Clinical Management Flashcards
You have foundation year 1 and 2 doctors on the ward round.
Hand over tells you that an anterior resection patient is tachycardia and has a temperature. Another patient seen by the night team has a swollen leg and is hypoxia. fy1 doctor comes to the ward smelling of alcohol.
You have a ward round to do and then a teaching theatre list arranged by your consultant.
- 5 mins reading
7. 5 mins answer
You are about to start a laparoscopic appendicectomy and are called by the ITU about an unwell patient with possible ischaemic bowels suggestive on CT scan. You have a CT1 scrubbed with you and a FY1 on the wards
- 5 mins to read
7. 5 mins to answer
You are about to start a laparotomy and small bowel resection with your consultant. Your Ct1 comes to find you in theatres and tells you there is a suspected AAA in resus and a 6 yo child AE referred with 3 hrs or acute onset testicular pain.
You have a Fy1 on the ward.
- 5 mins to read
7. 5 mins to answer
A 65 yo woman developed an anastomoses leak 5 days after her elective anterior resection. She has been rushed back to theatre and aspirated perioperatively. She is now in ITU requiring inotropes.
You have been asked to speak to her family.
- 5 mins to read
7. 5 mins to answer
Your consultant has received a letter of complaint from a local GP due to late discharge papers. He has asked you to bring about a solution to this.
2.5 mins to read
10 mins to answer
You are the ST3 weekend oncall. There is a CT1 on call during the day. The last 2 nights have been covered by a locum SHO as the CT2 was involved in an RTA where 2 people died and he required 2 nights stay in the hospital. No locum SHO is available for tonights shift and the day CT1 has been pressurised by his consultant into working 24hrs. The CT2 who has been discharged from hospital says he wants to work tonight and feels ok. What would you do?
2.5 mins to read
10 mins to answer
You are the ST3 on call. It’s 22:00. Your consultant has seen the days admissions and has gone to a rehabilitation hospital to see apatient where he gets no reception. So far he knows about a 68yo lady with 4 days bowel obstruction awaiting CT. There is also a 38yo man who was admitted for observation following head injury. You get called to A&E to attend trauma call where someone has been stabbed in the neck and is bleeding heavily. Your CT1 comes to find you in A&E to say the woman with obstruction has vomited and is having difficulty breathing, The head injury guy dropped his GCS. He also says he has to leave because his cat is sick. What do you do?
2.5 mins to read
10 mins to answer
Consultant is unavailable. You have a Theatre list with 4 cases and you can do only the first 2. However one of these patients has eaten and the other requires an INR.
- 5 mins reading
7. 5 mins to answer
You are the ST3 for colorectal and general surgery and are in the outpatients department during a morning clinic ( due to finish at 12pm). The doctors in the clinic are you, your consultant and an SHO. You also have 2 medical students on the firm who have come to the clinic as well. The clinic is overbooked. and by 1130am, there are still 10 patients waiting to be seen. The delay is over an hour and a half already. You have an afternoon list which is due to start at 1pm and has an elective laparoscopic cholecystectomy on a patient with previous obstructive jaundice ( secondary to gallstones) that settled spontaneously and a reversal of loop ileostomy 3 months after an anterior resection for rectal cancer but you have not seen these patients yourself.
Your consultant informs you that he has an important meeting in his office and leaves the clinic and start the team brief. The clinic sister is increasingly irate and tells you that 2 patients are increasingly angry about the delay and are demanding to be seen next. One of these patients is also demanding to see the consultant.
Describe how you would proceed and what clinical management and organisation issues need to be addressed.
- 5 mins reading
7. 5 mins to answer
