The Hands-on Guide for Junior Doctors, 3rd Edition

by Anna Donald (Bazian Ltd, London); Mike Stein (Royal Free Hospital School of Medicine)

• ISBN13: 9781405136099
• ISBN10: 140513609X
• Edition: 3rd
• Format: Paperback
• Copyright: 2006-03-01
• Publisher: Wiley-Blackwell

Summary

The Hands-on Guide for Junior Doctors is a practical book for junior doctors and medical students making the transition from Medical School to life on the Wards. This book is designed to help the reader prepare for the actual daily rigours of hospital life and is an essential guide for surviving the first years as a junior doctor. It covers the personal aspects of being a doctor and the day-to-day reality of clinical life such as responding to acute emergencies, dealing with common calls, drug prescribing and carrying out practical procedures. Unique to this book are sections on getting organized, arranging your finances, selecting a computer, organising the next job and how to practise evidence-based medicine. *clearly explains how to do everything required of a house officer *instructs on procedures *helps in diagnosing common symptoms *protocols for dealing with common diseases *describes ward calls, paperwork and self-care *new co-author to ensure that clinical details are updated *additional material in procedures section and on pay, tax and government guidelines

Author Biography

Anna Donald, is CEO, Bazian Ltd and Clinical Lecturer, School of Public Policy, UCL. She is also Kennedy Fellow, Harvard University

Mike Stein is Project Director, Medic-to-Medic, Royal Free Hospital

James Teo is a prize-winning final year student at Royal Free Medical School, who will be commencing his first PRHO job in August 2004.

