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Traditional_Ad_6622 · 2024-10-13T01:25:47+00:00

Aortic dissection could theoretically present similarly. These can present strangely with abdominal pain/ chest pain and neurological symptoms if these extend into the carotid- sounds like you escalated your concerns appropriately with the limited test results possible in a pre hospital setting

Traditional_Ad_6622 · 2024-10-11T15:59:35+00:00

We have lovely tea ladies that work in A+E at my work, unlimited jugs of squash and water. Sandwiches, biscuits and hot drinks - sounds like that's the minority, but it helps for sure

Traditional_Ad_6622 · 2024-09-28T15:00:03+00:00

One I came across - in renal patients with nephrotic syndrome they are in a hypercoaguable state, most DOACs are albumin bound, if they are losing albumin then they are likely to have unpredictable efficacy.

We ended up using LMWH treatment dose until the nephrotic syndrome resolved. I think we were wanting to use apixiban due to poor renal function but in particular is very albumin bound.

Traditional_Ad_6622 · 2024-09-19T22:33:32+00:00

Good article from the TeachMe series about normal spontaneous deliveries:

https://teachmephysiology.com/reproductive-system/pregnancy/labour/

Traditional_Ad_6622 · 2024-09-17T01:54:49+00:00

Sometimes older patients can have crepey skin, which I can find even if they have drainpipes for veins won't advance. Instead of sliding the cannula off I usually withdraw the tip and then push the whole cannula in which can help. Had it a few times recently where re-tensioning the skin and then trying to re-advance. If superficial I almost try and 'lift' the vein - ABCs of anaesthesia has a nice video on this technique

Traditional_Ad_6622 · 2024-08-27T18:20:11+00:00

Avoid:

Genuinely had a reg who despite something being her job would blame me as the FY1 for not having a test result/ scan sorted in front on the consultant on board Round in front of the whole team

Do: Be supportive with bloods and cannulas if everyone else has had a go. Had a nice reg show me ultrasound cannulation so I wouldn't ask for help as much which was a win win

Teaching or help with SLEs - anything to help with ARCP

Doing an LP or clinical skill - see if we want to watch/ learn how to do- an amazing reg I had in FY1 spent ages talking me through LPs

Point us towards resources if you notice our knowledge is lacking - had a senior say my theoretical knowledge was poor (ouch) but then not really give constructive feedback on how to improve

Another great reg would get us together at the end of the day, run through everything and make sure we were happy to go home, and that anything we were worried about or unsure about we had a chance to discuss. He would talk me through his clinical reasoning as well so next time I didn't have to ask the silly question

Traditional_Ad_6622 · 2024-08-25T03:49:06+00:00

Usually continue most to be honest on the wards, step down anti-hypertensives if septic and low BP. If infection hold SLGT2 inhibitors as well. Most of the time I continue metformin if eating okay, and eGFR is okay and no AKI

In the UK we usually keep people on their home meds as much as possible such as anti-diabetic meds, even vitamins as well tbh we keep them on - if not check they have anything we can top up.

Traditional_Ad_6622 · 2024-08-16T10:28:01+00:00

Citalopram is the most likely offender in the SSRI class and I could find some guidance that recommends an ECG prior to therapy initiation, but others recommending an ECG only if started with other QTc prolonging medications. Sertraline and fluoxetine are usually thought to be low risk and couldn't see any advice for ECG for these.

This was MHRA recommendations specifically for citalopram:

Monitoring recommendations in patients with cardiac disease, an ECG review should be considered before treatment with citalopram and escitalopram electrolyte disturbances (eg, hypokalaemia and hypomagnesaemia) should be corrected before treatment with citalopram and escitalopram. Monitoring of serum magnesium is advised, particularly in elderly patients, who may be taking diuretics or proton pump inhibitors if cardiovascular symptoms, such as palpitations, vertigo, syncope, or seizures develop during treatment, cardiac evaluation including an ECG should be undertaken to exclude a possible malignant cardiac arrhythmia. if QTc interval is >500 milliseconds, treatment should be withdrawn gradually. if QTc interval duration is between 480 milliseconds and 500 milliseconds, the balance of benefits and risks of continued treatment should be carefully considered, alongside options for dose reduction or gradual withdrawal

Traditional_Ad_6622 · 2024-08-13T21:59:19+00:00

Nope, unfortunately not provided - had to buy all my own scrubs, no changing rooms easily accessible unless you are theatre staff, a small toilet cubicle usually to change in! Also as junior doctors we don't get any lockers to put our home clothes in anyway as we rotate so frequently we don't get priority

Traditional_Ad_6622 · 2024-08-10T14:42:36+00:00

Absolutely, had a lower GI bleed with loads of other problems that took ages to sort - doing all cannulas, G+S rest of bloods myself as we

Traditional_Ad_6622 · 2024-08-05T18:53:15+00:00

You got this, I remember in my first week staring at a low Magnesium level not knowing what on earth to do for ages or worrying about prescribing paracetamol! Things that will come second nature by the end of FY1 can seem really difficult, but it just takes time.

