Communiation station! Flashcards
DVLA regulations- Seizures
Epilepsy and seizures
1st unprovoked/isolated seizure= Driving must cease for 6 months from date of seizure- or 12 months if causative factor that may increase risk.
For Group 2= cease for 5 yers from date of first seizure without epilepsy mediations and if after 5 years no risk lisence may be restored.
For epilepsy- Group 1 =Diriving must cease for 12 months from last seizure
Group 2 must be seizure free for 10 years without epilepsy meds
Driving disussions
Need to ascertain if person drives
Make them aware that they need to notify the DVLA
That this is a legal issue- and that if they have an accident during this time then they would not be covered by insurance and could be liable for any injury done.
Emotional point of would they want someone on the road who could loose control like this?
That if doctor or GP finds out that they are driving despite this instruction thtat we will have to inform the DVLA ourselves which we will convey to the patient
DVLA regulations Stroke
Stroke and TIA- Group 1 may resume driving after 1 month if satisfying clinical recovery.
DVLA only needs to be notified if ongoing visual field defects, cognitive defects and impaired limb funtion.
Group 2- not allowed to drive for 1 year.
DVLA regulations- ACS
ACS- for group 1 = Can resume after 1 week if successful PI and -no urgen revasularisation LV EF 40% on discharge No other disqualifying condition.
If any other above aren’t met then an resume after 4 weeks
For group 2- Not to drive for 6 weeks and prior to driving need an EF >40% and to pass exercise and functional tests.
Also note for angina if occurring at rest, with emotion or at the wheel.
Cannot drive until symptoms resolved.
Exercise test criteria for ACS DVLA
3 stages of Brue protocol without any signs of angina, syncope, hypotension or sustained VT
10 minutes of exercise
DVLA ICD
First is for VT with incapacity
Group 1- must not drive until 6 months post implant
Group 2 must never drive with ICD. Permanently revoked
In group 1- must also not drive for 1 week post box change,
1 month post revision
And 6 months post any legitimate shock for VT
In ICD for sustained VT without incapacity.
Must not drive for 1 month.
Need haemodynamically stable event
LV EF >35%
VT pace terminated by ICD without acceleration.
4 pillars of medical ethics
Automony
Benefience
Non malefience
Justice
Consent for procedure structure
Assess understanding of admission events
Understanding of suspected diagnosis
Queries or concerns
Explain the procedure in a simple way (practice for LP and OGD)
Check any anxiety about this
Inform of plan to talk it through
Explain fully- possibly with diagrams to demonstrate how the procedure works
And what the purpose of it is
Inform of risks in a sensative manner
Check fully understood the information-ask to repeat it!
Assess willingness to go ahead
If unwilling talk about alternatives (Probvably hardest part and depends on baseline knowledge here)
Criteria to be able to consent
1) Patient must be competent/have capacity
2) Should be informed about the intervention
3) Should give the consent voluntarily
Quitting smoking- an oddy but good to be prepped!
Emphasise importance of stopping smoking and that reduces risk from resp and CV and stroke disease/ Inform of inreased risk of all 3 while continuing to smoke
Steps to take
- Offer helplines to quit
-Link in with smoking cessation nurses
- Inform that many people have quit but need to be prepared to do
Dismiss myths about smoking
-Identify reasons to quit; health of family at home, good example to children, financial, social too.
-Involve family and friends
-Link in with smoking cessation groups
-Inform of nictonine withdrawal and offer gum, patch and inhaler to ombat.
- Advise to set a date to quit
- Stop completely don’t just cut down- more likely to succeed.
- Can discuss medial alternatives like varenicline but check for psych disease
DVLA insulin controlled diabetes
For type 1 and type 2
Will receive a 1,2 or 3 year
license
Need to fulfil all criteria
Aware of hypoglycaemia when it occurs
No more then 1 severe hypoglycaemia in last year with last >3 months ago
Practices glucose monitoring as recommended
Meets visual standards
Under regular review
If unaware of hypoglycaemia then cannot drive!!!!!!!!
Huntington’s disease testing counselling
Establish why she is here- ask if she would like anyone here today.
Clarify FH of huntington’s
Gauge her understanding of Huntington’s disease- its inheritence, symptoms and such.
Check what she knows about the test
Check she isn’t being pressured by anyone to have this
State that it looks for the mutation on the relevent chromosome and so establishes risk of developing Huntington’s
Inform her that this appointment will be more to discuss how the testing is done and establish the advantages and disadvatnages of testing
At next appointment can discuss further- with someone to support her. 1 month later
And arrange test which will take 4-6 weeks to come back.
Discuss affect that a positive test will have on her family and plans for the future
Discuss effect it will have on insurance
If positive and wishes to have children talk about options to guide this and minimise risk of passing on the gene
Emphaseise that throughout the process has the right to decide if they do or don’t want to know the information of the test.
Inform will link in with genetic counsellers and MDT input
Brainstem death and organ transplantation
Check if patient wants someone with them
Explain initial clinical condition and current state
Inform that unfortunately confirmed as brainstem death and technially dead
Allow time to process
Explain that breathing being maintained by machine and if it was stop- he would no longer continue breathing
Brain has died and so no longer can support the body
In light of this- the next step is to stop his ventilation. As we are not providing any clinial benefit by continuing it
Link in to discussion of organ donation- father’s opinion if expressed.
Opt out law in place currently.
Inform Organ nurses will attend- discuss what could be done and check for any side effects,
If organ transpplant then will continue ventilation until achieve
Allow time to process- can talk again later and allow family to visit.
Brainstem death- just in case they ask
2 clinicians with one a consultant to assess for- no corneal reflex,
pupils fixed and unreactive,
absent vestibuloocular reflex
no gag reflex or to bronhial stimulation
Post mortem coroner
In most natural deaths/due to medial issues. Can discuss with family but they can object to a post mortem and insist they would like things to go ahead with funeral arrangements
Key exception is in criminal cases- family do not have right to object
However will occur quickly
Will be referred to CPS and for criminal investigation
May retain organ and tissues for evidence but as soon as no longer needed will be returned to family.
Note also cases where coroner referral has to be done are;
Death during surgery or before anaesthetic recovery
Death due to industrial disease
Accident or poisoning
Death was sudden or unexpected