Table of Contents

Introduction	xi
How to use this book	xii
Acknowledgements	xiii
Abbreviations	xiv
Starting up	1	(7)
Panic?	1	(1)
people to help you	1	(1)
three basic tips	1	(1)
Other useful start-up information	2	(6)
dress	2	(1)
equipment	2	(1)
first-day paperwork	3	(1)
geography	3	(1)
ward rounds	3	(1)
social rounds	4	(1)
night rounds	5	(1)
discharging patients	5	(1)
work environment	5	(1)
bibliography	6	(2)
Getting organized (the folder)	8	(3)
Personal folder and the lists	8	(1)
how to make a personal folder	8	(1)
Keeping track of patients (List 1)	9	(1)
List of things to do (List 2)	10	(1)
Result sheets (List 3)	10	(1)
Data protection and confidentiality	10	(1)
Paperwork	11	(6)
Patient notes	11	(1)
Accident forms	12	(1)
Blood forms and requesting bloods	12	(1)
Consent	13	(1)
Death and cremation certificates	13	(1)
Discharge summaries (TTO/TTA)	13	(1)
Drug charts	14	(1)
Drug prescriptions	14	(1)
Handovers	14	(1)
Referral letters	15	(1)
Self-discharge	15	(1)
Sick notes	15	(2)
Accident and emergency	17	(7)
General	17	(1)
Admitting and allocating patients	17	(1)
Keeping track of patients	18	(1)
Medicine	18	(1)
Overdose	18	(4)
treating the patient	19	(3)
Surgery	22	(1)
Medical and surgical assessment units	23	(1)
Fast-track patients	23	(1)
Becoming a better doctor	24	(12)
Foundation programmes	24	(1)
assessments	24	(1)
leaving the Foundation programme	25	(1)
Information technology	25	(2)
the Internet	26	(1)
online medical databases	26	(1)
Keeping up with the literature	27	(1)
Evidence-based medicine	27	(1)
Paraclinical work	28	(1)
clinical audit	28	(1)
case reports	28	(1)
Courses	29	(1)
Professionalism	29	(5)
communication	29	(1)
consultants and senior registrars	30	(1)
GPs	30	(1)
nurses	31	(2)
patients	33	(1)
patients' families	33	(1)
Confidentiality	34	(1)
exceptions to keeping confidentiality	35	(1)
Consent	35	(1)
Cardiac arrests and crash calls	36	(3)
Cardiac arrest calls	36	(2)
`Do not resuscitate' orders	38	(1)
Common calls	39	(70)
How to use this section	39	(1)
Considerations for all ward calls	39	(3)
Abdominal pain	42	(2)
Anaemia	44	(2)
Arrhythmia	46	(4)
managing specific arrhythmias	46	(4)
Calcium	50	(2)
hypercalcaemia	50	(1)
hypocalcaemia	51	(1)
Chest pain	52	(2)
Confusion	54	(2)
Constipation	56	(1)
Diarrhoea	57	(1)
Electrocardiograms	58	(4)
important ECG abnormalities to recognize	61	(1)
Eye complaints	62	(2)
the acute red eye	62	(1)
sudden loss of vision	63	(1)
floaters	63	(1)
Falls	64	(2)
Fever	66	(2)
The immunocompromised patient with fever	68	(2)
Fits	70	(2)
Intravenous fluids	72	(2)
Upper gastrointestinal bleeds	74	(2)
Lower gastrointestinal bleeds	76	(1)
Glucose	77	(1)
Gynaecological calls	78	(1)
vaginal bleeding	78	(1)
dysmenorrhoea	78	(1)
Haematurta	79	(1)
Headaches	80	(2)
Hypertension	82	(2)
peri-operative hypertension	83	(1)
Hypotension	84	(2)
Insomnia	86	(1)
management with benzodiazepines	86	(1)
Itching	87	(1)
Major trauma	88	(1)
Minor trauma	89	(1)
The moribund patient	90	(2)
Nausea and vomiting	92	(2)
Oxygen therapy	94	(1)
methods of oxygen delivery	94	(1)
pulse oximetry	94	(1)
Phlebitis	95	(1)
management	95	(1)
Potassium	96	(2)
hyperkalaemia	96	(1)
hypokalaemia	96	(2)
Rashes and skin lesions	98	(2)
disease categories	98	(2)
Shortness of breath	100	(2)
diagnosing the important common conditions causing acute SOB	101	(1)
The sick patient	102	(1)
Sodium	103	(1)
hyponatraemia	103	(1)
Transfusions	104	(2)
blood transfusions	104	(1)
platelet transfusions	105	(1)
reactions	105	(1)
Urine, low output	106	(2)
Basic emergency routine	108	(1)
Death and dying	109	(9)
Terminal care	109	(1)
Communication	109	(3)
breaking bad news	109	(1)
ongoing communication with dying patients	110	(2)
Pain control	112	(1)
Symptom control	112	(1)
Prescribing for the dying	112	(1)
Support for the dying and for you	112	(1)
Death	113	(1)
What to do when a patient dies	113	(1)
Telling relatives about the patient's death	113	(1)
Religious practices on death	114	(1)
Post mortems	114	(1)
Death certificates	114	(2)
writing the death certificate	115	(1)
Referring to the coroner	116	(1)
Cremation forms and fees	116	(1)
to check for pacemakers	117	(1)
Further reading	117	(1)
Drugs	118	(10)
General	118	(1)
Prescribing drugs	118	(2)
drug charts	118	(1)
writing prescriptions	119	(1)
controlled drugs	119	(1)
verbals	119	(1)
Giving drugs	120	(3)
drug infusions	120	(2)
intravenous drugs	122	(1)
Specific drug topics	123	(4)
antibiotics	123	(1)
anticoagulation	124	(1)
anti-emetics	125	(1)
digoxin	125	(1)
night sedation	126	(1)
therapeutic drug levels	126	(1)
steroids	127	(1)
Miscellaneous tips	127	(1)
Handle with care	128	(8)
Alcoholism	128	(1)
alcohol withdrawal	128	(1)
Children	129	(1)
Depression	129	(1)
Elderly patients	130	(1)
Haemophiliacs	130	(1)
taking blood	131	(1)
for theatre	131	(1)
HIV/AIDS	131	(1)
taking blood	131	(1)
HIV testing	132	(1)
Jehovah's Witnesses/Christian Scientists	132	(1)
pregnant women	133	(1)
Sickle cell anaemia	133	(1)
The patient on steroids	134	(2)
side effects of steroids	134	(1)
managing ill patients on steroids	134	(1)
treating common side effects	135	(1)
withdrawing steroid therapy	135	(1)
Approach to the medical patient	136	(16)
History and examination	137	(1)
Clinical stalemate	137	(3)
Preparing patients for medical procedures	140	(6)
cardiac catheterization	140	(1)
