9780632053315

Introduction	p. xi
How to use this book	p. xii
Acknowledgements	p. xiii
Abbreviations	p. xiv
Starting up	p. 1
Panic?	p. 1
People to help you	p. 1
Three basic tips	p. 2
Other useful start-up information	p. 2
Bibliography	p. 2
Dress	p. 3
Equipment	p. 3
Geography	p. 4
Ward rounds	p. 4
Discharging patients	p. 6
Work environment	p. 6
Getting organized (four lists and a folder)	p. 8
Personal folder	p. 8
Keeping track of patients (List 1)	p. 8
List of things to do (List 2)	p. 10
Phone numbers (List 3)	p. 10
Firm timetable (List 4)	p. 10
Paperwork	p. 11
Patient notes	p. 11
Accident forms	p. 11
Blood forms and requesting bloods	p. 12
Consent	p. 13
Death and cremation certificates	p. 13
Discharge summaries (TTO/TTA)	p. 13
Drug charts	p. 14
Drug prescriptions	p. 14
Handovers	p. 14
Hand backs	p. 14
Referral letters	p. 14
Self-discharge	p. 15
Sick notes	p. 15
Accident and emergency	p. 16
General	p. 16
Admitting and allocating patients	p. 16
Keeping track of patients	p. 17
Medicine	p. 17
Overdose	p. 17
Treating the patient	p. 18
Surgery	p. 21
Becoming a better doctor	p. 23
Computers	p. 23
Hardware	p. 23
Software	p. 24
Access to on-line databases	p. 25
A bit about the Internet	p. 25
Keeping up with the literature	p. 26
Evidence-based medicine	p. 27
Professionalism	p. 28
Communication	p. 28
Consultants and senior registrars	p. 29
GPs	p. 30
Nurses	p. 30
Patients	p. 32
Patients' families	p. 32
Confidentiality	p. 33
Exceptions to keeping confidentiality	p. 34
Consent	p. 34
Cardiac arrests and crash calls	p. 35
'Do not resuscitate' orders	p. 37
Common calls	p. 38
How to use this section	p. 38
Considerations for all ward calls	p. 38
Abdominal pain	p. 39
Anaemia	p. 40
Arrhythmia	p. 42
Initial management for all arrhythmias	p. 42
Managing specific arrhythmias	p. 42
Calcium	p. 45
Hypercalcaemia	p. 45
Hypocalcaemia	p. 46
Chest pain	p. 47
Confusion	p. 48
Constipation	p. 50
Diarrhoea	p. 51
Electrocardiograms	p. 52
Important ECG abnormalities to recognize	p. 55
Eye complaints	p. 56
The acute red eye	p. 56
Sudden loss of vision	p. 57
Floaters	p. 57
Falls	p. 57
Fever	p. 58
The immunocompromised patient with fever	p. 60
Fits	p. 60
Intravenous fluids	p. 62
How to prescribe IV fluids	p. 62
Upper gastrointestinal bleeds	p. 63
High risk and hypovolaemic patients	p. 64
Low risk patients	p. 65
Lower gastrointestinal bleeds	p. 65
Glucose	p. 65
Gynaecological calls	p. 66
Vaginal bleeding	p. 67
Dysmenorrhoea	p. 67
Haematuria	p. 67
Headaches	p. 68
Hypertension	p. 70
Hypotension	p. 71
Insomnia	p. 72
Management with benzodiazepines	p. 73
Itching	p. 74
Immunocompromised (see Fever)
The moribund patient	p. 74
Nausea and vomiting	p. 76
Oliguria/anuria (see Urine, low output)
Oxygen therapy	p. 77
Methods of oxygen delivery	p. 77
Pulse oximetry	p. 78
Phlebitis	p. 78
Management	p. 78
Potassium	p. 79
Hyperkalaemia	p. 79
Hypokalaemia	p. 79
Rashes and skin lesions	p. 81
Disease categories	p. 81
Red eye (see Eye complaints)
Shortness of breath	p. 82
The sick patient	p. 84
Sodium	p. 84
Hyponatraemia	p. 84
Transfusions	p. 85
Blood	p. 85
Platelet	p. 86
Reactions	p. 87