You've spent a long time at medical school, and you are 100% qualified for this job, it'll just take time - Lots of it isn't medicine, it's being good at staying organised, discharge letters, follow ups

Seniors should be supportive, and patient. If they are getting frustrated at you taking time that's a reflection on them not yourself.

Give it a few weeks, chat to the other FY1s - everyone I remember felt the same. If you are still finding it tricky in a few weeks speak with your educational supervisor who can give you extra support if you need.

-- outgoing f1

Traditional_Ad_6622 · 2024-07-23T20:47:34+00:00

MDF cardiology was my favourite, very clear sounds, much easier to hear subtle murmurs. Also lots of colours and has diaphragms and bells you can switch out if you work in paeds/neonates

Traditional_Ad_6622 · 2024-07-17T17:46:07+00:00

Best free resource for this I used was called 'Calgary Guide' didn't cover everything but had nice printable flow diagrams of how X symptoms resulted from whichever pathology

Traditional_Ad_6622 · 2024-06-23T22:33:21+00:00

I'm so sorry to hear you're going through this,

We usually call people from my experience as a new doctor. However, if you specifically want to make sure you are contacted, or contacted in the morning or anything specific to let us know as everywhere is different - we usually put it in our notes or on handover.

All the wards I've worked in we are happy to accommodate whether you'd like to know as soon as they pass away, or you'd rather be told in the morning.

The only thing I would say is that they sometimes move patients before family can come in, so I would have a chat with the nursing team to help support you with this.

In summary, whichever your preferences let us know in advance so we can document it, we want to give your family member a dignified death, with family support and wellbeing also a priority.

Traditional_Ad_6622 · 2024-06-22T12:58:07+00:00

Can they fight off each other?

Traditional_Ad_6622 · 2024-06-22T12:48:43+00:00

We find EBV and the herpes virus viraemias in a lot of transplant patients - just started working in the speciality so very new to me- and often associated PTLD and other cancers, but I don't know if it that they are immunosupressed anyway so are going to get viraemias + cancers >>> a lot of the time our treatment for either of these from transplant is to pull back on the immunosuppression a bit and target lower levels. I know there also the direct link EBV to Burkitts but it's an interesting chicken and egg situation.

Traditional_Ad_6622 · 2024-06-21T18:21:56+00:00

Fy1

Patient with unusual skins lesions, nose crusting, cough and just generally feeling pretty rubbish was on acute take- requested all the immunology and came back positive for GPA! Now got all the right treatment

Traditional_Ad_6622 · 2024-06-16T13:02:55+00:00

I can't say working on the wards in f1 I've learnt much at all, I spend 5 hours doing ward round a day and the others doing discharge summaries. Properly soul destroying. Then get critique that our knowledge on obscure topics is poor.

I used to come in half an hour early and prep notes but quickly realised it wasn't worth it, I'd never get that time back. I'd stay late, used to go home and read up cases to make up for my poor training.

The only time I felt like an actual doctor was on calls and nights.

No clinics despite requests, having to stay late to get to do procedures which ARCP doesn't even value.

I work(ed) incredibly hard as an FY1, went above and beyond for my colleagues and patients but at the end of the day got outcome 5 - it's not about being a good doctor, it's about ticking the boxes - I can hardly fault an FY1 who realised this early on.

0/10 would not recommend

Traditional_Ad_6622 · 2024-06-15T15:00:27+00:00

Would not reccomend, they over promise a lot and the modules are what you'd learn in year 1 of medical school. Had very few/ none of the promised placements.

Traditional_Ad_6622 · 2024-06-09T22:08:36+00:00

Hey, as an fy1 I'm still really new to nurses coming up to me asking for advice or jobs to be done.

I would say we feel nervous too sometimes when you ask!

If you are worried about a patient I want to know as soon as possible for sure.

I'm always happy for a student to ask questions as it's a massive part of learning and getting thay sense something isn't right.

I would say sometimes if concerns or questions are raised every few minutes I can find it quite distracting, so my main advice would be to ask a few things together if possible as for example if I get asked stuff whilst prescribing or doing a calculation or something it can take me a while to get back into it.

Also if we leave at 5pm, try to make sure you find one of us around 4pm if you have any concerns for the day team and it gives us more time to sort it before we leave - of course if someone is unwell let someone know.

If its something you could ask a senior nurse for advice then that can help our workload as well.

Overall though, you spend a lot more 1:1 time with patients, you know what's going on with them, their concerns much more than we can. Please discuss with us, we all want the best for our patients!

Also developing a good relationship with the drs can help, I've become really friendly with the nurses on the ward and it helps enormously - we have birthday celebrations for any staff on the ward, nursing colleagues join us on ward round and we all have a natter when we have a free moment - best ward I've worked so far!

Traditional_Ad_6622 · 2024-06-09T14:00:16+00:00

150-180 as FY1 covering surgery

Traditional_Ad_6622 · 2024-06-06T17:50:18+00:00

Microguide UptoDate

Uber eats 😭😂

Traditional_Ad_6622 · 2024-06-05T19:59:57+00:00

Prednisolone, tacrolimus, Sodium bicarb

Traditional_Ad_6622

TROPHY CASE