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A bit intensive

May 29th, 2009 2 comments

It’s the end of day 4 of my first week in intensive care and intensive is a pretty good summary.

Generally the days have consisted of me turning up around 9am (earlier than that is pushing it) and joining the ward round. This lasts a variable length of time usually finishing by around 11am with a plan for all the patients on the unit. The rest of the morning is spent following up on any tasks needing done with a break for lunch slotted in somewhere. Early afternoon a rather brisker round takes place to catch up on any developments and again tasks from these are dealt with.

Typically around this time there seems to be something happening elsewhere in the hospital which needs attention such as a transfer into the unit or someone wanting advice.

Today’s highlight was my ability to bleed a patient on a general ward that neither the FY1 or Reg could find a vein on. Finding somewhere to put a cannula was a bit more awkward, it finally ended up on a thumb – thankfully by the anaesthetist and not me!

I’m certainly enjoying the week so far, probably far more than if I were doing an SSM from a set list. I’m hoping to try, by the end of my stint in ITU, to get a good grip of how to cope with a patient going poorly. This seems to be a struggling point for FY1s so hopefully my time now will actually help in the future.

After this I will have only 2 SSMs (and another elective) left to pick things like this. I was considering doing some more of anaesthesia/critical care but I’m now thinking that wouldn’t really help me. Will be a tough decision over doing something sounding interesting or something that’ll be useful (not that they are mutually exclusive…).

Categories: Medical Tags: ,

Clinical examination – what book?

April 30th, 2009 3 comments

Clinical examination is an important part of being a medical student, particularly from year 3 onwards in the UK. As everything medical students do requires a bookshelf to itself, clinical examination is no different. Back in first year I fell victim of my own advice:

Wait until you know which book you need and like before buying any

I say this many times to prospective medical students, it saves both money (quite important!) and wasted space. However, being only a 1st year, I took the advice of my tutor and ran out to buy Macleod’s Clinical Examination, It’s a popular book, no doubt about that. Mention it to most medical students or doctors and they’ll generally nod approvingly. There is a new edition due out in June (on my brother’s birthday, possible present? probably not) which will no doubt be just as popular. Anyone who wants to go buy a copy would probably be best waiting until the new version. I say this not only to gain the benefits of whatever the refresh will contain but also because Student Consult becomes unusable after an update is published.

I kept my Macleod’s happy on my bookshelf for the better part of 2 years. Recently, however, I noticed something funny – I hardly used it. In fact, I was using it less than I was using a similar book from the library. Which book? This one:

Oxford Handbook of Clinical Examination and Practical Skills

oxpracIt’s a great book. Instead of aimless rambling that I found prevalent in Macleod’s this book is very focused to the detail required. Don’t think this is lacking some of the basics either – each chapter begins with relevant anatomy and physiology which is a very useful summary. I have found things explained here which would take much searching in Macleod’s or that aren’t even there to begin with.

The book is part of the Oxford Handbook Series (like the cheese and onion) and will therefore be familiar to the majority of students. Being a handbook is particularly useful and means it’ll fit in most pockets without trouble.

Still, one of the best features has to be the latter part of the title. Practical skills include everything from hand washing and cannulation to pericardial aspiration and airway management. This is interesting for me but surely could be extremely useful for junior doctors. Don’t try looking for anything like this in Macleod’s, by the way.

To finish of this excellent piece of work, Thomas and Monaghan have included a chapter on interpretation – going through most of radiology, clinical chemistry and not forgetting the dreaded ECGs.

The book is relatively new (May 07) and so far seems pretty scarce. For Glasgow students there are only 2 across campus at time of writing (and none in the SL!). If you can track it down though, give it a glance and see what you think. Not all books are for everyone though, so don’t forget my original advice.

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I don’t get any commisson from this book, by the way, despite what it sounds like above. I also don’t get anything from the Amazon links.

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In the end – I sold my Macleod’s.

Categories: Medical, Review Tags: , ,

Channel 4 – The Hospital

April 14th, 2009 No comments
A&E in the UK

A&E in the UK

This is a 3 part documentary on the effect of young adults on the NHS. The first part was on last week and was excellent. The second, regarding teenage pregnancy, is on tonight at 9. Recommended watching for all those thinking of working in the NHS.

Will chip in my views about it all after I’ve seen all 3.

Why do we do it?

April 13th, 2009 1 comment

It’s not unusual – I go home or manage to meet up with my family. I’ll usually be presented with a “present” in the form of a cut or bruise from my brother or sister. More recently I’ve had the joy of a rash. These are generally trivial and more of a joke than any serious test of what I’ve learned.

