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so everyone Money's pressure. I'm currently a final year medical student UCL on. But I'm also the marketing the question but uh on I'm also going to be starting an AFP post ST Georges in Monday, Um, this coming August and a Z consulted and talk to you about so less Med is a question bank which really sets itself from from the rest for a few reasons. I think one of the main ones is the fact that the questions make you think of a bit more and more laterally on dumb on the next light. Now you can see a few testimonials about about question bank, but just give you a personal one. As someone who's recently passed finals, I think I attribute a lot of that's Quest Med because I feel like the questions on there with the most similar to my finals on doll so as um, someone who's going to be starting an AFP. I've used a resume for the past few years on by a tribute lot that to me getting a competitive, that salt to them attain that um on uh but some of the main features that sets itself part is there is a searchable. There's a global search function, which allows you to search for topics. A safe example. Your advising multiple sclerosis in search for that. And then do I press cards on that with the president? Questions on um, so with the cards, there's over 15,000 ANC. He stopped flashcards, and these a rule cremate so you don't have to make them yourself on, but they're sort of a I within placement will automatically republic, which cartoon you to go over based on the questions that you get it wrong. There's also a timed a question mode, which is essentially that stimulate the increasingly common online testing. You choose selection of questions. It will give you a time limit, and you won't see which questions about right or wrong until complete. It'll questions on um, what's also really useful is that all the features that I've mentioned you can also access through the Quest Med moved up a terrible on IOS on droid on, but it also acts off line, which means, for example, for me, I use that quite a bit, walls on the tube and also just within hospitals where Wessel any chest WiFi leaves a lot to be desired. You can still use the app on, um, today we're sponsoring the Siris of lectures, and you can use the code on STS 25. 25% in your questions on gout. Also be in the chapter of it. Anyone has in questions. Yeah, really Recommend Quest Med. Thank you, Lovely. Thank you so much. And so normal is hand you over to, um, a lovely after you called cart. I was going to take in this left actually today and just very experienced in lecturing em on his liver pill currently, And we're going to give you some practical tips and just about using a bleed. What a bleep is four or how you use it. Um, on just all the things associated with Fats and so just over to you cut. Thanks very much. We'll just stay on my screen now. Thanks those for the introduction. And so today was what was doing an introductory session. Maybe about doing your first search, grown call and answering oblique. Most of this will be sort of things I hopefully hope you'll have learned in medical school. But often, lots of these things are sort of the the softest skills that aren't necessarily medical content that are really important to know when you start the left one. So I'll try and give you some hints and tips from my time doing surgical on, cause a surgeon, you doctor, and help me three. Um, so just to be a background like myself, I'm an F two doctor based a little ball, and I did my pre clinical medical school at Cambridge and then my physical Oxford on. Then I've seen do my foundation program a little, and I'm crying on GP, but I've done some s h o surgical job started to, you know, And then I've also done General Pedes old. Hey, and then I'm going on to do pediatric surgery. Next year is the next three job. Um, so I'm quite passionate about surgical teaching. Um, so you to get on and cover what we need to cover today, So these are sort of are learning objective. So think about how to cope with your first surgery on core shift oblique. What? It is how you get one when you answer it. How you obtaining course information using sort of it's, um, frameworks to help guide you when you need to be part of people, and then how to prioritize your jobs. That's quite an essential well, because in some jobs you'll be overwhelmed with tasks that you need to get on and do. And you need to be able to quickly assess which ones they're important and critical to do right away. Which ones can wait on. Don't cover little bit about giving 208 is This is definitely something I don't think particularly well covered in medical school, and you develop it really with practice but just giving you a framework to use to know how to want to do 100 of correctly. So to start off with what is a bleak for and and how do you get one? So oblique is primarily for sick patients on virgin tasks Everyone should hope. You know what We pears are big plastic, very unbreakable things that you were on the uniforms somewhere that make quite a high pitch sound and go off, and they give you an extension number normally, what you need to call very basic things in terms of how to use them. Every hospital has different numbers to call to bleep someone on but on the hospital main system. So for some, it will be like a number nine. And then you insert the extension number you wished, Oh, the bleed number us to sleep. And then you put your extension on both the phone you're using different muscles have slightly different systems and different on Mr Course. So once you get to your foundation job, you'll get told how to do that. And then in terms of answering it, um, really critical thing to do is to make sure that you recall the extension number that comes through on the bleak. If you're really busy, particularly when you get into that, you have to your jobs. But possibly also, if you're in a busy DJ, where you're getting lots of lots of bleeding, you're responsible for lots of different wars. You can get bleeding quite several times quite quickly. So keeping track of the numbers that I called you in the time they called you so you can get back to doing good time is really helpful on buttons he can use. But no one really knows how any of that work and different beliefs have different ways of dealing, eating number and things like that. And then you sent you just call the extension number on the phone. That just covers the very basics of it. And so, getting back to what the bleep should be used for, what other start should use your bleed for, uh, so the most important thing is seeing sick patients on These are patients that you need to go on assess in passing on, then urgent task. So this could be a huge range of things. Many of them can actually be dealt with virtually if you have, if you're lucky enough to have an electron ixis tum that hospital you're working out. But I knew that's not always the case everywhere. So these are things like prescribing, communicating, so someone might bring you from the lab or from radiology to communicate that a scan results are artery. Test is available for you to look at you, too, before management as a result off, um, or it could be a condition calling you that wants to discuss the management of a certain patient on do. Also, you could get bleeped by various staff to do other tasks. Such a blood and Cannulas death certification and then non urgent review tasks or communicating with family of a patient in some hospital. Is your lucky enough that on call your beliefs might well be filtered by other healthcare professionals, particularly nurse practitioners. You could be phenomenally helpful, Um, or they may well be an electron ixis. Tomorrow we're on to which on call, task the place and then you're able Teo triage them yourself. But in many places, particularly in DJ Ches, your bleeding will just be used for anything and everything. Um, so imagine that you are on call and you just need to eat. It's your first day as an F one and your unfortunately, on a long day, so it's after it's in the evening. You have your hand over and you being bleeped by a nurse about a patient. What are you going to do? So we're now going to discuss an approach or framework that you can use and that will be used continuing throughout the Siris of factors that are being given them to go through different scenarios. Okay, so