Re located first shoulder today, didn't work using entonox but went in really easily with a bit of propofol.
Getting a really good idea of where paramedics can be useful in the department.
Wednesday 30 March 2011
Sunday 27 March 2011
Good, pretty full on day yesterday.
Started the morning in Minors picking up some seemingly straight forward complaints that had interesting twists. Needless to say I learnt quite alot about autism and Christmas disease (haemophilia b). The afternoon slot was pretty epic in Majors and resus. I managed to select a patient with an array of differential diagnoses that finally was diagnosed as pneumonia, after an initial presentation of central chest and abdo pain. Required a thorough assessment as well as bloods, cultures, chest X-rays, urinalysis, ECG and aggressive pain management. Great consultant support too.
Then went on to manipulate an open ankle fracture dislocation as the boss administered ketomone. Was pretty chugged as they really had to look hard for the fracture on X-ray as the relocation was so successful. Boosted my confidence after the shift the day before endedwith a simple head lac that turned out to be a 15 cm full thickness scalp lac with arterial bleeding! Again good support from some of the senior docs. Learnt an excellent way to make a head pressure dressing with bandages!
Lessons:
Ask for help early if things look bigger than expected
Give antibiotics in first 2 hours if they are required
Started the morning in Minors picking up some seemingly straight forward complaints that had interesting twists. Needless to say I learnt quite alot about autism and Christmas disease (haemophilia b). The afternoon slot was pretty epic in Majors and resus. I managed to select a patient with an array of differential diagnoses that finally was diagnosed as pneumonia, after an initial presentation of central chest and abdo pain. Required a thorough assessment as well as bloods, cultures, chest X-rays, urinalysis, ECG and aggressive pain management. Great consultant support too.
Then went on to manipulate an open ankle fracture dislocation as the boss administered ketomone. Was pretty chugged as they really had to look hard for the fracture on X-ray as the relocation was so successful. Boosted my confidence after the shift the day before endedwith a simple head lac that turned out to be a 15 cm full thickness scalp lac with arterial bleeding! Again good support from some of the senior docs. Learnt an excellent way to make a head pressure dressing with bandages!
Lessons:
Ask for help early if things look bigger than expected
Give antibiotics in first 2 hours if they are required
Thursday 24 March 2011
Just finished a fantastic Patient Management in Hostile Environments course at the Shelterbox International Academy on the Lizard Penninsula, Cornwall, with students from the Rescue and Emergency Management FdSc course at Cirnwall College. Final scenario included 2 real downed helicopters and 5 serious trauma patients on an operational airbase at 2300!
Back to the day job today! Another excellent and varied day managing patients with serious facial trauma, cauda equina syndrome, spinal damage and the usual array of limb injuries. Without wanting to sound corny, every job is a learning experience. Trying to look up each condition as, or after, I deal with it.
Lesson of the day:
Don't be complacent! An old lesson that needs re emphasising every so often!
Back to the day job today! Another excellent and varied day managing patients with serious facial trauma, cauda equina syndrome, spinal damage and the usual array of limb injuries. Without wanting to sound corny, every job is a learning experience. Trying to look up each condition as, or after, I deal with it.
Lesson of the day:
Don't be complacent! An old lesson that needs re emphasising every so often!
Saturday 19 March 2011
4 th week completed and to be honest I'm pretty knackered!
It's been pretty full on and the learning curve is still going up. I am now selecting patients from mainly minors, but also majors lists at my discretion and seeing them through to discharge or referal. I have done lots of wound closure and limb assessments but also enjoying the challenges of managing majors patients. A lot more time consuming than I had anticipated.
All patients are reviewed by consultants even if they don't see the patient ( which is happening more regularly). You really couldn't pay for the learning opportunity. I also am beginning to feel like I am actually contributing to the dept (even though I had a breach today :(. There are still some nurses and docs who I think are a bit resistant to the idea of paras/ ECPs working in ED but overall the support has been fantastic!
Learning points:
1. Anatomy
2. Anatomy
3. Anatomy
4. Biochemistry
It's been pretty full on and the learning curve is still going up. I am now selecting patients from mainly minors, but also majors lists at my discretion and seeing them through to discharge or referal. I have done lots of wound closure and limb assessments but also enjoying the challenges of managing majors patients. A lot more time consuming than I had anticipated.
All patients are reviewed by consultants even if they don't see the patient ( which is happening more regularly). You really couldn't pay for the learning opportunity. I also am beginning to feel like I am actually contributing to the dept (even though I had a breach today :(. There are still some nurses and docs who I think are a bit resistant to the idea of paras/ ECPs working in ED but overall the support has been fantastic!
Learning points:
1. Anatomy
2. Anatomy
3. Anatomy
4. Biochemistry
Monday 14 March 2011
Pretty tired after a really busy fri sat and Sunday shift. It definitely flies by when there are a lot of patients but your feet and brain certainly know about it afterwards. I take my hats off to the guys who do it day in day out continuously,
I have been selecting, assessing and treating my own patients from minors and more recently from majors. I find majors a lot more time consuming as the patients often requir bloods, X-rays and advanced investigations. They are also less likely to be going home, or if they do it is with a much more robust and structured care plan in place. It is also extremely rewarding to receive a patient from ambulance crews, assess them and discharge them with consultant review, it also means my personal knowledge is increasing all the time, especially as I have the oppotunity to review all my patients with the consultants.
