Background The transition period from undergraduate training to postgraduate “foundation” practice is brief – often only a matter of a few days - but its impact is profound. What was previously a well supported, structured learning environment is suddenly a strange and potentially frightening place where critical decision-making skills, authority and professionalism seem suddenly more relevant than all of the knowledge amassed in undergraduate training. Foundation doctors indicate that the undergraduate experience does little to prepare them for the shock of actual practice. Summary of work An emerging initiative within the University of Edinburgh’s College of Medicine and Veterinary Medicine is to adopt the easy-to-use authoring tools and principals associated with Game Informed Learning to afford collaborative groups of later year undergraduates and foundation doctors the scope to create learning objects for undergraduates. Conclusions Using in-house developed instruments such as the branching scenario authoring tool “Labyrinth”, these groups draw on their recent experience of this transition period to create learning objects that not only directly address perceived gaps in the range of learning support activities available to undergraduates but also, using the principals of game-informed learning to situate the activities within realistic contexts, and plausible scenarios which offer an indication of what practice will feel like. Take-home message Learning tools to ease the transition between medical student and doctor.
over 11 years ago
Fluid resuscitation done poorly can result in significant complications to the patient. This episode will present some of the newer considerations in fluid resuscitation in traumatic shock.
Jeffrey S. Guy, MD, FACS
over 10 years ago
A powerpoint covering Emergency Presentations. A lot of this is from the Oxford Handbook of clinical medicine or clinical knowledge summaries. I figure this stuff is something we should be able to rattle it off for clinical finals. I must credit my slide on shock to DrCrunch. Visit his site (drcrunch.co.uk) and follow him on twitter/facebook/youtube. There's a youtube video where he actually talks through the pacman diagram. I felt it was a brilliant way of explaining shock so put it in there! All images are off google.
almost 8 years ago
The typical thoracic vertebra has a heart-shaped body (Figure 1) bearing one or two facets for articulation with the head of a rib. Its vertebral foramen is smaller and more circular than those of the cervical and lumbar regions. The two pedicles bear long and strong transverse processes. It articulates with its neighbouring vertebra with articular processes that bear nearly vertical facets facing (superior) posteriorly and (inferior) anteriorly. Its spinous process is long and slopes posteroinferiorly so that its tip overlies the level of the vertebral body below. Figure 1The typical lumbar vertebra has a larger kidney-shaped body and its vertebral foramen is larger than that of the thoracic vertebra (Figure 2). Its transverse processes are long and slender and its articular processes are directed (superior) posteromedially and (inferior) anterolaterally. Its spinous process is shorter, broader and more horizontal than those of the thoracic vertebrae.Figure 2Joints and ligaments of the vertebraeJoints: the articular surfaces of the bodies of adjacent vertebrae are covered by hyaline cartilage and united by a thick fibrocartilaginous intervertebral disc. These are strong cartilaginous joints designed for weight-bearing. The disc is a shock absorber, its centre, the nucleus pulposus, is gelatinous and surrounded by a fibrous part, the annulus fibrosus. Adjacent vertebrae articulate by two synovial facet joints between the paired articular processes.
about 7 years ago
Pensioners expecting a government cap on the cost of elderly social care in England will mean help paying their bill are "in for a shock", a report warns.
almost 7 years ago
Why can we see a sharp demarcation between the cortex and the medulla in shock kidney? What is the pathomechanism that govern the process of acute renal failure that causes that morphological sign? Thank you all.