So, um, first thing to think is to just stop and remain calm particular at the start when you get bleach, it could be quite stressful. And again it's inserted. He get lots of lots of times that could be really stressful. So you need to establish some really key information, the most important information being who's sleeping you and also so that they know who you are to make sure they get the appropriate passing. Eso. What is your responsibility for the patient that that they're sleeping? You about all the problem that people about and then making sure you know who they're believing you about. So make sure you get the patients name idea hospital ideal, the date of birth, so that you can either find them on the electronic system or find their notes, probably when you need to on then also where they are geographically. So what water they on? What are they in? Or they in a clinic or elsewhere, and then what? The problem is. So the key thing in terms of assessing what the problem is, is to think about. How urgent is this problem? Your main job that I would say to think of when you're in half one you're on cool is to keep the patients alive until the dating are coming, whatever that might be that that's in the evenings with. That's overnight with us that the weekend, your job is to make sure that critically on more patients are stabilized. And I kept well to the team that knows the best convention. Uh, so you need to know how allergic things are so you can manage them and assess them appropriately and see the things that most urgent fast hum and then other things to do is on depending on how you know the healthcare member of stuff that's calling you and their level of expertise. What more information can get about the about the problem on. But they tell you other things, such as the patient's observations that after you on also, critically, the speed of the terrorist in of the patient. This is all a shooting that they're calling about a second patient, by the way. So then thinking about while you still on the phone, formulating a plan when you mean once you got some information? Onda So having some initial thoughts about the problem, So can you talk this out over the phone? Or do you need to go Come and see the patient, and then can you get anything done before you arrive? Um, this is something that's a new just mint to come from medical school into you foundation being a doctor, Um, often at the Starks it here I found this is that you feel that you need to do everything yourself and that you need to get on. You want to be doing everything but the nurses and other healthcare stuff. Absolutely fantastic. And they can help you. They can do talks so often. Actually, they can do things a lot more quicker than you can, and actually often have much more experience of doing them. So can they do with the observations for you? Can they get access? Lots of them are amazing at doing access. If you just ask them, um, can they take some initial blood of you? Can they do a blood glucose on? They put a catheter in Is that you got your input output? Can they get the sort of things weren't ready for you. So next chart any CG, they can do a urine dip and then also discovering other equipment. So silly things like a tendon hum which impossible to find or things that you might need a gently that you're not going to know where they are because often you'll be covering Was that you don't study work on during the day? Um And then I'm also thinking about if this isn't a critically on location, is there something you console over the phone? So is this something that you can provide reassurance for this, A really small thing that doesn't need seeing now. So it is a patient. Maybe that's had a rash for three weeks, and the nurse just wants you to review it. Can you sort of find out more about what's actually going on there? And is there something that you need to go to right away? Or can it wait, or can it wait actually for a day or so? Okay. Is it ever chew a task that you can just do such a computer? Um, also managing a workload. Is there something that you condemn a gate? Um, and can you manage the person that read into that? Expectations about how likely it is that you'll be able to come and see them urgently, or how long it's gonna take you to get their for their own reassurance, particular that someone critically sick, they need to know what you're on the way or they can call someone else. Or are you absolutely run down with other things to be doing and this person's not actually that sick. So making that person aware of how many other things you have to do, we'll give them an idea realistic idea of when you got to arrive. So you've done this. You hung up the phone and you've written this down. So what you gonna do when you're on your way to the war? Because in this scenario, this is actually a patient that you think needs to be assessed because they seem like they're deteriorating. So these are just some things to sort of think about when you're way doesn't cover everything, but just particularly when you're on a surgical on call stuck to be thinking about as you're walking down. Or maybe you had a quick look at our electronic notes before you set up for the ward, and so were on surgery. So what surgery has this patient had? Um, when critically, when did they have it? So we can think about POSTOP complications. And most like the thing that could be going on if someone's deteriorating. What's their background history on what is the normal function, like? So particularly for surgical patients, they can become quite delirious and they can compare in well, and it's really useful to know or to think about. How well were they before they came hospital before the operation? And is this new? And what drugs they onto the Have any allergies on briskly? They on an antibiotics. So they already being asked to be treated for an infection? Or is that something that you need to think about? Um, thinking about? You need to prioritize getting pain relief if they're in pain, and then how serious is there? So in terms of that, we're thinking when we arrived, we're going to be taking a history right away, or we're gonna go straight into doing a tree, or are we gonna just literally check on them and immediately call for senior support? So then you've arrived at the wart, um, and you get to the ward. So this is sort of a structure of sort of seeing someone awards, which I didn't do it first then quickly took on and learned from either myself or colleagues in the stakes. We're going to see someone. Personally, I'd be deteriorating. So to me, always the first thing I do when I get step foot on the ward is walk past that patient's room or that day, and I bought them to check their not critically on Well, because sometimes in the time it's taking you to get the world, they may have become much more on well, or you may have been really worried and rush there, and they're actually fine, so that can help you decide how long you take to sort out the other things before going to assess them yourself. And so a really helpful thing is to get a hangover from the person that called you on or that you spoke to on the phone. This is often a lot easier said than done, particularly if the nurses have loads of tasks they're doing. They might be busy preparing drugs in the, um, in the utility room. They might have gone on their break. They might be turning to another patient, but ideally speaking with the person that you spoke to could be really, really helpful to just find out a bit more information and just, you know, get a feel for what's going on on what they're concerned about and then gathering your notes on Be having me up today. Observations. So, ideally, if it was someone who was cetiri ating, the nursing star may have done another set of observations. Still know things have changed, Um, And then having your equipments keppra, I tend to take equipment I think I might need with May. So if this patient doesn't have any access and I think they might be on well, then I'm going to be taking my blood's and cannula Quit mint with me so I could do that at the same time to save myself time, Um, and then, in terms of also having the notes, is looking into a computer. He can just so it's near by so you can check things, always quickly record your notes and then going in to see the patient. Obviously, introducing yourself on