BRIDGING COURSE – TASTER – JuniorDoctor.net

COURSES

INTRODUCTION

Reach 30 mts early esp first week – early bird – Parking sweet spot 7.30-7.45 night shift finish
Go to theatre – Change into scrubs
Get Laptop/Computer on Wheels (Cow) – Switch on(Sign-out after use on each ward)
Print patient list x 3
Prep notes
Jobs Book – Ward, Patient label, jobs
Patient Review – attend with Ward Sister
Confirm Name & DOB
Chaperones – If Draw Curtain & Examine
Leaving use Handrub
Get Consultant, Registrar, SHO name & numbers
Review Jobs Book – Prioritise & allocate jobs
Document everything you do
Lunch from 11am – Packed Lunch
Chase results by 2pm – update Hierarchy SHO/Reg Bleep/SMS/Theatre
Handover to on call team 1/2 hr before finish time
Confidential Bin – Dispose of handover sheets everyday

Background – Ccrisp Course
CHERIAN Technique
Charts
EWS
I/O Input=PO + IVF Output = Urine + NG tube + Drains. Optimal output 0.5ml/Kg/Hr
History (+PMH, PSH, Drug History)
1/7, 2/52
Examination
Chaperone – use clinical person e.g. HCA, Staff Nurse etc (not ward clerk/auxillary or nurse on drug round)
GMC guidance – intimate examinations
Safer guidance – Any situation where you need to pull the curtain around
Results
Date everything
Bloods 14/04 Hb 92(104) Not just isolated value
Urine
Imaging – USS/CT
Impression – Diagnosis
Differential Diagnosis
Advice – Plan
Management – Tests, Treatment
Update Nurse looking after patient/Ward Sister
Name + Bleep + GMC Number

7 Parameters
Remember 322
3 Respiratory – Respiratory Rate, Saturation, Oxygen
2 Cardiac – Heart Rate, Blood Pressure
2 Other – Temperature & Consciousness
Remember what makes Zero (0) – you should be able to identify which parameter abnormal
Pitfalls Temp 38 HR 90 – don’t score
Note – Rise in Resp Rate & Supplemental O2 increase score straight by 2. Non alert patient = 3
Alert Doctor at 5
Alert Senior/Critical Care at 7

FBC & CRP:
WCC 4-11 Lower/Higher = inflammation. Very low/very high ~ Malignancy
Hb
Gradual drop – Right sided colonic malignancies
Sudden drop – Trauma/ GI bleed Malena x Lower GI bleed Mgt: Bloods(Urea rise), OGD, CT Angiogram
Indication for blood transfusion – Absolute value 70 or drop of 20/24 hours
CRP esp imp if >100 +/- ProCalcitonin
U&Es
Us: Ur, Cr, eGfr
Creatinine 100 ~C = 100
Prioritise eGfr. Not for Contrast CT if <40
Es: Na, K – know treatment especially for hyperkalemia
LFTs: Acronym
2345 L=50 (Roman)
Bilirubin 20
ALT 30
GGT 40
Lipase 50

ALP=Amylase 125

Others Tests
DM: Glucose (BM Boehringer Mannheim Blood Glucose Test Strips – Capillary Blood Glucose) , HbA1c
MI: Troponin (+ ECG)
PE: d-Dimer (+ CTPA)
Ischemia: Lactate >2
G&S – Anaemia, PR bleed, Laparoscopy, Any major operation
Coagulation: Platelets, INR, APTTr

BM = Boehringer Mannheim, a company that produced blood glucose test strips