over 8 years ago
Is it possible for a healthy adult who donates 500 mL blood to get into the (compensated) shock with pale, cool and sweaty skin? I mean, does anyone know if this has actually happened to someone? Also, is it any quick and reliable test to differ between hypovolemic shock and vasovangal syncope? Symptoms of both seem to be similar
over 7 years ago
This is an excerpt from "Wound Care Made Incredibly Easy! 1st UK Edition" by Julie Vuolo For more information, or to purchase your copy, visit: http://tiny.cc/woundcare. Save 15% (and get free P&P) on this, and a whole host of other LWW titles at http://lww.co.uk when you use the code MEDUCATION when you check out! Introduction A burn is an acute wound caused by exposure to thermal extremes, electricity, caustic chemicals or radiation. The degree of tissue damage caused by a burn depends on the strength of the source and the duration of contact or exposure. Around 250,000 people per year sustain burn injuries in the UK (NBCRC 2001). Because of the specialist care burns require, they are considered here separately from other traumatic wounds. Types of burns Burns can be classified by cause or type. Knowing the type of burn will help you to plan the right care for your patient. Thermal burns The most common type of burn, thermal burns can result from virtually any misuse or mishandling of fire, combustible products, hot fluids and fat or coming into contact with a hot object. Playing with matches, pouring petrol onto a BBQ, spilling hot coffee, touching hot hair straighteners and setting off fireworks are some common examples of ways in which burns occur. Thermal burns can also result from kitchen accidents, house or office fires, car accidents or physical abuse. Although it’s less common, exposure to extreme cold can also cause thermal burns. Electrical burns Electrical burns result from contact with flowing electrical current. Household current, high-voltage transmission lines and lightning are sources of electrical burns. Internal injury is often considerably greater than is apparent externally. Chemical burns Chemical burns most commonly result from contact (skin contact or inhalation) with a caustic agent, such as an acid, an alkali or a vesicant. Radiation burns The most common radiation burn is sunburn, which follows excessive exposure to the sun. Almost all other burns due to radiation exposure occur as a result of radiation treatment or in specific industries that use or process radioactive materials. Assessment Conduct your initial assessment as soon as possible after the burn occurs. First, assess the patient’s ABCs. Then determine the patient’s level of consciousness and mobility. Next, assess the burn, including its size, depth and complexity. Determining size Determine burn size as part of your initial assessment. Typically, burn size is expressed as a percentage of total body surface area (TBSA). The Rule of Nines and the Lund–Browder Classification provide standardised and quick estimates of the percentage of TBSA affected. Memory Jogger To remember the proper sequence for the initial assessment of a burns patient, remember your ABCs and add D and E. Airway – Assess the patient’s airway, remove any obstruction and treat any obstructive condition. Breathing – Observe the motion of the patient’s chest. Auscultate the depth, rate and characteristics of the patient’s breathing. Circulation – Palpate the patient’s pulse at the carotid artery and then at the distal pulse points in the wrist, posterior tibial area and foot. Loss of distal pulse may indicate shock or constriction of an extremity. Disability – Assess the patient’s level of consciousness and ability to function before attempting to move or transfer them. Expose – Remove burned clothing from burned areas of the patient’s body and thoroughly examine the skin beneath.
Lippincott Williams & Wilkins
about 8 years ago
“You’re a boring whore! Fix it.” The barked criticism came like a slap in the face. The director of Les Miserables was right, though. I was a boring whore. Actors need to immerse themselves in their roles, shed inhibitions and squelch embarrassment. I was not managing to do this while rehearsing the Lovely Ladies prostitute scene. My performance was overly self-conscious and restrained. Three days later I found myself at a medical education conference, attending a session discussing learning plans. A popular tool in adult education generally, and a training requirement for all GP registrars, learning plans are actively disliked by many. Done purposely and thoughtfully, they can be of great benefit; completed hastily or reluctantly because they are compulsory, they are next to useless. I have to confess that, as a registrar, my own learning plans were dashed off with little thought, submitted and then promptly forgotten. I’d never thought this technique would work for me. At the conference, the attending educators were instructed to each write a learning plan that addressed an aspect of their non-medical lives. We were asked to choose something that we genuinely wanted to improve. I instantly knew what I’d write about, and completed the task with seriousness and sincerity. The facilitator randomly picked a few participants to read out their learning plans. The