your role is you would, when you see anyone and then because this is a sick patient, you want to be taking quite a brief history on doing an 83 assessment. So in terms of your assessment, as I said, brief history is the priority here. Um, you can get a lot from speaking to a patient and also from from just looking at them from the end of the bed. But this isn't a medical school. Oscar history here. This is how sick is this person, And what can I do to help them right now? So the most important thing is really what? We're speaking to someone. We're finding out what sort of cognition level they have. Um, how old are they Are? Are they any pain? And where is the pain and just covering that briefly. You can do Socrates if you like, um, and then getting their experience of their symptoms and how quickly things have changed from them. Uh, then obviously from the notes themselves, you'll be able to get rid of information about the patient's background. You'll be able to see the trends in the different results on also in their observations and also any other investigations that are important for you to know about. And then, as I said before about getting 100 from personal, spoke on the phone, a collateral history, actually, in any form could be super helpful. So so hopefully postcode times potentially, there might be a relative of the bed. So plenty time tonight and social encores. There's been a relative with the patient who said that they're not that on myself. And that could be really helpful to understand when that second, what you need to do also healthcare assistant are amazing. How over those two? Because they often see the patient a lot more than the nursing start. All the doctors do, um, and then just having a look at their medications they're on and the allergies and then doing an examination. So doing in a to the examination. So put your familiar with that, and then either having a new set of observation or actually taking the observation to yourself to establish what their new score is and how that's changed. So then, once we've done our assessment, we want to be thinking about differentials. So what are you thinking is going on is the critical thing to be thinking, but then also, But your state, you want to be thinking, Can I manage this myself? Is there something that I can treat on investigate and sort out and patient will get much better. Or is this something I need to immediately sleep to a senior about? Or is there something that I can manage first, do some initial steps and then potentially contact the senior with a bit more information? And the critical thing to say is that. And do not feel afraid to ask the support, don't wing it and manage a different situation yourself. Often that ends much more broadly than calling someone when you think it might be too early. So I've been told about a few times that the safest doctors are the ones who call tubes. What they think is someone who's not who actually isn't very unwell. But calling early is really, really important and know Senior should be upset about being called about. A patient actually turns out to be fine, because your job is to make sure that the patients say so. Then just having a think about investigations based on your different yours, just the principles of doing them. So you need to think about basic meds. I think so. As we said things that perhaps the nursing star may have been able to do for you on your way on things like a blood glucose getting, ah, pre and post void bladder stand or getting a catheter inserted and seen what the residual volume is. Um, getting some blood and sending them off to the lab is a priority, Um, and then just thinking about imaging. So I'm thinking, from basic up to more intense imaging and also a potentially whether you need to discuss that with a senior or if you're able to call directly. So in lots of hospitals, things like CT scans are only able to be ordered by registrars or above. That's a new sort of this age maximum that's being introduced, which could be a bit of a nightmare, because often you know the patient best, and you actually are the best person to discuss the scan with the radiologist. But just knowing the protocols that exist in your hospital so that you can make sure that you're allergic the right person to be able to get the scan you think you might need, um, but also thinking about radiation exposure on what other imaging, as the patient had recently used to do, we need to repeat it all. If things have changed and do we need to repeat it? Almost certainly. But if things are similar to before them have, you don't on do with all these things you can ask for help, So don't think, as I said before that, you need to do one of these things you sell. You consent to ask another colleague who's on call with you to help you out. If the patient's really on, well, you can ask a senior, you can ask the nursing star. Um, you can discuss it with lots of different members of star so that you can work out exactly what you need to be doing. And then, obviously, you need to think about your management plan. So you've done some investigations. What are you gonna do? Um, so something that could be quite common at first is to just think right. We'll do the things that almost everyone gets the EKG, some blood, a transit rate and then get them reviewed by a senior. Unfortunately, that's something that we want to get away from because if you've been thinking about what the difference was, are you might have some ideas about what's going on and just doing broad brush things could be really helpful. It is a safe thing to do if you want, if you're not sure what's going on but isn't really a plan. Um, sort of thinking of things as a learning opportunity and practicing different management pounds and also having, you know, recently passed finals and having the conference behind you that you know, medicine and that you, you know, you can make reasonable plans even at your stage is is what we need to be thinking. Really? Um and then senior review. Actually, that is critical. That isn't adequate plan. But you need to make sure that you do actually inform you of senior so ideally should be bleeping them yourself in having a discussion over the phone or getting them to come and see the pet patient in Paris, and you could be there to give a hand over, and then you can learn from their plans. So you make your own plan to start with. It may be that you're not sure what to do, but just make a plan and your head even discuss it with your senior, see what they do and compare and contrast what? What? You thought what they decided to do on. Actually, you will find the time that the plans that you've made it almost identical to what your seniors would have done to you. And then, um, you're learning process. So then, in terms of documentation, so this is quite critical thing. And regardless of what this is Elektronik or on paper, there's, um, re important thing is the imagery write down so critically the time that you've gone to do your view on also your name and your role and a lot of people in, especially in written notes, where there's not as much of a easy, older trouble for the GMC number down so and then it go instructors or followers? You've asked us to be nasty a patient regarding and then whatever the reason for your initial bleed, you can write down. So it might have been chest pain, but I mean shortness of breath right down. What? That what? That initial reason for you to be called waas and then if you have time, you know, run off your feet with other patients need to go and see, and you want to have a good thing about this. You can write a brief history of the patient and the reason that they come in on a potential, you know, day out, day to POSTOP laparotomy or whatever in the notes there. But previous notes would have seen quite thorough recording. That's that's not critical to write down, um, thinking about this little clinical details of what happened. So how was the patient before? How have they changed the manual rate? Reassessment. Um, so literally just writing 80 in putting your findings for each thing is actually fine. Um, and then the investigations that you did, and if there's any results back popping them in there, um, or writing down things, you're a waiting and then and some people like to write a different diagnosis, but I actually prefer to put an impression, but that's sort of your own choice. But putting impression of things are going on, particularly, you're not sure exactly all the all the diagnosis, but you can put down some potential. Currently, Rachel's in the notes you happy to and then having a manager of time. That's good. That's logical. And that's safe. That's based on the impression that you made before and then any further back you're gonna take or any warfarin would have made and discussions with the senior and then leave your bleed number in that note as well, so that the water can contact you again more easily because often times that have had to have ring switchboards get your BLEEP. Or they have had to have looked at some crumpled piece of paper that someone's handed them to find out which doctor is on call. Because it may be that you keep your BLEEP with you for the whole rotation. Or it may be that it is about one believe that's carried found. So then thinking about other structures for note for note taking. So that's just one. The eye have followed, and this is quite a similar one, actually. But this is also really useful for surgical ward rounds, which particularly you'll find if you are doing right notes, they're super fast moving. It could be very difficult to keep track of the note taking, but also to bury in mind what you need to know about that patient. So sometimes you can go on a whole surgical ward round of a whole ward and find that there's some patients where you're not even sure what the plan was or what you needed to do that day. So put in the situation so daytime, who was present and who was leading the ward around a brief thing about the patient's background. And then they're working diagnosis what operation had and how many days they are post up or if they're pre op and then the subjective things. So how do they feel they are? Are they in any pain and then objectively? So things that you've noticed on, sort of looking at the patient so comfortable, sat up in chair things like that, Um, and then recording the assessment. So putting their news or observation score in the notes at the time, or the most recent observations that were done and then recording the examination? Don't be afraid to ask the the senior doctor that's performing the ward round or more drums to shout out what their findings are. Sometimes there could be a lot of people on a surgical will drive, as you probably found in your experiences and actually knowing what the findings are coming. Quite tricky exactly if it's something like abdominal tenderness, you might know, of course, where the tenderness waas or if there's any positive signs, you know, that might be things that you've missed and that comes to be a learning opportunity, even though the priority for you at that time is to be reporting the notes, then thinking about the plan. So I, ideally, you should be sort of formulating this on the ward around to, but often these things will be dictated to you by a senior on. But don't be afraid to ask for more details. You know, surgeons kind of a tendency to rapidly move on to the next patient because their priority often is getting to the actual clinic. But very mind that the risk patients is your responsibility once they leave the wart. So you need to know if your own parity what what is going to be done? What's the priority? Got patient today? So is that fluid they need more blood's doing? Do they need a change in the medications or they're antibiotics reviewed to? You need to bring my quality to discuss their antibiotics. Should the patient be nowhere? Now that's it. Here, something that the nursing staff will come to you to ask. So helpful to ask if you're unsure on the ward round and then the two critical things which trick people up the most enough or when they're on a surgical job is imaging so often? Um, a senior doctor might say, Get a CT scan. But there are all thoughts of different types of CT is a different form the contrast with no contrast of different areas of the body looking for specific things, that specific phasing. So it's really invaluable that you ask what imaging is needed and why. Don't be afraid to ask this, particularly also because again, as I mentioned before, when you're on call again during a normal day job, and when you're ordering scans and investigations often you may well have to have a discussion with a consultant radiologist about the scan on why you need it, and particularly on surgery, when scans tend to be quite particular for surgical planning and such. And knowing why it used to happen is really helpful, because otherwise you'll have a conversation with a consultant, and then you have to go and find your senior to find out what the reason was, and it just you know it would save you time to have married at the beginning. What you needed to find out why it was a C competitive request, Um, and then also discharged plan. So prompting a senior or the consultant about these is really, really helpful. Um, remembering that as an F one here, you don't have the authority to independently discharge patients. So about beans and you do you need to know what enables them to go home and states they might, they might say, if it distracted, there might be a condition on that such a Z they've past year in. You need to know those things and then just to cover a little bit about how to escalate to assume because I've mentioned a lot that, you know, contacting your senior is really important. Um, so, as I said before, just to reinforce, if you're worried about someone you're not sure what's going on, then it's never too early to ask for help. No doctor should ever criticize you for asking them to support as and when you're still in a row where you're learning. So you're there to be, you know, to get supported where you need to pay if it's an urgent situation, but the patient sort of relatively stable, you need to have a discussion with someone more senior. Could you think more things need to be done, then? The first part, of course, Normally, to speak to the surgical S h o a little red stronghold, depending on how your hospital instruction works, Um, often times, especially out of hours, they could be in the theater or just unavailable sometimes also, if you're in a particular special and you need to call that, that's definitely is registrar. Say patients had a fracture and they've got some pain postop all and or someone's fallen and perhaps broken. They happen. You want a repeat it red straw. Sometimes they can do, um, reason on calls where they're based on on cool room, and they have a move all that often times that mobile might be switched off on. If that's great cops and things that sometimes your weight God's got hold of the person you need. If you tried those routes beforehand, or you tried other ways of getting three went through switchboard things, and at that point you can ask the medical register on all the help and also for, um, POSTOP complications that tend to be medical things such as pneumonias. Ask you for support from the medical regimen. Call could be really helpful, and especially in those first few weeks where you're unsure, that's absolutely fine. And they should be welcoming off that, um, the other people is depending on the hospital again that you work in. Lots of hospitals now have the critical care outreached him. So this is for patients that are deteriorating on the ward. Who could possibly be needing hates to you All right to you on these are often really experienced nurse practitioners or even junior doctors that can give you a lot of support, can help you get abscess of It's really difficult consists, and they often have a direct line through to a 90 or hate you consultant so you can get the patient admitted quite quickly. If you're unable to get hold of your your other seniors on the ward level, Um, and then if things are less urgent or you're not really sure who to ask, then again, the S h o Z good port, of course, or sometimes if you're on call that might that might will be enough to working with you on team. They will have probably a lot of experience of going through the sort of common things on call, because there tends to be passions of conditions that you'll see on there have got to go to that step really useful person to grass. And then also, if you are still has them. Nurse practitioners, Um, very useful and can also. Sometimes you might just need a next pair of ham. So