Move up a few generations and things are a bit different. Here I have statins, B-blockers and ACE inhibitors of all sizes. I get updated on any recent changes (whether I want to know or not) and spend a bit of time trying to work out what the trade name actually is. This is fine, I’m (sadly) quite interested in this. I stop myself from making any real comments though – save maybe trying to explain what the drug does. Anything beyond that 1) I tend not to know and 2) don’t want to treat my family anyway.

Unfortunately my restraint doesn’t seem to be shared by my peers. The most recent example of this was one of my colleagues explaining to a relative the findings of a new study. The relative was told they “probably don’t need to be on it” and that it “has these new problems”. More annoyingly, my friend was planning to send the article so that it could be taken to their relatives GP who “might not have seen it”.

I have no doubt that evidence based medicine isn’t practiced as well as it possible could be but this concerns me for different reasons. Firstly, treating family members is not exactly recommended, even by those fully qualified. More than that, however, is the poor GP who is going to be presented with a BMJ article that the patient was told to bring.

It’s confusing for the patient and annoying for the GP. I don’t like it.

This isn’t an isolated incident either. I’ve heard of younger students advising about post-stroke medication for example.

Perhaps we should be taught about where our limits should be as students? I can think of a few sessions that this could fit into.

Categories: Medical, Rant Tags: , ,

A&E anybody?

August 13th, 2008 2 comments

I got an email yesterday replying to an enquiry about spending my 3rd year (junior) elective in the Southern General Accident and Emergency Department. Happily I’m all booked up for July next year! Why that choice?

A&E because:

  • It may actually be my future career. May be nice to get some experience as early as possible.
  • I will see a variety of people, hopefully consolidating a lot of what I’ve learned already and will learn by the end of 3rd yr.
  • It’s not an area that we’ll cover in the course for a while (if at all?)
  • It’s a busy place and I’ll hopefully be able to get involved at some level

The Southern becase:

  • I know where it is!
  • I can live in the area without spending too much money. I can save more for my senior elective (where i’ll probably go abroad).
  • It’s a busy hospital, lots to do
  • It even has a helipad (the only one in Glasgow).
  • Probably a few more.

So, basically, if anyone is planning on being injured near the Southern in July 2009 (I’m sure people plan it…) then you might just see me looking after you.

…I feel your pain.

First aid for first years?

August 7th, 2008 2 comments

I got an interesting email a few days ago looking for 3rd-5th years (oh boy, that’s me!) who have a valid First Aid certificate and would be happy to help out with teaching first years some first aid. The content is to include:

  • Responsibilities of being a first Aider
  • Personal Safety
  • Regulations and Legislation
  • Action at an emergency
  • Assessing a casualty- primary and secondary survey
  • Recognition and treatment of Hypovolaemic shock
  • Fainting

Not a bad list (although not quite a comprehensive course) and it’s a big improvement from the maybe 30 minutes CPR that has been the norm for the last few years. It’s not clear whether CPR is actually included in the above (primary survey?) or how much will be practical work compared to lecture based.

Because I’m interested in this kind of thing and because I seem to be a tool for volunteering I’ve already agreed to help. Now I just need a timetable…

…ha!

Contemplating

July 29th, 2008 No comments

So recently I’ve been contemplating whether starting my own St Andrew’s Section in the West End would be a good idea or not.

According to the regulations I only need 4 members to start a “Section”. This would be attached to a Company (would I have a say in which one? no idea) and if I achieved 12 members after it year it could become a Company itself. Honestly, I don’t see 4 members being a problem. With some decent effort I don’t even think 12 would be a problem. The problem comes when I try and think about the logistics involved.

  • To hold meetings I’d need some sort of hall. This would involve money, probably around 100 a month.
  • To train I’d need equipment. Equipment costs money. Storage is also a problem
  • New members would need to undergo a full course before being allowed on duty. This cost me 60 to go through (probably not the best deal in the world). Could I pass on some of this onto the applicants?
  • Income probably wouldn’t happen until a number of members were able to go on regular duties.
  • Uniform costs.
  • The time and effort involved, combined with me going into 3rd year, might burn me out.

On the other hand, there are a number of pros:

  • I wouldn’t be annoyed at my current situation any longer
  • I would be leaving a, hopefully successful, Uni society behind when I left. That’s pretty cool as well as looking good on my CV.
  • I might be able to expand upon the training normally provided.
  • There would be a much more social aspect, great for everyone meeting other people, etc.

I’m still not too sure. Theoretically it would be comparable to the LINKS aspect of St John’s ambulance which seems to work well.

At the moment I’m going to wait until I start back again. This way I’d be able to see how much time I’ll have and how much I can get annoyed about my current company.

Early morning walk..

July 21st, 2008 No comments

This is usually the bridge I walk over on my way to work. As you can see, on Saturday my options were a bit restricted. I didn’t even know the bridge could do that so was a little surprised when I saw it. The River Festival was on and a number of boats were in the area which is why it was raised. Thankfully there’s another bridge a few minutes down the river and I managed to get to work on time (phew!).

