All 12 entries tagged Wards

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 |  Tags: Joanne Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

I am training to be a doctor, right?

For many people becoming a Doctor is the fulfillment of a lifelong dream. For myself I remember as a 7 year old in school being asked to draw what I want to be when I grow up and I drew a Doctor complete with white coat and stethoscope. Staring Warwick Medical School was one of the best days of my life, however the relentless lectures and seemingly endless amounts of information soon brought me down to earth with a bump. The one thing that kept me going was the promise of all the clinical, practical medicine in 2^nd year. Now that I’m over halfway through core clinical education I’m starting to ask myself where did all the practical medicine go?

In our GP placements, in particular, I’m struck by the number of medical problems that turn out to be social issues. When taking a history from a stressed out single mother who is having panic attacks due to the pressures of looking after her children alone, one of whom is autistic, I’m left thinking: how can the GP help her? Sure we could think about medication or a referral for counselling but what she really needs is some help at home and some time to herself and unfortunately that doesn’t come in a pill. We also see a lot of cases of anaemia, most of which are caused by a lack of dietary intake of iron. In the area we are in many people have poor diets, some through a lack of education, some through a lack of equipment: one lady didn’t have a working oven as her landlord had still not fixed hers after 3 months! Some people just don’t have enough money to feed themselves properly. Are iron supplements really going to solve that problem?

You may be thinking that social issues are a big part of medicine in primary care but social issues have been causing problems in hospital for a long time. I am currently assigned to a Geriatric (Elderly care) ward at UHCW. Speaking to older patients is extremely satisfying, you get to hear wonderful stories and they often enjoy testing your knowledge by throwing in a few left field answers, especially if they have spoken to medical students before! While the Geriatric ward can be very fulfilling it can also be heartbreaking. Some of the patients are only in hospital because they haven’t been looking after themselves and sadly no one else has either. Patients come in dehydrated and malnourished and with poor levels of self-care. The paramedics who brought them into hospital might have been the first people they have spoken to in weeks. Social issues bring people into hospital but they can also prevent them from leaving. If people aren’t coping at home they need to remain in hospital while packages of care are organized, every extra day that goes by is another chance to acquire a hospital acquired infection. As a medical student I am starting to understand just how complex the healthcare system is and just how many people are involved. All the cogs have to turn together to make the machine work and sadly it is often social care issues that this all come unstuck! As medical students we need to know to navigate this minefield so we can help our patients in the future and stop social inequalities impacting on the health of our patients. I’m training to be a doctor, not a social worker, but I don’t think you can be a good doctor without all the other cogs!

Joanne

Catrin Davies : 27 May 2016 11:56 |  Tags: Joanne Mbchb Patients Social Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Cradle to Grave…

Writing about web page http://www2.warwick.ac.uk/fac/med/study/ugr/

In medicine we are privileged to witness both the birth of new life and the end of life. During Core Clinical Education (CCE) 1 there were times when I started on the ward and enquired about a patient only to learn they had passed away; other students have been present for a patient's last moments and others have been present when families have been informed. All of these situations present unique challenges to doctors and to us as medical students. I still feel like an unwelcome intruder in these situations but the only way we will learn how to cope with these difficult times is by observing others. We have excellent teaching from doctors and nurses who work in palliative care in the local hospice, teaching us about care at the end of a person’s life. I’m grateful of any extra knowledge in the hope that it will help me when it’s my turn to cope with these difficult situations, although I'm prepared to feel like I said all the wrong things the first time knowing that after reflecting I will be better next time.

An equally pivotal moment in a patient’s life that we get to witness is their birth. In my first couple of weeks of CCE2 at University Hopsital Coventry and Warwickshire I have had shifts on the Labour ward (both day and night!) and have also spent time in the community with the midwives. These have been amazing experiences and have made me think a lot about what specialty I see myself in. Working with the team of midwives and Obstetrics and Gynaecology doctors was great, I got to spend lots of time with the patients and was able to provide a lot of practical help to the midwives as well as be a much needed distraction for some of the women whose contractions were pushing them over the edge! I was able to observe both natural deliveries as well as some emergency Caesareans.Seeing the team come together to ensure that it is no longer than 30 minutes from the time of the call to when the baby comes out was incredible. Seeing the midwives, anaesthetists, theatre staff and obstetricians all working as one to ensure both Mum and Baby are safe was incredible and I had tears in my eyes on several occasions. As a second year medical student we are limited in what we can do and therefore how helpful we can be, but we can talk to patients and reassure them, and nowhere is this needed more than on the Labour ward. Leaving my 13 hour shift and saying bye to a patient I had worked with for the last six hours I was really touched to be hugged by both the patient and the midwife who said I was a pleasure to work with, hearing this was so rewarding and makes you realise that no matter what stage of your medical career you can make a difference. I’ve learnt that One Born Every Minute is not entirely accurate but the Labour Ward is certainly filled with some very special moments that are great to be part of.

In our first year we learnt a lot about health inequalities and the effects of social deprivation on the health of both mothers and children. Nowhere is this highlighted more than when working with the community midwives. The community midwives spend a lot of time educating patients about their health and wellbeing and also take part in multi-agency schemes designed to support families in a variety of ways. Seeing pregnant mothers living in damp, overcrowded housing makes you realise just how important health professionals are in tackling poverty and social isolation. Working with the community midwives we spent a lot of time trying to find a good place to listen to a heartbeat in the antenatal clinic in cases where a baby was especially active (apparently a sign it’s a boy!) as well as spending time on postnatal visits ensuring families were coping and checking for signs of postnatal depression. What I really liked about Obstetrics and Gynaecology is that it is a specialty that takes a holistic approach, the whole family and social circumstances around a patient are relevant and can have a huge impact on outcomes.