often you'll find that in the first couple of weeks or month as an F one, things could be quite scary and overwhelming. But then you'll start to get to grips with what you need to be doing. But sometimes when a patient's quite sick and maybe that you just need more help, so you want to be ordering a chest X ray. You want to be doing that blood. You want to be doing an EKG and just having another pair of hands or couple pairs of hands to make things a lot quicker. Um, and then on that note, as's well, I'm if it's getting to a point where you feel this is a very aggressive situation. Non see printing the buzzer call you for helping us and someone to put out a double to double to cool. Um, you need to specify lots of possible side say, in general, just a lot stronger when you when that person makes that cool. If it's a cardiac arrest or situation where the airways endanger them, make sure you specifically ask for any tests because they always do. They come and then some hospitals have a really bringing new system, which is a medical emergency teams or met cause it's called, and often that's by the same methods of double to double, too. On that tends to bring a junior doctor like an F one or two. That's all not believe for the day on S H o Medical registrar on, but it might will bring the critical care or each team or nurse practitioners who work on that team. Um, and they consider a 60. We're looking at someone and in some hospital is if a patient's new school reaches a certain level, then there, and the sort of the protocol that the nurses have to follow is just to put that cold out. So you now sort of have some idea of how to handle oblique on sort of the things are doing. And I've covered a little bit about some tips and tricks for surgical ward rounds and also just escalating to a senior. So I mentioned before about you might well get a lot of weeks in one go. So what are you gonna do when that happens? So as I mentioned before, um, keeping accurate records is really important and good practice. And, um, for myself, I didn't learn so much is left one. I needed to do this because I was fortunate enough to work and Austral, where obliques was sort of filtered by a nurse practitioner and most of the surgeon fasting used to do it on an online system. But when I was working as an F two on drama pedic in a major trauma center, I was getting up to 10 bleeps in the space of two minutes. And if I hadn't have been writing down the bleeps and the times, I would have completely lost track of you would bleed me and being to get back to them, and it's hard to function. Um, so having a piece of paper when you start on on call shift blank piece of paper, script, people wherever and starting and having the details time that you're bleeped. What the bleep number waas What? The situation is in the task and putting the patient I d down. And then you can make some of, like the jobs less to yourself of task. You need to be related to them. So once you discuss them, you can just write down things and, you know, chase chest X ray or check the blood some things like that. So you just can keep track of all the patients that you've seen in that shit and make sure that you don't miss jobs Little on the need to go back to um And then we talked a little bit about how to sort of filter out and workout on the phone, which bleeps? A more important, um, this is something that comes of experience, but quite quickly, all sort of realized things that are critical and your know, from your own learning in med school stuff that's important to go see a sap. So just, um, examples here someone that a nurse is called you about who's got low BP, who is fibro versus what can actually sound to the nurse to be quite urgent, which would be completing a district summary. So a critical thing to remember is that, as I said before, when you're on call, your priority is to keep the patient's safe and alive until the day Teen who are most experienced looking off these patients are there. So in that sense, doing a discharge summary is no a critical task for you. It might be a very helpful task be done, and it might save a lot of anguish for a patient. So I'm not saying it's not an important task to do. But in that scenario where you've had to bleeps, going to see the patient that's got a little BP that's federal is much more important. And then again, patients whose having chest pain versus a medication to take home that needs to be signed or done. Uh, you need to go and see the patient that sick always go and see the patient that sick and manage expectations off. You've been bleeding by and explained that you've got a number of more agent tasks and also there may be people that can help you with this. As I said at the hospital, I worked enough one. There was a nurse practitioners that filter bleeds but also were able to help with the ankle task so often, and a destroyer summary can be quickly completed by someone with enough clinical experience to read the notes and see what's happened. But actually you have the skills to go and see a a sick patient and assess them, which is what your priority is to do on. If you do feel overwhelmed with with the number of tasks you've got to do, then just take a moment and just have a look at your jobs list, and you can even just number them and prioritize which things you want to see. If it's getting to the point where, UM, you feel like you've got too much to do and there's too many patients that need to be seen right away, then contact a senior on the other people to help his ask your colleagues. The other foundation doctors that you work with me on your rotations will become your friends, and I'll support you on in certain hospitals, especially big hospital, that you're doing such chronic all that often be three or four other F one or two doctors that are also doing an uncle by evening, and you can watch that there is a team help each other out, you know, makes you got the phone numbers off the people that you're working with and have a plan to take a break it a certain time. And, you know, they may well be able to help you with things. Lots of my friends and I'd help my other friend, my friends with doing so task quick tasks like things like warfarin prescriptions that have been left door checking someone's bloods and just filing them so that when they were having a really, really busy, um, hold lots of patients didn't have to worry about about those small things on Do something else. I just wanted to mention is more sort of like human factors thing and also sort of communications goes and managing your workload. Sometimes when you get a cool from somebody or belief for somebody to go and see a patient, the impression you might get on the phone could be that the person's really sick. But if it's difficult to understand what problem is, someone might just say to you comin. See this patient, Um, and be reluctant to give her information. That doesn't necessarily mean it's a clinical party. So it's really important that you carry five the reasons you've been asked to go and see someone, Um, because it can be really easy to just think I'll just go to the world and see them when actually you've got a much sicker patient elsewhere, and then something else to mention in terms of your jobs is things that should be done by the day. Teen when you're on call that you shouldn't really be doing so. As I said before, sometimes war from descriptions could be left there things that should be done by the day team. And also, if a patient's stable on the ward postop, they're meeting fluids and they're having their in power port looks up. The fluids for 24 hour period should have been prescribed by the day team. So if that becomes consistent task that you're being asked to do on your own course, that's something you should raise because those aren't really things that you should be having to do while you're on call. Obviously, for the safety, the patient, you should do them. But if it gets to a point where that's becoming repetitive thing, then it's stopping you from doing your other critical things. You have to do such a success in the sick patients, so you should raise that. Um, I'm just helping out your colleagues as well. And when you're working on a ward, making sure you don't do those things before you go home so that you're on call. Carly doesn't have to, because it's a lot quicker for person who knows the patient in denounce. Next thing about them to do that than somebody who's never met him before, and it might require them to spend five or 10 minutes looking for the notes check. And I use the knees and doing that, actually doing a clinical assessment of the patient before they feel comfortable to prescribe the fluids that you could have done in a minute. Then sort of just quite busy site. Um, I've written out five scenarios here of, um, of different briefs that you have received, and I just wanted to take a sort of a moment to think about the party that you would go for in terms of addressing them. And then we'll talk freedoms that just give you a couple of minutes out to just have a think. Well, sorry, just give you another minute. Kind of think there's no I'll say now there's no particular right along on spot. Just do a bit of explanation about each one in a second. Okay? So just go it through each of them in town. And it's just more of thinking. That's nice for you to sort of imagine yourself in this situation. It's just quite common thing. And all of these, all of these scenarios of beliefs that I've had one. I've been on calls or similar type beliefs. So the first one when I beat you with vascular disease, who you went to the toilet is now it's come back and it's really drowsy in his breathing slowed, and the nurses are really worried about him. So from the sounds of that, this is possibly someone that shot up something with that be heroin or something else that's made them reduced consciousness. So that's definitely a clinical priority that you go and see them, the nurses explicitly said. She's very worried. Um, obviously you need to cover more patients is just a brief summary of what they told you. But that's definitely something. You should be going to see him soon as you can. Um, then the second one on the wife of a patient wants to speak to you because she's really distressed. But I'm being a lot more confused and that you're seeing things. And he's Hard day unoperated two days ago. But since then, he's been okay. Hey, then got quite agitated on the water, but he's much more that good. So this is someone that sounds like they potentially have postoperative delirium, Um, the nursing staff being flying to it by the wife. Uh, he's stable at the moment, but he's being very agitated so potentially could get agitated against and considering the safety of him and and the other patients on the ward. But also, if you're completely overwhelming here, we have got five things to go and see. It's comedy settled, so this is possibly something that could wait a short time while you do see the other patients that you need to go and do an assessment of delirium for this patient. Then and then we've got, um, a person that beat you about this and daughters who are some family members who are really upset because they don't know what's wrong with their mom, and they're insisting on speaking to someone. And this could be very common in normal times. And as we go back to having visitors on the ward, unfortunately, when it's very busy in a very visit, busy hostile environment. And unfortunately, sometimes family members come get left out of discussions or could have had thing to explain, that they have not really taken them in and once they've had time to reflect, which often will happen when they come to visit the patients in the evenings, in the evening visit times or the weekends when you're the on call person, Um, you know, she's been newly diagnosed contracting cancer, and it seems like there is a plan in place which the staff of helpful told you that there is a plan. So we're shooting that you may be on call at the weekend. This is a really difficult one and can be quite challenging. To do is especially when you've got lots of the demands on your time is really important. You do go and speak with the family, but equally realizing that you don't know the patient. I'm making them aware of that, but that you're able to interpret what's going on. And what's happening in the management plan is. But she can convey really helpful, to just ease anxieties and sort of help ensure that they're happy and that the patient's also happy with the care and understands what's going on. Equally, there's a plan finding out if there is a plant. In this case, there was but finding out if there is a plant that to be some sort of meeting. Four discussion, especially with senior doctors there to school crossed the implications of diagnosis could be really, um, really helpful to know and commune that you don't have to spend an hour or two hours of your ship speaking with a family when you don't actually really know what the count is on. And then number four. So patients returned from fantasy had a frame fixation of a tip. It fracture. He's not complaining of a lot of pain. He's been given some pain relief and it's not made any difference. So here, so they're thinking about the immediate thing in your head. Should be. Could this be compartment syndrome? It's the right type of patient and the right sort of presentation. That's again. Something that you need to go and see is quickly she come. And then the last one, um, 81 year old lady who's medicated for discharge. But now she doesn't seem well, and she's got a new score of five. So again, the clarify exactly where the observations have gone off, and this is a really, really cold one. Don't be lowered into a false sense of security by the fact that, um, only person who's that on award for up to three weeks and being completely well and all they've needed from the hospital with their meals, essentially insulin. And that is your therapy waiting, maybe a nursing her in bed. And these patients can often suddenly deteriorate out of no where you need to go and do what. Are there a setting off the Put a manager. If you have a place, often they'll have asked you acquired pneumonia or other infections, which is a UTI. So again not someone to prioritize going to see. So then I'm thinking about handover, so you made it to the end of your own call. You absolutely exhausted on your desperate to get home eso What information do you need to pass on to the next person who's taken on your role? So the critical stuff that you need to make sure you tell them about is the patients that are on while that you've seen patients to be aware off. So this could be somebody who's been handed it to you was a quite complex patient, so they needed a verbal hand over to you, but they've actually been fine. But if something were to go on, you need to know what management hand would be. So this might be somebody who's come back from a parathyroidectomy, for example, that potentially could have a hypocalcemia attack. So you need to know what the month, um hum would be. That could be something that might have been on it over to you on down. Also, anything outstanding so often I find it's quite helpful, too. Take the last five minutes of your shift rather than trying to address any more issues you've got going on to just look through your sheet of paper that you were in on your task on and just see if there's any cast outstanding. And is there anything you can quickly do, such as? Just check someone's blood results or, you know, just review that chest X ray To get a sort of fill diagnosis, you don't have to handle things that undone, um, and then also investigations or bloods that need to be chased by person. So again, this will need a hand it off the patient and the clinical situation. But these sort of things and things like proponents, gentamicin levels or other antibiotic levels. And then I in ours or clottings. Um, so you kind of want to make sure that you're doing, uh, effective 100 over the covers, all the stadium points, but also something that's safe that's protecting patients on also ensures that the relevant manager comes that you've made during your hard working out's on call or inactive and continue to help the patient when you go home, especially to see you can wind down when you get home. So I'm just gonna give you ah, about handover and then give you a good hand over just for an example of different. So on. This is I'm in a phone. Call me honey for another wrong colleagues. So, um, there's this patient walked five, or actually, I think it's 10. The names, Mr Smith. And they've been hostile while. And they had something done to the abdomen a few days ago. They