elective DC cardioversion	141	(1)
upper gastrointestinal endoscopy	142	(1)
colonoscopy	143	(1)
flexible sigmoidoscopy	143	(1)
liver biopsy	144	(1)
pacemaker insertion	144	(1)
renal biopsy	145	(1)
Specialist referrals	146	(6)
cardiology	146	(1)
endocrinology	147	(1)
gastroenterology	148	(1)
haematology	149	(1)
neurology	149	(1)
renal medicine	150	(1)
respiratory medicine	150	(1)
rheumatology	151	(1)
Pain	152	(7)
Pain control	152	(1)
general	152	(1)
Specific analgesics	152	(4)
inhaled drugs	152	(1)
oral drugs	153	(3)
IM/IV opiates	156	(1)
other	156	(1)
Pain control by severity and underlying condition	156	(3)
Practical procedures	159	(36)
General hints	159	(1)
Arterial blood gases	159	(5)
interpreting arterial blood gases	161	(2)
respiratory disease and arterial blood gases interpretation	163	(1)
Bladder catheterization	164	(1)
men	164	(1)
women	165	(1)
Blood cultures	165	(1)
Blood letting	166	(1)
Cannulation	167	(3)
Central lines	170	(5)
insertion of central lines	170	(4)
problems with temporary and tunnelled central lines	174	(1)
using central lines	174	(1)
measuring the CVP	175	(1)
Chest drains	175	(2)
managing a chest drain	175	(1)
how to remove a drain	176	(1)
DC cardioversion	177	(1)
Electrocardiogram	178	(1)
reading ECGs	178	(1)
Exercise stress test	179	(1)
relative contraindications	179	(1)
the procedure	180	(1)
Glucose tolerance test	180	(1)
Injections	180	(1)
subcutaneous	180	(1)
intramuscular	181	(1)
Intercostal block	181	(1)
Joint aspiration/injection	182	(2)
aspiration	182	(1)
injecting joints	183	(1)
Local anaesthesia	184	(1)
Lumbar puncture	184	(3)
Mantoux test	187	(1)
Nasogastric tubes	187	(1)
Peritoneal tap	188	(1)
Pleural aspiration	189	(3)
Pulsus paradoxus	192	(1)
Respiratory function tests	192	(1)
spirometry	192	(1)
peak expiratory flow rate	193	(1)
Sutures	193	(2)
Radiology	195	(8)
Requesting investigations	195	(1)
Minimizing radiation	195	(1)
Common concerns about X-rays	195	(1)
Pregnancy	196	(1)
Plain films	196	(2)
chest X-rays before surgery	196	(1)
skull X-rays	197	(1)
abdominal films	198	(1)
Contrast studies	198	(2)
intravenous urography	198	(1)
barium swallow	198	(1)
barium meal	199	(1)
small bowel enema	199	(1)
barium enema	199	(1)
Ultrasound	200	(1)
Computed tomography	200	(1)
general	200	(1)
CT head	200	(1)
Arteriography	201	(1)
Magnetic resonance imaging	201	(1)
Radioisotope scanning	201	(2)
Surgery	203	(13)
Routine clerking	203	(1)
pre-admission clinics	204	(1)
Perioperative prescribing	204	(3)
Consent	207	(2)
expected side effects after surgery	208	(1)
Anaesthetics	209	(1)
Drawing up theatre lists	210	(1)
Marking patients for surgery	210	(1)
Post-operative care	210	(1)
Complicated patients	211	(2)
jaundice	211	(1)
diabetes	211	(2)
steroid-dependent patients	213	(1)
thyroid surgery	213	(1)
pituitary surgery	213	(1)
Day surgery	213	(1)
Oro-facio-maxillary surgery	214	(1)
Surgical protocol clerking sheet	214	(2)
Obstetrics and gynaecology	216	(5)
Talking to the patient	216	(1)
Gynaecological examination	217	(1)
examining the abdomen	217	(1)
vaginal examination	217	(1)
using the speculum	217	(1)
Obstetric examination	217	(1)
reading the CTG	218	(1)
Being a male	218	(1)
Termination of pregnancy	218	(1)
Fertility	219	(1)
Contraception	219	(2)
General practice	221	(5)
What you can and cannot do	221	(1)
Referral letters and note keeping	221	(1)
General points	221	(1)
Public health and health promotion	222	(1)
The hidden agenda and health beliefs	223	(1)
Follow-up	224	(1)
Home visits	224	(2)
Self care	226	(20)
Accommodation	226	(1)
Alternative careers	226	(1)
Bleep	227	(1)
British Medical Association	227	(1)
Car and insurance	227	(1)
Clothes	227	(1)
Contacting medical colleagues	228	(1)
Contract and conditions of service	228	(5)
what you need to know about your contract	228	(5)
Doctors' mess	233	(1)
making money for the mess	233	(1)
Drug representatives	233	(1)
European Working Time Directive	234	(1)
Insurance (room contents)	234	(1)
Jobs	234	(3)
Trust and other non-training posts	234	(1)
curriculum vitae	235	(1)
the interview	236	(1)
consultant career prospects	237	(1)
Locums	237	(1)
Meals	238	(1)
Medical defence	238	(1)
Money	238	(3)
income protection	238	(1)
student debt	238	(1)
mortgages	239	(1)
payslip deductions	239	(1)
pensions	239	(1)
tax	240	(1)
telephone and on-line banking	241	(1)
Needlestick injuries	241	(1)
if the patient is known to be HIV-positive	242	(1)
if the patient is known to be hepatitis-positive	242	(1)
Not coping	242	(1)
Part-time work	243	(1)
Representation of junior doctors	243	(1)
Sleep and on-call rooms	244	(1)
When things go wrong	244	(2)
bullying and psychological stress	244	(1)
whistle-blowing	245	(1)
Appendix A: Useful tests, numbers and other information	246	(8)
Addresses	246	(1)
Poisons information	246	(1)
Barthel score	246	(1)
Glasgow Coma Scale	247	(1)
Mental Health Act	247	(1)
Mini-mental test score	248	(1)
Notifiable diseases	248	(1)
Results	249	(1)
Haematology	249	(1)
Biochemistry	249	(1)
Useful biochemical formulae	250	(1)
Fitness to drive	251	(3)
Appendix B: Diagrams for explaining procedures to patients	254	(9)
The thorax	254	(1)
Coronary arteries	255	(1)
Upper gastrointestinal tract	256	(1)
Large intestine	257	(1)
Digestive organs	258	(1)
Female pelvis	259	(1)
Male pelvis	260	(1)
Urinary system	261	(2)
Index	263	(12)
Notes	275