Surviving the A

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A&E Dept Quick Tips :

A&E Dept Quick Tips

When Consulting Seniors, please present the case as follows::

When Consulting Seniors, please present the case as follows: 2 - Age/Race/Sex - History - including risks factors, relevant negatives, pmed hx,drug hx , social hx - Relevant Physical Examination - including relevant negatives - The investigations that you have done - eg ECG, CXR, blds , etc........ - Diagnosis or Differentials - Yr Treatment do so far - Yr Proposed Plan and Disposal

See Emergency cases first, those with "E" beside them on the Q, and not according to number sequence . All E cases must be seen within 45mins, call seniors if help needed:

See Emergency cases first, those with "E" beside them on the Q, and not according to number sequence . All E cases must be seen within 45mins, call seniors if help needed 3 See arrow

Click patient out of Main Q into your personal Q after you've seen the patient(and not after the patient's results/x-rays have come back).  This has medico-legal implications and also so that senior on duty has an accurate idea of the patients waiting to be seen.:

Click patient out of Main Q into your personal Q after you've seen the patient(and not after the patient's results/x-rays have come back). This has medico-legal implications and also so that senior on duty has an accurate idea of the patients waiting to be seen. 4 See arrow

Resus Rm cases are to be seen stat.  Administer the appropriate initial treatment/analgesics based on your assessment b4 sending for xrays/other investigations.  The turnover of Resus patients should be less than 1 hr.  If in doubt, consult seniors :

Resus Rm cases are to be seen stat. Administer the appropriate initial treatment/analgesics based on your assessment b4 sending for xrays /other investigations. The turnover of Resus patients should be less than 1 hr.  If in doubt, consult seniors 5

Go for your meals during the allocated times, don't worry about “non E” patients on your Q, they can wait. :

Go for your meals during the allocated times, don't worry about “non E” patients on your Q, they can wait. 6 See arrow

Please give the printed Discharge Summary to patient If you think that a patient needs an MC, give it at the time of your consultation (even if the patient declines).  These will save yourself problems as patients often change their minds later, and then it is difficult for you to back date an MC (even if they don’t request for it) :

Please give the printed Discharge Summary to patient If you think that a patient needs an MC, give it at the time of your consultation (even if the patient declines). These will save yourself problems as patients often change their minds later, and then it is difficult for you to back date an MC (even if they don’t request for it) 11/8/10 Corporate Presentation 7

If early SOC appts are not available, consult senior to "force-in".  Patients may also be referred to their GP/OPS/SAF MO for review in the interim.:

If early SOC appts are not available, consult senior to "force-in". Patients may also be referred to their GP/OPS/SAF MO for review in the interim. 11/8/10 Corporate Presentation 8

Registrars/MO s from upstairs are not supposed to call you to question you, if you receive any call from them, channel them to the A&E Senior staff, don't allow yourself to be harressed. The decision to admit to any particular discipline is based on the A&E seniors decision and MUST NOT be influenced by any ward doctors. This is hospital policy:

Registrars/MO s from upstairs are not supposed to call you to question you, if you receive any call from them, channel them to the A&E Senior staff, don't allow yourself to be harressed . The decision to admit to any particular discipline is based on the A&E seniors decision and MUST NOT be influenced by any ward doctors. This is hospital policy 11/8/10 Corporate Presentation 9

Teaching: Be reminded that we take attendance and participation at our teaching programs very seriously. Would like to remind you that our teaching program is not only for your benefit but to ensure that the patients u see are managed according to some set minimum standards/protocols (the latter having medico-legal implications).  Every posting some MOs get into trouble as a result of not applying the above. Emergency Medicine is a high risk specialty and the deficits in your core knowledge must be corrected. If you have missed any lecture, make sure that you read the relevant notes in the Blackboard Also remember that your attendance during ALL teaching sessions is taken into account for your End-of-Posting Appraisal. :

Teaching: Be reminded that we take attendance and participation at our teaching programs very seriously. Would like to remind you that our teaching program is not only for your benefit but to ensure that the patients u see are managed according to some set minimum standards/protocols (the latter having medico-legal implications). Every posting some MOs get into trouble as a result of not applying the above. Emergency Medicine is a high risk specialty and the deficits in your core knowledge must be corrected. If you have missed any lecture, make sure that you read the relevant notes in the Blackboard Also remember that your attendance during ALL teaching sessions is taken into account for your End-of-Posting Appraisal. 11/8/10 Corporate Presentation 10

Work safely, don't rush.  Ask seniors for help. :

Work safely, don't rush.  Ask seniors for help. 11/8/10 Corporate Presentation 11

A tip on dealing with MC seekers:   Try not to give more than 2 days MC (unless indicated) routinely.  Instead given them a discharge letter and tell them to go to OPS/GP for review & extension of their MC if needed.  For NS  personnel, I usually treat & give them a letter to present to the SAF MO for admission to their medical centre sick bay for rest & review by their MOs:

A tip on dealing with MC seekers: Try not to give more than 2 days MC (unless indicated) routinely.  Instead given them a discharge letter and tell them to go to OPS/GP for review & extension of their MC if needed. For NS  personnel, I usually treat & give them a letter to present to the SAF MO for admission to their medical centre sick bay for rest & review by their MOs 11/8/10 Corporate Presentation 12

Listen to the nurses, they can help you a great deal :

Listen to the nurses, they can help you a great deal 11/8/10 Corporate Presentation 13

Communication: The chart must tell one story Documents the advice by seniors accurately Document all discharge advice given to patients :

Communication: The chart must tell one story Documents the advice by seniors accurately Document all discharge advice given to patients 11/8/10 Corporate Presentation 14

Do not prescribe more than 2 weeks of meds from the ED, if patient needs refills, tell them to go to their GP/OPS with the discharge summary/referral:

Do not prescribe more than 2 weeks of meds from the ED, if patient needs refills, tell them to go to their GP/OPS with the discharge summary/referral 11/8/10 Corporate Presentation 15

All stat medications, procedures, discharge advice must be documented into the computerised casenotes:

All stat medications, procedures, discharge advice must be documented into the computerised casenotes 11/8/10 Corporate Presentation 16

Minimise prescription errors by only giving the minimal of medications, check for drug allergies (from EMR and patient), use the drop down list available in the A&E computerised medical record:

Minimise prescription errors by only giving the minimal of medications, check for drug allergies (from EMR and patient), use the drop down list available in the A&E computerised medical record 11/8/10 Corporate Presentation 17

Check your email daily for important staff announcements please ensure that Angela has your updated & valid email address and handphone nos :

Check your email daily for important staff announcements please ensure that Angela has your updated & valid email address and handphone nos 11/8/10 Corporate Presentation 18

Check your pigeon holes daily when you come to work for medical reports, reported x-rays :

Check your pigeon holes daily when you come to work for medical reports, reported x-rays 11/8/10 Corporate Presentation 19

Be mindful of how you carry yourselves and what you say, some examples of what NOT to say   - I don't know what's wrong with you - you can have physio if you want - there is nothing wrong with you - even if the guy is a malingering NSF, just give symptomatic rx and admit to SAF sick bay for rest and review by the SAF MO - you should not have come/your GP should not have referred you to the A&E (it is faster to just see and quickly dispose of them then to counsel and eventually answering a compliant from the patient or GP) b.  Being cocky c.  Taking personal calls when seeing patients d.  Poor bedside skills and clinical acumen - if you are not sure ask seniors e.  Doctors not reading thru past notes/EMR for past med hx f.  Poor communication skills g.  No explanation of diagnosis, proposed treatment/what to do/what not to do h.  Pain highlighted but no analgesics given i.  No explanation in layman's terms :

Be mindful of how you carry yourselves and what you say, some examples of what NOT to say - I don't know what's wrong with you - you can have physio if you want - there is nothing wrong with you - even if the guy is a malingering NSF, just give symptomatic rx and admit to SAF sick bay for rest and review by the SAF MO - you should not have come/your GP should not have referred you to the A&E (it is faster to just see and quickly dispose of them then to counsel and eventually answering a compliant from the patient or GP) b.  Being cocky c.  Taking personal calls when seeing patients d.  Poor bedside skills and clinical acumen - if you are not sure ask seniors e.  Doctors not reading thru past notes/EMR for past med hx f.  Poor communication skills g.  No explanation of diagnosis, proposed treatment/what to do/what not to do h.  Pain highlighted but no analgesics given i .  No explanation in layman's terms 11/8/10 Corporate Presentation 20

Drug Allergies – ALWAYS CHECK & ASK FOR ALLERGIES B4 PRESCRIBING MEDS DO NOT prescribe: paracetamol if allergic to anarex and vice versa penicillin, amoxicillin if allergic to cephalosporins and vice versa any NSAIDs if asthmatic or allergic to another NSAID Beware of drugs contra-indicated in G6PD deficiency Sulfonamides eg.Sulfamethoxazole (Septrin/Bactrim), Anti-bacterials eg Nitrofurantoin, ciprofloxacin, Nalidixic Acid:

Drug Allergies – ALWAYS CHECK & ASK FOR ALLERGIES B4 PRESCRIBING MEDS DO NOT prescribe: paracetamol if allergic to anarex and vice versa penicillin, amoxicillin if allergic to cephalosporins and vice versa any NSAIDs if asthmatic or allergic to another NSAID Beware of drugs contra-indicated in G6PD deficiency Sulfonamides eg.Sulfamethoxazole ( Septrin / Bactrim ), Anti- bacterials eg Nitrofurantoin , ciprofloxacin, Nalidixic Acid 11/8/10 Corporate Presentation 21

Communication with Patients/NOK -   all patients/NOK/relatives are to be updated of the provisional/differential diagnosis & management plan prior to discharge/admission DIL (P1 patients where necessary) to be informed by the A&E DOCTOR speak to them in person or by phone:

Communication with Patients/NOK - all patients/NOK/relatives are to be updated of the provisional/differential diagnosis & management plan prior to discharge/admission DIL (P1 patients where necessary) to be informed by the A&E DOCTOR speak to them in person or by phone 11/8/10 Corporate Presentation 22

The following MUST be vetted by ED senior staff on duty before deciding on disposal:

The following MUST be vetted by ED senior staff on duty before deciding on disposal P1 and P2 cases Patients referred from another medical practitioner Category A prisoners with medical complaints (excluding medical examination for legal purposes) Patients that have returned within 72 hours following a previous A&E attendance. Patients that have just been discharged from the in-house wards (it is advisable to seek the review of the doctors from the discipline which had discharged the patient home). Ambulance cases Patients who have been recalled for abnormal x-rays or other abnormal results. Cases which need ‘forced-in’ SOC appointments Observation cases more than 2 hours All x-rays/CT scans 11/8/10 Corporate Presentation 23

Good Luck & Enjoy your Posting:

Good Luck & Enjoy your Posting Please download from your email the following- Treatment of medically unstable/potentially stable How to see cases and dispose o them quickly Common misdiagnoses in the ED Follow the attached protocols for high risk conditions - 11/8/10 Corporate Presentation 24

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