As well as cooing over newborn babies I presented my summer project at the Warwick Academic Medicine Society’s annual conference, an amazing day filled with excellent talks from both staff and students and tonight I start my first week of the optional Student Selected Component (SSC) in Medical Education. There is definitely never a dull week as a medical student!

Joanne

Sarah Hill : 30 Mar 2016 09:58 |  Tags: Birth Caesareans Care Joanne Labour Mbchb Medicine Midwife Midwives Palliative Patient Student Ward Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Two Weeks on a Surgical Ward

As part of the Core Clinical Education block during the second half of our second year, each student is assigned to spend two weeks on a surgical ward. The purpose of this rotation is to see how the ward operates, speak with and examine pre- and post-operative patients, and hopefully to observe some procedures in progress. My clinical partner and I just completed our two-week rotation and it was extremely useful.

The surgical ward at our hospital was an interesting place ­ and entirely different to the respiratory ward where we'd spent most other days since the beginning of this year. For one thing, most patients in the surgical ward are more acutely unwell than those of most other wards ­ this is logical, as they've either just been operated on and are not well enough to go home, or they are in a state in which they require an operation. This presented its own challenges when finding patients who were willing to speak with us and to let us examine them, but after some investigation and detective work (and handy tip-offs from helpful doctors) we found several willing patients over the course of the two weeks.

The variation in age was also far greater on the surgical ward than the respiratory ward. Perhaps it has to do with the fact that most people with significant respiratory ailments are elderly (and many of them have a decades-long history of smoking) and that surgical candidates can be of any age. There were far more middle-aged patients to speak with (and even a few under the age of 30, which was a novelty!).

My clinical partner and I had the wonderful opportunity to observe a few different surgical procedures over the course of several days as well. Once again, I was humbled and impressed by the utter professionalism on show at all times by the staff. The surgeons, the nurses, the anaesthetists and the rest of the team all worked seamlessly together as a matter of course to ensure the very best outcomes for the patient.

On one afternoon, I was asked to help assist by manoeuvring the little camera for a routine laparoscopic abdominal procedure (this is the one where a few small holes are cut in order to minimise tissue trauma to the patient and everything is conducted using apparatuses at the end of long, thin rods). It was absolutely excellent. Not only was the surgery like an anatomy lesson come to life, but it took a while to get my head round the fact that I was actually looking in someone's living abdomen ­ I was honoured and grateful to have been given that chance. But the most rewarding part of all was speaking with the patient the next day (who was very well recovered and well enough to go home). The patient was immensely grateful for the care delivered and for having met all of the surgical staff before the procedure, and thus couldn't have been more gracious. Moments like these reminded me that sometimes the best lessons are taught outside of the lecture theatre.

John

Megan Earle : 22 Feb 2016 09:49 |  Tags: John Mbchb Student Surgical Wards Warwick Wms |  Comments (1) |  Close comments |  Report a problem

A balancing act…

Now that we are on the wards I’m starting to fully appreciate the monumental struggle doctors face to maintain a healthy work life balance. The hours are punishing and the work emotionally and physically draining. Even as a medical student the balancing act is tough. At the moment I’m in hospital 4 days a week 8-5 and on my day in GP land we are in 9-7 to see a late surgery. An average day is a long time on your feet, a few periods of absolute terror (usually when taking blood and missing!) and a lot of mental effort. I usually get home and collapse in a heap, so finding time to study is difficult and finding time to relax even harder. Having said all that even after 4 weeks it’s getting easier and I’ve simply learnt that when it gets to a certain time I just have to switch off no matter what needs doing!

In first year I didn’t get involved in many extra-curricular things although I had a small part time job on campus. I’ve kept it up this year and I’m still enjoying a couple of evenings a week totally free from medicine. I speak to graduates of the university so I get plenty of helpful tips and advice from previous students, many of whom are now practicing doctors in the local area.

A big change for me this year has been getting more involved in societies. I’m involved in the committee with a new society that is gong out into schools to teach teenagers about mental health and reduce stigma. Getting involved in projects like this is great and you feel like even as a medical student you can make a real difference and get involved in causes that you are really passionate about. I’m organising a few talks and events this year with other societies and finding more and more people in the medical school who are equally passionate about those topics. You can feel a bit odd if you’re not really into anatomy or your sole aim in life isn’t to be a trauma surgeon, but there are so many graduates studying at Warwick and so many societies you will find people who share similar interests and passions and who will point you in the direction of some amazing opportunities.

Juggling hospital, a part time job, and extra-curricular commitments is hard enough but then the medical school throws in academic days which come with the usual lectures which must be prepared for and revised as well as our case based learning sessions. Our academic days happen every two weeks on a Friday and they are very long and busy days. They are usually around one topic so it’s quite an intense day where you question if you remember anything for phase 1, but it’s also a good chance to catch up with everyone over coffee.

This week we had our first day in GP. GP consultations are so different to histories and examination in hospital so I feel like I’m having to reinvent the wheel on top of everything else! Having said this I had a great day and saw a huge variety of patients and conditions. I even used an interpreter in one of the consultations. Working in different clinical environments is a juggling act in itself and I’m sure I’ll drop a few pins before I get the hang of it!

Joanne

Megan Earle : 10 Feb 2016 10:38 |  Tags: Gp History Joanne Mbchb Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem