All entries for Monday 18 July 2016
July 18, 2016
It’s as simple as ABCDE
As a medical student we are usually quite far from an emergency situation, but that doesn’t mean it will stay like that forever, we need to know how to manage an emergency situation in case it does happen while we are students. Even as students we may find ourselves able to do some practical procedures that some nurses on the ward cannot do that are needed in an emergency, such as inserting cannulas or managing an airway. Staying calm under pressure and been able to fully assess a situation are vital skills as a doctor especially when you are the one called to an emergency.
To help us prepare for this all second year medical students are sent on a course designed to teach you how to recognise a deteriorating patient and how to systematically approach and manage an emergency situation. Students at Warwick and UHCW do the AIM course, where as I did the ALERT course at George Eliot. They all teach you the ABCDE approach. A for airway, B for breathing, C for circulation, D for disability and E for exposure/everything else! You work through each part systematically, never moving on until you have secured each part. If your airway isn’t secure you won’t be able to get oxygen to your tissues and organs so this must be assessed first. In Breathing you have to conduct a mini respiratory exam, you might hear some crackles on their chest and start thinking about an infection and sepsis or you might hear a wheeze and think asthma attack. The ABCDE approach isn’t just designed to manage an emergency, it also gives us the framework to find a reason for the deterioration and a diagnosis quickly so we can start the right treatment. In C for circulation you check pulses and blood pressure, you may discover they are hypotensive and need fluids, so then you need IV access. In Disability you check blood sugars, consciousness and pupil responses. Exposure ensures you don’t miss anything, like a rash or a source of bleeding.
As part of the course we had a series of lectures taught around clinical scenarios. What is your approach to the acutely hypotensive patient? ABCDE of course! What is your approach to the unconscious patient? You guessed it ABCDE! In the afternoon we had several practice stations where we all got a chance to manage a situation and receive some feedback on our performance. One of the students was the patient and others in the group could act as helpers as they were needed. In my scenario my patient was unconscious and their airway was compromised so I placed an oropharyngeal airway in, I then made my way through to D and found that they were hypoglycaemic (low blood sugar), I gave them some glucose and they became more responsive, so much so that they started to gag on the oropharyngeal airway. Back to A it was! I removed the airway adjunct and they could breathe on their own. I went back through B, C, D and then onto E. I thought the end was in sight but then they vomited and were making gurgling sounds, back to A again! After some suction everything was ok and the crisis was averted! Although these practice scenarios are obviously very different from the real thing the facilitators try to make it as realistic as possible, if you don’t do something then the patient will deteriorate. In my station if I had forgotten to take to blood sugar levels my patient would have started to have a seizure, so I’m glad I averted that!
I really enjoyed the ALERT course and I think it helped me a lot that I have been volunteering as a helper for the Advanced Life support course run at UHCW. The ALS course is for doctors and nurses working in emergency areas and also uses an ABCDE approach but for more advanced and life threatening scenarios. It is run in a very similar way with actors playing patients and helpers who the candidate can call on to help them as they manage the scenario. Through the Warwick Emergency Medicine and Trauma Society I have been able to volunteer for this which has meant I have acted as a helper to the candidates on the ALS course, which certainly helped me in my own practice situation! Hopefully when I’m getting ready to start my first job as an FY1 in 2 years’ time I won’t find the ALS course too scary and will be ready when I’m that doctor on call!
Joanne
Catrin Davies
18 Jul 2016 10:04
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Coming to the End of Core Clinical Education
It’s hard to believe that we’re now more than halfway through the final block of Core Clinical Education. Time has just flown by – although sometimes I have to remind myself that it seems every other university student is done for the year, and we’re still going even though it’s mid-July! Ah well, that’s what we signed up for. Anyway, it’s not much longer to go now until revision and then exams.
I’m really getting a lot out of CCE, and looking back on the past seven months, I can see how lucky we are to have got exposure to so many different basic disciplines – respiratory, orthopaedic and cardiac medicine, just to name a few. Most recently, my clinical partner and I were lucky enough to spend the past month or so on a ward dedicated to cardiology patients. So many of the cases were fascinating and very eye-opening, and in many cases it was (I know this sounds like a cliché) a lecture series come to life. We got to hear lots of heart murmurs, some artificial valves, uncommon heartbeats and we got to investigate some pathologies that we’d only heard about but never seen. We got drilled by the (very nice but scarily knowledgeable) consultant on the different drugs given to cardiac patients, their mechanisms of actions and side effects, indications and contraindications.
And it was extremely inspiring when we actually realised how our skills changed and grew over the course of the placement. I have sat through several lectures on electrocardiograms, have read countless websites and books and other resources, but until I actually saw some “hot off the presses”, as it were, it was difficult to know where to start. But standing in the middle of a ward and being asked what’s wrong with a patient’s ECG (warning: sometimes there’s nothing wrong with it, and you have to have the confidence to say so!) made me think on my toes. By the end of the rotation, and with some helpful encouragement from the doctors and other staff around us, my clinical partner and I felt much more comfortable with things that had terrified us barely a month before. I wouldn’t say I’m the world’s expert at interpreting ECGs, but I feel far less intimidated than I ever have.
So far, Core Clinical Education has been a very useful and worthwhile experience. We have been exposed to opportunities and disciplines that we’ve never seen before, and might not get to see again for a very long time. We’ve learned how to conduct clinical skills and then have been given the chance to practice them. We’ve got stuck into clinical teams by very welcoming and informative staff. And we’ve been able to put our pre-clinical teaching to work in a supportive and educational environment. I will miss the CCE experience when it’s over, so for now I plan on enjoying everything more that it has to offer.
John
Catrin Davies
18 Jul 2016 10:00
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