Urine, low output	p. 87
Basic emergency routine	p. 88
Death and dying	p. 90
Terminal care	p. 90
Communication	p. 90
Breaking bad news	p. 90
Ongoing communication with dying patients	p. 91
Pain control	p. 93
Symptom control	p. 93
Prescribing for the dying	p. 93
Support for the dying and for you	p. 93
Death	p. 94
What to do when a patient dies	p. 94
Telling relatives about the patient's death	p. 95
Post mortems	p. 95
Death certificates	p. 95
Writing the death certificate	p. 95
Referring to the coroner	p. 96
Cremation forms and fees	p. 97
To check for pacemakers	p. 97
Further reading	p. 98
Drugs	p. 99
General	p. 99
Prescribing drugs	p. 99
Drug charts	p. 99
Writing prescriptions	p. 100
Controlled drugs	p. 100
Verbals	p. 101
Giving drugs	p. 101
Drug infusions	p. 102
Intravenous drugs	p. 103
Specfic drug topics	p. 105
Antibiotics	p. 105
Anticoagulation	p. 105
Anti-emetics	p. 106
Digoxin	p. 106
Night sedation	p. 107
Therapeutic drug levels	p. 107
Steroids	p. 107
Miscellaneous tips	p. 107
Handle with care	p. 109
Alcoholism	p. 109
Alcohol withdrawal	p. 109
Children	p. 110
Depression	p. 110
Elderly patients	p. 111
Haemophiliacs	p. 111
Taking blood	p. 112
For theatre	p. 112
HIV/AIDS	p. 112
Taking blood	p. 112
HIV testing	p. 113
Jehovah's Witnesses/Christian Scientists	p. 113
Pregnant women	p. 114
Sickle cell anaemia	p. 114
The steroid patient	p. 115
Side effects of steroids	p. 115
Managing ill patients on steroids	p. 115
Treating common side effects	p. 116
Withdrawing steroid therapy	p. 116
Approach to the medical patient	p. 117
History and examination	p. 118
Clinical stalemate	p. 118
Preparing patients for medical procedures	p. 121
Cardiac catheterization	p. 121
Elective DC cardioversion	p. 122
Upper gastrointestinal endoscopy	p. 123
Colonoscopy	p. 124
Flexible sigmoidoscopy	p. 124
Liver biopsy	p. 125
Pacemaker insertion	p. 125
Renal biopsy	p. 126
Specialist referrals	p. 127
Cardiology	p. 127
Endocrinology	p. 128
Gastroenterology	p. 129
Haematology	p. 130
Neurology	p. 130
Renal medicine	p. 131
Respiratory medicine	p. 131
Rheumatology	p. 132
Pain	p. 133
Pain control	p. 133
General	p. 133
Specific analgesics	p. 133
Inhaled drugs	p. 133
Oral drugs	p. 133
IM/IV opiates	p. 136
Other	p. 138
Pain control by severity and underlying condition	p. 138
Practical procedures	p. 140
General hints	p. 140
Arterial blood gases	p. 140
Interpreting arterial blood gases	p. 142
Respiratory disease and arterial blood gases interpretation	p. 144
Ascitic tap (see Peritoneal tap)
Bladder catheterization	p. 145
Men	p. 145
Women	p. 146
Blood cultures	p. 146
Blood letting	p. 147
Cannulation	p. 148
Central lines	p. 151
Insertion of central lines	p. 151
Problems with temporary and tunnelled central lines	p. 154
Using central lines	p. 155
Measuring the CVP	p. 155
Chest drains	p. 157
Managing a chest drain	p. 157
How to remove a drain	p. 158
DC cardioversion	p. 158
Electrocardiogram	p. 159
Reading ECGs	p. 161
Exercise stress test	p. 161
Relative contraindications	p. 161
The procedure	p. 161
Glucose tolerance test	p. 161
Injections	p. 162
Subcutaneous	p. 162