Getting pretty good at wound care and more confident working in majors although I still have a long way to go before I feel comfortable working there.
Apologies for poor grammar and spelling as I'm on an iPhone and trying to do several things at once as I write...
I have been selecting, assessing and treating my own patients from minors and more recently from majors. I find majors a lot more time consuming as the patients often requir bloods, X-rays and advanced investigations. They are also less likely to be going home, or if they do it is with a much more robust and structured care plan in place. It is also extremely rewarding to receive a patient from ambulance crews, assess them and discharge them with consultant review, it also means my personal knowledge is increasing all the time, especially as I have the oppotunity to review all my patients with the consultants.
Getting pretty good at wound care and more confident working in majors although I still have a long way to go before I feel comfortable working there.
Apologies for poor grammar and spelling as I'm on an iPhone and trying to do several things at once as I write...
Thursday 10 March 2011
Started of Wednesday morning with Junior Doctors training, as usual. 1 1/2 hours of teaching from consultant plus a case revew or teaching slot by one of junior docs. Todays topics; Burns and anaphylaxis.
I was then asked if I would go and help with the registrars training in the postgrad centre. There are quite a few senior doctors whp are going for their RCEM (Fellow of College Emerg Medicine) and a series of moulages and skill stations had been set up. I was assisting in the FAST (Focused Abdominal Sonography in Trauma) skill station. Really interesting, useful bit of kit. 5 years time I reckon they will be (or a portable version) on selected pre-hospital vehicles.
After a bit of teaching on FAST scan use in cardiac arrest I went back to the dept. Turned into one of the more unproductive afternoons. Consultants were in a meeting and there just werent too many patients in the department. Provided a welcome change to many of the staff but I am still keen to get stuck in. I ended up going through all the paediatric kit in Resus and trying to familiarise myself with how it all works and what it all does.
Plan;
-get involved/assist in MAU clinic (Manipulation under anaesthesia)
-go on plastercast study day
I was then asked if I would go and help with the registrars training in the postgrad centre. There are quite a few senior doctors whp are going for their RCEM (Fellow of College Emerg Medicine) and a series of moulages and skill stations had been set up. I was assisting in the FAST (Focused Abdominal Sonography in Trauma) skill station. Really interesting, useful bit of kit. 5 years time I reckon they will be (or a portable version) on selected pre-hospital vehicles.
After a bit of teaching on FAST scan use in cardiac arrest I went back to the dept. Turned into one of the more unproductive afternoons. Consultants were in a meeting and there just werent too many patients in the department. Provided a welcome change to many of the staff but I am still keen to get stuck in. I ended up going through all the paediatric kit in Resus and trying to familiarise myself with how it all works and what it all does.
Plan;
-get involved/assist in MAU clinic (Manipulation under anaesthesia)
-go on plastercast study day
systematic review of PAs in US
Interesting article on efficacy of Pysicians Assistants in US.
Emergency Medicine Australasia (2011) 23, 7–15
A systematic review: The role and impact of
the physician assistant in the emergency
department
Abstract:
This systematic review describes the role and impact of physician assistants (PAs) in the
ED. It includes reports of surveys, retrospective and prospective studies as well as guidelines
and reviews. Seven hundred and twelve studies were identified of which only 66 were
included, and many of these studies were limited by methodological quality. Generally the
use of PAs in the ED is modest with 13–18% of US EDs having PAs although academic
medical centres report PA use in 65–68% of EDs. The evidence indicates that PAs are
reliable in assessing certain medical complaints and performing procedures, and are well
accepted by ED staff and patients alike. There is limited evidence as to whether PAs
improve ED flow or are cost-effective. Future studies on work processes, cost-effectiveness,
unfamiliar patients’ willingness to be treated by non-physician providers, and ED physicians’
acceptability of PAs are needed to inform and guide the integration of PAs into EDs.
Emergency Medicine Australasia (2011) 23, 7–15
A systematic review: The role and impact of
the physician assistant in the emergency
department
Abstract:
This systematic review describes the role and impact of physician assistants (PAs) in the
ED. It includes reports of surveys, retrospective and prospective studies as well as guidelines
and reviews. Seven hundred and twelve studies were identified of which only 66 were
included, and many of these studies were limited by methodological quality. Generally the
use of PAs in the ED is modest with 13–18% of US EDs having PAs although academic
medical centres report PA use in 65–68% of EDs. The evidence indicates that PAs are
reliable in assessing certain medical complaints and performing procedures, and are well
accepted by ED staff and patients alike. There is limited evidence as to whether PAs
improve ED flow or are cost-effective. Future studies on work processes, cost-effectiveness,
unfamiliar patients’ willingness to be treated by non-physician providers, and ED physicians’
acceptability of PAs are needed to inform and guide the integration of PAs into EDs.
