStockphoto; Heartbeat © Rinelle /iStockphoto; Pills and capsules © FotografiaBasica /iStockphoto; ECG © enot-poloskun /iStockphoto; Filled vials and syringe © Liuhsihsiang /iStockphoto
Dedication
The wonderful Anna Donald died during the preparation of the 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 2 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.
Introduction
I expect to pass through this world but once. Any good, therefore, that I can do or any kindness I can show, let me do it now. Let me not defer or neglect it for I shall not pass this way again.
Your first years as a doctor are guaranteed to contain some of the most memorable 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 few years. 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.
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!
Anna DonaldMichael SteinCiaran Scott HillSelina J Chavda
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 (BNF). Whilst 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.
Abbreviations
We include a long list of abbreviations to aid reading medical notes and for reference throughout this book.
μg
micrograms
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
AED
automated external defibrillator
AF
atrial fibrillation
AFB
acid-fast bacillus
AIDS
acquired immunodeficiency syndrome
ALS
Advanced Life Support
ANA
antinuclear antigen
APTT
activated partial thromboplastin time
ARCP
Annual Review of Competence Progression
AS
aortic stenosis
AV
atrioventricular
AVCs
additional voluntary contributions
AXR
abdominal X-ray (plain)
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
CCF
congestive cardiac failure
CK
creatinine kinase
CNS
central nervous system
COPD
Chronic Obstructive Pulmonary Disease
CPR
cardiopulmonary resuscitation
CRP
C-reactive protein
CSF
cerebrospinal fluid
CT
computed tomography
CV
curriculum vitae
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