topics were predictable: “I want to exercise each morning”, “I want to get at least seven hours of sleep a night” and the like. Yes, you can see where this is leading ... I should have anticipated being called upon, but when the “We have time for one more, how about you?” came, along with direct eye contact and a kindly smile, I momentarily panicked. Surveying the room of mostly middle-aged, male faces, many of whom I didn’t know, I considered making something up on the spot. Instead, I stood up, took a deep breath and read out: “I want to be a more exciting whore.” I then outlined my proposed methods for achieving this objective and how I intended to measure my progress. Without explanation, I then sat down. Silence. Not a sound. Most eyes were glued to me, the others looking anywhere but. The atmosphere was thick with shock, amusement, confusion, suspense and fascination. I didn’t leave them hanging for too long. After my disclosure as to why I chose the topic and the context in which I was “whoring”, there were audible sighs of relief and a sprinkling of laughter throughout the room. It was memorable for those present. Four years later, I still get the occasional question about my “whoring” when I run into certain educators at conferences. I am pleased to report that my learning plan well and truly achieved its aim. I enacted my plan exactly as written and practised diligently. I knew I had been successful when the director instructed me to “Tone it down a bit. This is a family show, you know!” I now feel a lot more comfortable extolling the benefits of learning plans to unconvinced registrars. I tell them: “I used to think that I wasn’t a learning plan-type person either but I’ve discovered that if you choose a relevant and important objective and spend time and effort working out how to achieve it, the technique can really work.” I tend to leave out: “It didn’t do much for my medicine, but it turned me into a fabulous whore.” This blog post has been adapted from a column first published in Australian Doctor. Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/
Dr Genevieve Yates
about 7 years ago
In the USA the issue of indiscriminate use of expensive, sophisticated, and time consuming test in lieu of, rather than in addition to, the clinical exam is being much discussed. The cause of this problem is of course multifactorial. One of the factors is the decline of the teaching of clinical skills to our medical students and trainees. Such problems seem to have taken hold in developing countries as well. Two personal anecdotes will illustrate this. In the early nineties I worked for two years as a faculty member in the department of ob & gyn at the Aga Khan University Medical School in Karachi, Pakistan. One day, I received a call from the resident in the emergency room about a woman who had come in because of some abdominal pain and vaginal bleeding. While the resident told me these two symptoms her next sentence was: “… and the pelvic ultrasound showed…” I stopped her right in her tracks before she could tell me the result of the ultrasound scan. I told her: “First tell me more about this patient. Does she look ill? Is she bleeding heavily? Is she in a lot of pain and where is the pain? What are her blood pressure and pulse rate? How long has she been having these symptoms? When was her last menstrual period? What are your findings when you examined her ? What is the result of the pregnancy test?”. The resident could not answer most of these basic clinical questions and findings. She had proceeded straight to a test which might or might not have been necessary or even indicated and she was not using her clinical skills or judgment. In another example, the resident, also in Karachi, called me to the emergency room about a patient with a ruptured ectopic pregnancy. He told me that the patient was pale, and obviously bleeding inside her abdomen and on the verge of going into shock. The resident had accurately made the diagnosis, based on the patient’s history, examination, and a few basic laboratory tests. But when I ran down to see the patient, he was wheeling the patient into the radiology department for an ultrasound. "Why an ultrasound?" I asked. “You already have made the correct diagnosis and she needs an urgent operation not another diagnostic procedure that will take up precious time before we can stop the internal bleeding.” Instead of having the needless ultrasound, the patient was wheeled into the operating room. What I am trying to emphasize is that advances in technology are great but they need to be used judiciously and young medical students and trainees need to be taught to use their clinical skills first and then apply new technologies, if needed, to help them to come to the right diagnosis and treatment. And of course we, practicing physicians need to set the example. Or am I old fashioned and not with it? Medico legal and other issues may come to play here and I am fully aware of these. However the basic issue of clinical exam is still important. Those wanting to read more similar stories can download a free e book from Smashwords. The title is: "CROSSCULTURAL DOCTORING. ON AND OFF THE BEATEN PATH." You can access the e book here.
DR William LeMaire
almost 7 years ago