Intramuscular	p. 162
Intercostal block	p. 162
Joint aspiration/injection	p. 163
Aspiration	p. 164
Injecting joints	p. 164
Local anaesthesia	p. 165
Lumbar puncture	p. 166
Mantoux test	p. 168
Nasogastric tubes	p. 169
Peritoneal tap	p. 169
Pleural aspiration	p. 171
Pulsus paradoxus	p. 173
Respiratory function tests	p. 173
Spirometry	p. 173
Peak expiratory flow rate	p. 175
Sutures	p. 177
Radiology	p. 178
Requesting investigations	p. 178
Minimizing radiation	p. 178
Common concerns about X-rays	p. 178
Pregnancy	p. 180
Plain films	p. 180
Chest X-rays before surgery	p. 180
Skull X-ray	p. 180
Abdominal films	p. 180
Contrast studies	p. 181
Intravenous urography	p. 181
Barium swallow	p. 182
Barium meal	p. 182
Small bowel enema	p. 182
Barium enema	p. 182
Ultrasound	p. 182
Computerized tomography	p. 183
General	p. 183
CT head	p. 183
Arteriography	p. 183
Magnetic resonance imaging	p. 184
Radioisotope scanning	p. 184
Surgery	p. 185
Routine clerking	p. 185
Peri-operative prescribing	p. 186
Consent	p. 189
Expected side effects after surgery	p. 191
Anaesthetics	p. 191
Drawing up theatre lists	p. 192
Marking patients for surgery	p. 192
Post-operative care	p. 192
Complicated patients	p. 193
Jaundice	p. 193
Diabetes	p. 193
Steroid-dependent patients	p. 195
Thyroid surgery	p. 195
Day surgery	p. 196
Oro-facio-maxillary surgery	p. 196
Surgical protocol clerking sheet	p. 197
Self care	p. 198
Accommodation	p. 198
Alternative careers	p. 198
Bleep	p. 199
British Medical Association (BMA)	p. 199
Car and insurance	p. 199
Clothes	p. 199
Contacting medical colleagues	p. 200
Contract and conditions of service	p. 200
What you need to know about your contract	p. 200
Doctors' mess	p. 204
Making money for the mess	p. 204
Drug representatives	p. 204
Insurance (room contents)	p. 204
Jobs	p. 205
Curriculum vitae	p. 205
The interview	p. 206
Consultant career prospects	p. 206
Locums	p. 206
Meals	p. 207
Medical defence	p. 207
Money	p. 208
Income protection	p. 208
Payslip deductions	p. 208
Pensions	p. 209
Tax	p. 209
Telephone and on-line banking	p. 211
Needlestick injuries	p. 211
If the patient is known to be HIV-positive	p. 211
If the patient is known to be hepatitis-positive	p. 212
Not coping	p. 212
Part-time work	p. 213
Representation of junior doctors	p. 213
Sleep	p. 213
Useful tests, numbers and other information	p. 215
Addresses	p. 215
Poisons information	p. 215
Barthel score	p. 215
Glasgow Coma Scale	p. 216
Mental Health Act	p. 216
Mini-mental test score	p. 217
Notifiable diseases	p. 217
Results	p. 218
Haematology	p. 218
Biochemistry	p. 218
Useful biochemical formulae	p. 219
Fitness to drive	p. 220
Diagrams for explaining procedures to patients	p. 223
The thorax	p. 223
Coronary arteries	p. 224
Upper gastrointestinal tract	p. 225
Large intestine	p. 226
Digestive organs	p. 227
Female pelvis	p. 228
Male pelvis	p. 229
Urinary system	p. 230
Tunnelled central lines (see Fig. 13.4)
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The Hands-On Guide for House Officers: For Junior Doctors and Medical Students

0632053313

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