Monday 7 March 2011
Had some very interesting jobs over the weekend including a crushed toe that required ring block ( me) deriding (by consultant) cleaning (with a toothbrush) (me) and nail bed sutures(me) also saw a patient whose fingers were swollen to 3 times the normal size but hadn't managed to take of their rings... One for the surgeons... Not me...
I Worked with a consultant I had not worked with before. Initially everything i did was checked and each patient reassessed. As the day progressed however, i felt i was given more space and responsibility. I totally understand that people are initially cautious and it re emphasised the fact that this really is a new role and I have to really prove myself in order to gain peoples trust and create a good reputation. Fortunately I quite enjoy this pressure but I hope that when I do mess up ( which is an inevitable part of emergency medicine) that I don't go back to square 1.
Tips of the day:
1. If you are told something, remember it
2. When you ask a question listen carefully to the answer and don't reask the same question
3. Learn your anatomy
4. Know your limits
I Worked with a consultant I had not worked with before. Initially everything i did was checked and each patient reassessed. As the day progressed however, i felt i was given more space and responsibility. I totally understand that people are initially cautious and it re emphasised the fact that this really is a new role and I have to really prove myself in order to gain peoples trust and create a good reputation. Fortunately I quite enjoy this pressure but I hope that when I do mess up ( which is an inevitable part of emergency medicine) that I don't go back to square 1.
Tips of the day:
1. If you are told something, remember it
2. When you ask a question listen carefully to the answer and don't reask the same question
3. Learn your anatomy
4. Know your limits
Friday 4 March 2011
Another day done.
Certainly not drinking as much tea as on the road.
Got stuck into a long minors cue as soon as I arrived. Quite satisfying to take a patient handover from the ambulance crew (head inj, mech fall), assess patient, stitch head wound, give advice, make arrangements for getting patient home, assess social arrangements and discharging patient from dept.
Also performed a finger dislocation manipulation under n2o and a ring block on a nasty finger lac that finally required plastics referral.
Support from middle grades and consultants seems to be increasing as they become more familiar seeing me in dept.
Had my first official review with lead consultant as well. It went well and was very positive. Plans for next review will include a formal review of cases and paperwork which I am looking forward to. A bit of critical reflection will be good. Also need to start thinking about writing experience up for a publication. Any ideas on a postcard;).
Certainly not drinking as much tea as on the road.
Got stuck into a long minors cue as soon as I arrived. Quite satisfying to take a patient handover from the ambulance crew (head inj, mech fall), assess patient, stitch head wound, give advice, make arrangements for getting patient home, assess social arrangements and discharging patient from dept.
Also performed a finger dislocation manipulation under n2o and a ring block on a nasty finger lac that finally required plastics referral.
Support from middle grades and consultants seems to be increasing as they become more familiar seeing me in dept.
Had my first official review with lead consultant as well. It went well and was very positive. Plans for next review will include a formal review of cases and paperwork which I am looking forward to. A bit of critical reflection will be good. Also need to start thinking about writing experience up for a publication. Any ideas on a postcard;).
Wednesday 2 March 2011
Great shift yesterday.
I walked into a very busy dept. Consultants were all in a meeting so I asked around the doctors to see if there was anything could do to help. There was. I was soon transporting a potential CVE patient round to the CT scanners taking the resus bag with us in case anything should happen. On my return I walked into an eventful traumatic resuscitation in Resus. There were a lot of clinicians in the roomhelping and I was tasked with managing the airway. The pt had been brought in by the HEMS crew and was intubated. The capnography kit was not working, so we put a new adaptor on and got it back on track. A surgeon arrived to drain a tampoade whilst the ED consultant performed a FAST ultrasound and IDd lots of free fluid in abdo. Unfortunately the pt went into asystole and it was called shortly after.
I was then allocated some patients from majors including a collapse ? Cause with a head inj that I sutured and an Epileptic patient with a head injury before managing some minors patients. A good shift, lots of learning. Managed to discuss all patients in some depth with the consultant before he went on to review them. For me this is one of the best ways to develop my practice/ knowledge. Something we should do more of when working on the road!
I walked into a very busy dept. Consultants were all in a meeting so I asked around the doctors to see if there was anything could do to help. There was. I was soon transporting a potential CVE patient round to the CT scanners taking the resus bag with us in case anything should happen. On my return I walked into an eventful traumatic resuscitation in Resus. There were a lot of clinicians in the roomhelping and I was tasked with managing the airway. The pt had been brought in by the HEMS crew and was intubated. The capnography kit was not working, so we put a new adaptor on and got it back on track. A surgeon arrived to drain a tampoade whilst the ED consultant performed a FAST ultrasound and IDd lots of free fluid in abdo. Unfortunately the pt went into asystole and it was called shortly after.
I was then allocated some patients from majors including a collapse ? Cause with a head inj that I sutured and an Epileptic patient with a head injury before managing some minors patients. A good shift, lots of learning. Managed to discuss all patients in some depth with the consultant before he went on to review them. For me this is one of the best ways to develop my practice/ knowledge. Something we should do more of when working on the road!
Subscribe to:
Posts (Atom)