Work itself is remarkably different at the weekend than the weekday. Things are a lot more relaxed and enjoyable as the majority of us are students. I’ve gained a lot of experience already at phlebotomy but I know I could do with more practice. When we get to the haematology ward then I really notice how much I struggle. Thankfully, most patients are happy to let me try a couple of times and many know they have, quite honestly, terrible veins.

I felt so sorry for the patients that I decided to go into town on Saturday and donate blood in the afternoon. One of my first aid colleagues works there but was unfortunately on a training course. Nevertheless the member of staff I was with knew him well enough to slag him off.

I’ve been told by 02 that I can’t get an iPhone until my contract is almost up. While this obviously makes business sense I was hoping for something similar to what they did for the original iPhone. Hopefully when they get a decent level of stock they’ll start to offer an upgrade to those who’ve registered interest. This puts my aim of christmas quite possible but we’ll see.

T in the Park

July 10th, 2008 1 comment

T in the Park 2008 begins tomorrow evening in Balado. I will be joining festivities early on Saturday morning where I will be part of the first aid team onsite. I’m covering the hours of 10am-6pm on both the Saturday and the Sunday. Honestly, I can’t wait.

The atmosphere will be terrific, the bands will be awesome (any bets on whether Amy Winehouse will turn up?) and the first aid requirements are likely to be greater than any I’ve experienced. Because of that, I’m not quite sure the best way to prepare. At the moment it looks like I’ll be a foot patrol on the site which means the majority of cases I can probably send/escort to a first aid post. I do imagine I’ll be rotating around throughout the day.

Ideally I’d like a few (not too many!) cases where I might need to rack my head to think of how to deal with it. Interestingly we have a number of St John’s members from down south (particularly Leeds) who are coming up, a few on my shifts and possibly as my partner. This would be quite good, I’d love to hear about the differences between us. On the other hand if they wear the green uniform everyone is going to treat them like ambulance staff. Should be interesting!

I’d planned to do some live-twittering but we’ve been told phones should be off whilst on duty. I might manage to slip a few in during my breaks and in the evenings.

All in all, I hope the weather stays nice and that I don’t loose anything I need. Hopefully I’ll be enjoy myself!

In other news, I have 1 week remaining of teenage years. Ahhh! May be getting an iPhone for my birthday though!

Voluntary services in the thick of it

May 2nd, 2008 No comments

I’m a regular reader of The Paramedic’s Diary and couldn’t help but notice the new poll question – Should the voluntary services support the ambulance service on frontline duties?

This likely comes from a recent diary post of his and I felt compelled to write just a bit about it.

Firstly, I’m commenting on this as it would be under usual circumstances – in the event of a major incident (London bombings, etc) then things are obviously different. I’m also basing this mainly on experience in St Andrew’s. I’ll be the first to admit St John’s are quite different on a number of aspects although I’ve tried to come at it from a combined VAS point of view.

The problem with this is how the definition of “support” is taken. If it means relying on a VAS crew attending any type of 999 call then I’d have to say no. Whilst training for some of the St John’s advanced courses (say Emergency Transport Attendant) is undoubtedly tough it is still nowhere near the level required for technicians and paramedics. A VAS crew turning up at a large RTC would, I feel, be quite overwhelmed and wouldn’t have the experience to help them.

Taking another situation, lets say a complication in late pregnancy, would possibly be worse still. Not only is there the medical condition to deal with but there is also a highly emotional situation that a number of professionals would probably not like to be in.

Further, what if there were complications in relation to the actions of the VAS crew? Insurance exists, yes, but to what level? What about regulation? A registered paramedic could face being struck off in a serious situation, but what would happen to a voluntary member? Would communication be effective enough to impose levels of discipline?

These may seem a bit far-fetched, but are foreseeable problems.

On the other hand if we take the situation where a patient is assessed by a technician/paramedic and that professional requests and is confident allowing the care to pass to the voluntary crew then that really is a different matter. Transporting a stable patient doesn’t carry quite the same risk as attending an unknown.

But in the event of a cardiac arrest when even basic lifesaving skills can help, this doesn’t really apply. I might even go as far to pick a VAS crew over a number of GPs I’ve met, basic lifesaving having long since left them.

I guess my point then is that VAS crews might have a use, particularly in busy or definite emergencies. The problems will start when they become preferential to qualified professions which, in today’s cost-effective health service, seems all too likely.

I often comment on St Andrew’s rather slow expansion capacity but if we ever get to the point of covering 999 calls I’d want to be damn sure we covered all the bases.

I’d be interested to hear other views on this and I’ll happily admit I’m not totally knowledgeable about the current policies.

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