run well again today. I'm not really sure what's going on, but I didn't have a chance to discuss anyone was really dizzy. So I'm just waiting for the bloods that you said you haven't tested. Great. Could you review those for me? Ah, on also, I haven't seen them since off a couple of hours ago. So, actually, could you just do a clinical review? So just unpacking that in terms of the information you received, you've not really received a great deal of information. You've not been told really who the patient is other than their names, Mr Smith. They're not sure of the location. The patient, You know what? Any identity for them? You don't know how it only being hostile that background off. Then they had something done that up today. Um, and all you know is that they've been on well and that they've had some investigations done. But you don't really know what the clinical impression of the doctor, because so these are things that you need to know and that you can challenge. So if someone has something over to you and your insure, ask them questions until you feel you have a good a grass. The what situation is, it's then a good 100 was using the S bar from work. So, you know, looking at the situation in the background, assessing them and thinking about what the response should be for the finishing you're having over to. So I'll give you one of the same patient answer than that you might realize bit more that's been going on. So this is Mr Jacque Smith. His austra numbers are Q 657891 he's on war, 10 in bed for, and he's a 51 year old gentleman who is day five POSTOP anterior resection for colorectal cancer, and he's got a background of the skin, it heart disease and type two diabetes, which he's on insulin for. On this afternoon, he spikes temperature, and he became tachycardia and hypertensive, and his abdomen is soft nontender that you have some crackles auscultation at the right base. So I've started him on the pier. Cool antibiotics for a half. I've taken some blood cultures, and I did the rest of steps in six for him. He's also having any surgery because he has some chest pain. He's got some old que ways, but there's no new abnormalities are then reassessed, Um, and his BP to come out with the three. A challenge was clipped. Improved, um, managed to check his blood just now and supposed to need to figure in a race crp from his POSTOP baseline. And I've called down for a mobile Chester X ray. So could you please check this? And then, if you could get a chance, could you assess his food balance later under? See if he needs any additional blue. It's so that's a Z can tell is a much better handover in terms of covering this different thing, you need to know. See, you know enough about the patient and so you know more about the background. You know what happened and what the assessment of the doctor that saw them waas on what management plan had been put in place on most. Hopefully, the doctors managed to go back and just take stock and reassess the patient to see where they're in. Their management has made any difference. Um, and in the same way they still done in East Egypt bloods and chest X ray. But they have managed to chase those investigations and 100 over quickly something for you today, which is to check the chest X ray on. Do it. Sounds like you have an idea of what the differential that they're working with this and what's wrong with the patient? Uh, so those are important things to remember with on Well, patients is what's the background? What happened and what did you do? What treatments are they now on? When do they need a reassessment? Does that need to be in the next hour? Does it need to be in the morning if it's a night shift so they can manage to sit for a copy about 10 hours up to 10 hours without being seen? What's the escalation plan? This could be really critical, especially the surgical patients where there's a tendency for these discussions to not necessarily be hard. So it's good to carry for these sorts of things because in a busy shift, you might not have the time to figure this stuff out. What is that station? If this patient was is very sick and does get more second gets critically on, well, are they fry two. You are they for CPR? Um, I'll defer any investigations that we're in intention to tall are or are they to be kept comfortable? That reaches a certain point. So those are things you might want to know and also asking your colleague who they called for senior support or who you should call. They may well be hard to tell you all the I spoke to the vascular extra, and they're happy to be with contacted about this patient, those that information to be really helpful for you to know. Um, and then also other things with your hand over is to he can update some places, have surgical lists if you get the chance of dating the list of the patient nations upstate, Um, another said, I'm handing over every unwell patient individually to the person taking of your role nose what's wrong with them and who they are. And then, as I said before, Honey was just really important because it allows you to leave work with a good of mindset. Um, course could be really, really busy on, But, um, often you can get home and start to then reflecting process things that have gone on and worry and having handed the things that you have left to do and the sick patients that you've seen over to, someone can really put your mind at ease and help you relax when you get home. And then another point to say is we live in a modern agent. Also, remember that when you're in a group of F ones, there's always gonna be someone at the hospital that's taken over from you and in my cohort. Oh, that one's you know, it would be one of us to the other. The 2024 7 for the whole of the last two years has always being one of the people in the hospital and doing the job. Rather, you just don't It's not cool. You'll have a what's that route with everyone in, and especially in the first couple of weeks. If you're worrying and struggling, we'll worry about to say someone's potassium on a blood test on you can't remember. If you checked it, you can. You can message them and ask them to check for you. I would discourage you from doing that sort of a later on, and you'll probably find anyway, that is. You've done some uncles in the first couple of weeks and months of being enough one that these things don't bother me as much, and you are able to so reach a good equilibrium were concerned, but also relaxing when you get home. But if you are worried, you can always contact someone. And actually, one time I even called the water the water of there stuff, too, and just spoke to one of the nursing staff and just chat something that I could just put my my knees and go to sleep. Um, so that brings us to the end of the first session. So I hope that's being really helpful to you. I realize it's being quite general when I've not really covered many specific scenarios, but the following lectures are going to cover sort of specific scenarios. You might face on a search grown call in more detail. Thanks very much listening. And please do the, um, for the QR codes that you can just give us a VBAC. Thanks very much. Lovely. Thank you so much. Cut that list. Drift. Um, really useful things and covered as Custer's mentioned. And if you're looking for some more specific uses and we have things on prescribing on the fluids, abdominal pain, all of that is going to covered and over the next four weeks got to lectures per week, Tuesdays and Thursdays. And so, if you like to hear more than place chin in and unjust in for more things, um, in terms of questions, a few questions if you like, 200 for these place, feel free. And there's also a secure code for the survey to fill that in for cat. Just giving up her time, time to speak tissue, and that really appreciate it. Thank you. Um, so some of the questions so far and highly gee, approach confidentiality with the pancreatic cancer patient. Um, that's a really good question, actually, on this convene, sometimes quite difficult. Especially if you're coming in a zone. Uncle, Doctor on your know, I'm sure how much everyone knows or what the agreement was being. So I often find that asking maybe the family to go into a quiet room. So the idea being that you could speech them, but then just quickly, having a word with the patient and asking them what they know about what's going on