Categories
Cardiology Medicine

Atrial Fibrillation

Atrial Fibrillation is the most common arrhythmia (1, 2) and it can often feel like an on call shift is dominated by patients with AF when it is not controlled. Patients with AF present to Emergency Departments and acute medical takes frequently and it complicates many surgical patient admissions too. On the face of it, […]

Categories
Uncategorized

Difficult Conversations

Difficult conversations are exactly that: difficult. They may be difficult for numerous factors that are related to the subject matter, the patient, their relatives and friends and yourself. The first time you go through one of these conversation, you may feel drained, raw and emotional or you may not feel affected at all. Dr James […]

Categories
Medicine Renal

Acute Kidney Injury – Part 2

Acute Kidney Injury (AKI) is a disease process that carries a significant mortality impact (1). The complications that accompany AKI can be difficult to manage and may require specialist input if resistant to treatment. The management of AKI also changes when faced with some special situations. Dr Aled Lewis is a Consultant Nephrologist at Glan […]

Categories
Renal

Acute Kidney Injury – Part 1

Acute Kidney Injury (AKI) is not only common but has an enormous impact upon patients. Length of stay in hospital can be increased alongside increases in mortality (1). This effect on in-hospital mortality has attracted significant attention from the media in recent years (2). Increasingly, hospital blood reporting software includes AKI alerts based upon creatinine […]

Categories
Surgery

Head Injuries

Head injuries are a common reason for attending the Emergency Department (1). They are also a common situation to be called about when a patient falls on the ward whilst you are on ward cover, especially at night when you have less immediate support. How do you assess these patients? Who needs a CT scan? […]

Categories
Elderly Care

Falls

Over 280 000 falls occur in acute, community and mental health hospitals across England and Wales each year (1). Falls can increase the length of stay and prevent patients from returning to independent living and at worst result in severe injuries and death (1, 2).   Dr Josh Deb-Barman is a speciality doctor in Elderly Care […]

Categories
Surgery

Bowel Obstruction

Acute bowel obstruction is a common surgical presentation. Delay in identification of bowel obstruction can lead to decreased bowel perfusion, ischaemia, necrosis and perforation. In one study, inclusive of both large and small bowel obstruction, 30-day mortality was as high as 36.6% with in hospital mortality 6.6% and a mean survival of 173 days from […]

Categories
Acute Care

Metabolic Acidosis

You are the medical FY2 doctor on call and a GP referral has just arrived in the Medical Assessment Unit (MAU). You are told the patient has been vomiting for 2 days with associated polyuria and polydipsia, they are tachycardic but have a stable blood pressure. The nurse is worried and the patient looks sick. The nurse […]

Categories
Elderly Care Pharmacy

Polypharmacy

  I talk with Dr Lishan Liu, an Elderly Care Medicine Registrar at Chester, about Polypharmacy in the older patient. Lishan has previously undertaken work investigating Polypharmacy and Potentially Inappropriate Medications (PIM) amongst patients on Elderly Care wards and the application of a tool to help with improving prescribing. Whatever speciality you work in, with the […]

Categories
Acute Care

Acute Pain, Epidurals, Rectus Sheath Catheters

I speak with Dr Dominic Cliff, a Consultant Anaesthetist with a special interst in acute pain. Dominic runs the acute pain service in Chester and has been instrumental in the adoption of rectus sheath catheters for post operative pain relief in major abdominal surgery. Oooww!! You B!*^&$d!! Is my normal response should I hit my thumb […]

Categories
Pharmacy

Antibiotics 

Antibiotics were revolutionary when they were first introduced and have come a long way since. However, the prescribing of them is not always as straightforward as we may like. In the podcast, I talk to Joy Nicholls, the Antibiotic Pharmacist at Chester, about starting and swapping antibiotics and particulars of Gentamicin and Vancomycin prescribing. iTunes […]

Categories
Working Life

Referrals: a primer and troubleshoot guide

How do we refer patients? Why do we? When do we make a referral? I was taught at length in medical school aspects of communicating with both professionals and patients but I was never taught how to refer a patient to another healthcare professional. This particular skill has taken time, practice and reflecting upon both good and […]