and how much their family know and what they're what they want their family to know, because the most important thing is making sure that the confidentiality of that patient that's your responsibility is maintained. And it may be that the patient may not have told on their family the full details or may not want to. So then you need to know that from the get go, and you don't want to put your feet into some into a great mass, especially when you've got lots for the priorities on call. But equally you tend to find that patients families are really well informed on do. Also, the other people to ask in this instance are the nursing staff, who tend to know much more, be a much more up to date with the with the family situation and what's happened in the previous in the normal kinds when you know when the room wall staff of being there. So using your other colleagues to help you in that situations Really helpful. Okay, lovely. Another we one. And it's just what do you carry around during your shift and to make a list of all the jobs could have a list. That's a really, really good question, actually, like stuffed equipments carry so ideally, hopefully or well, you might be wearing your own clothes, but in sort of post covert times, most people wearing scrubs it is really good, because I got loads of pockets, making sure you've got least a pet one pen, if not to having them in different places or one drops out. You've still got another pen because you're not going to get a pen for love normally, and then it just hospital on having your phone with you. There's lows of great resources that you can get on different ups having the being a fat downloaded, um, so you can quickly check prescriptions, lots of hospitals actually having a nap called induction, which has, um, you can literally Google search on it from your house. You can log into your hospital for and then you can search for wards or certain registrar. Is it will. It will tell you the belief numbers, all the extension numbers that you can cause that's really quick, so you have to go through switchboard. Just directly call them. That's really helpful. So having a Lowe's resources and things on your phone having a stethoscope, I know that it's surgery. But you really do need the stethoscope because you're a lot of your care is going to be dealing with medical problems of patients, especially when you're on call in surgery. And then also having if you can. Having a pen torch with you could be quite helpful. Just when you're assessing. Sometimes people's, um And then I'd say, also having a little snack with you, like a cereal bar or something, so that if you are runoff your feet to the point where you don't have a chance, have a proper fill break. You can at least have a snap. Lot of people like to carry a walked around with them as well on and then obviously having your list so you may well be given a surgical less so These are sort of a four sheets of where the patients have written down with their identity numbers and exactly what's happening in some places, and you can use uber, he told with, like the blood's up to date blood, zand, CT results and things on them. Or in some cases, they can be very brief. So if you give him one of them, then holding onto that and also with you having a blank sheet of paper. That said, with a lot of the patients details on Sometimes it's helpful. But you just grab a sticker from patients notice and just put it on that sheet goal of relevant identity. And before the more you write things down and say, That's the core stuff. I don't have it with me or a non cool shift. Okay, not play. And just for your ask, the next question to start, I'd mention and for the 56 here laughed, um, on the weapon. Or if you feel in the survey, you got a Wii certificate and just for your attendance, so that's we incentive to get that done. Okay, next question. Is it good practice to ask. Play an order. I eat to your schedule first. Or do you think a patient is really six? You to ask it straight to Reg? Who? What does it mean by an order? Sorry. I'd like you to go straight to the after you're just go. Yeah, the more senior year I was thinking, whether you meant like a blood test on something like that. Okay, so So this could be a hard one, especially at first to sort of gauge. But if a patient is critical well and is rapidly deteriorating, then I would go to the senior person first, go straight to the red if it's a specific thing to do with the operation that the patients have been definitely going to. The registrar's the best thing because they're the one that has the power to organize theater and getting the patient back into surgery needed on. Also, they're likely to have a new specific specialty expertise and dealing with that problem as well. Um, again, if you can't get hold of them, then getting any member of junior star is the best is the best thing to do on. But I wouldn't feel put off too cool of registrar if you're confident in what's wrong with the patient or the background of the patient, and you feel that you can do a good hamburger then sometimes getting contact them for advice could be the best thing to do, because the shor, maybe we'll just have to contact them anyway. There's a bit of a judgment call that, but in general, I'd always going to the S h o if you come. But if someone's sick and go straight to the read yet So um, so you're fine? Okay, Two questions left and when taking 100 or would it be a good idea to write everything doing on asked the person giving it to slow dine and some of the hand of examples had a lot of information. Yeah, absolutely. So that's something So I didn't mention expressively, but I would go 200 with the piece of paper and take so as as the same well I do when I get bleak during your whole shift, taking down the information that the person is telling me so critically taken down there name where they are in their identity number or date of birth, and then I'll just write like in short hand like a grief summary of what there is. And then I make myself a job's list of things that that person wanted me to change. So in the case, I gave you a B chasing the test X ray and also doing a few about seven. And I would write a time that I needed to do that just to drop my MRI. Later on, when I go through my list of jobs to check to do that on, yeah, definitely ask someone to slow down, even if it's someone really seen you to say sorry. Could you just repeat that for me on also clarify the hospital number as well? Because that because sometimes the digits could be ms and then you can't find the patient if they got quite common. Okay, lovely on final question what after you recommend diluting. Oh, so I covered this a little bit before I said the B N f at on induction, but she's going to get my phone up and see what other medical arts I have on there now. Um, but there were loaded and everyone has individual preference is so I have the up today after well which is quite academic but really helpful for if there's an unusual condition, you just wanted to have a read up on it, especially on corn. It's something you've never encountered before. That could be quite useful. Got that time? Um, I have the I recess out, which is from the Resource Councilman that has all of the less algorithms for cardiac arrest tachycardia, bradycardia and the pediatric ones on there as well. So that's really good. If if you're in extremist, you're just not sure you can't move your with them or that is not available on the trolley for whatever reason, then you can get that up. Um, and then from when I was in orthopedics, I've got the author flow out, which was a couple of pounds, and that stays keep, got the whole body on it, and just all the different fractures and what they might look like on an X ray on how to manage them on those are the main ones that I used to really on. Then our hospital had an emergency medicine up, which has, like lots of guidelines on my counter, manage hyper clean. You're in the hospital, guidelines say if you ask who has something like that, that could be really good. I think that's all of thumb. That's really the best one. That record. Lovely. Thank you so much. And I think that's all of our questions. And that's the end of the lecture, folks. Thank you so much for coming and those to stay to the end. And then somebody fill in the me survey. That'd be great. Thank you so much.