handbooks for interns.

brumindub

Hi, just wondering if anyone has any good suggestions for intern handbooks, oxford handbook of clinical medicine excluded. Thank You.

Breezer

BNF smartphone app. emedicine.com. Know how to do a septic screen. Tazocin for hospital acquired pneumonia, Augmentin/nitrofurantoin/trimethoprim for UTIs (check the sensitivity of the last urine), flucloxacillin for cellulitis. 5mg of amlodipine for hypertension and give it two hours to work, then another 5 if you need it. After that break out the ramipril. 4-8 units of Actrapid for hyperglycaemia and give it 4 hours to work (just make sure it's not a DKA!) Sugar for hypos. Calcium resonium for hyperkalaemia >6. Slow K for hypokalaemia >3, 40mmol KCl over 6 hours then 20 over 8 hours for . Base warfarin on whatever their last few INRs have been. MONA for an MI and call the Reg. Write down the Reg's and SHO's bleeps before a call.

That was literally all I needed for intern year. The handbooks were abandoned early on.

MrCreosote

BNF, local antimicrobial guidelines if available and for bedtime reading the A+E Xray book by Raby:

http://www.amazon.co.uk/Accident-Emergency-Radiology-Survival-Guide/dp/0702026670/ref=sr_1_2?ie=UTF8&qid=1355809516&sr=8-2

That's about it really

(Oh and the 'O' in MONA for MI might be up for debate, so best to check what the local cardiologists want first!)

ThatDrGuy

Calcium resonium isnt used much for hyperkal anymore on account the fact it doesnt work in humans and causes nasty constipation. insulin - dex is your friend there. It baffles me how inpatients managed their potassium levels before interns were around to do it for them....

Vorsprung

Another hyperk tip - think is this actually hyperk or is it a spurious result. Repeat the bloods but do a venous gas at the same time (venous blood in an abg syringe). Takes less than 2 minutes to get a result, if it's normal you can relax and wait for the formal u&e. If its still up, lash on a few salbutamol nebs, each can reduce the k by upto 0.4mmol/L. Get an ECG - if there's any hyperk signs on the ECG, give calcium gluconate (dose varies locally). Patient should be on a monitor if its up past 6.5 (arbitrary number Ive picked, assuming lab range is 3.5-5). Also give insulin dex. Agree with not giving resonium. Also ask why is it up - if the patient looks dry, give fluid. New renal failure - stop nephrotoxic drugs, give fluid, put in a catheter.

Chest pain - 1 ECG is never enough! Have a few ECGs, 15-20 minutes apart while the patient is in pain and when the patient is pain free.

MrCreosote

Another handy tip with chest pain, especially at 3am:

By the time you've answered the bleep, gone to the ward, fumbled around in the dark for a while, woken the patient, assessed them, found out they didn't have chest pain, found the correct patient, woken them, assessed them, gone to look for an ECG machine, found one on another ward, returned with it, woken the patient, realised the ECG machine is broken, found another one on anther ward, returned with it, answered your bleed, charted some paracetamol, run off to a cardiac arrest, answered your bleep, returned to and woken the patient, gone off to find some ECG stickers, woken the patient, answered your bleep, woken the patient, gone off to get some ECG paper, woken the patient and taken the ECG, it'll have given enough time for the cardiac enzymes to rise so you can do the bloods at the same time.

resus

http://www.internguide.ie

opinion guy

http://books.google.ie/books/about/Definitive_Personal_Assistant_Secretaria.html?id=TOXjGEKgsBoC&redir_esc=y


:pac:

Rick Dagless

ThatDrGuy wrote: »

Calcium resonium isnt used much for hyperkal anymore on account the fact it doesnt work in humans and causes nasty constipation. insulin - dex is your friend there. It baffles me how inpatients managed their potassium levels before interns were around to do it for them....

It baffles me how the general public can cope with their trips and stumbles without an intern to fill out an "Incident Report Form" for them...

drzhivago

check out www.lifeinthefastlane.com

list of books there I can recommend

Breezer

ThatDrGuy wrote: »

Calcium resonium isnt used much for hyperkal anymore on account the fact it doesnt work in humans and causes nasty constipation.

I'm surprised to hear this. Admittedly I've never delved into the literature on it but from observation it's seemed to work great for me. Must have a gawk at that so.

Vorsprung

Breezer wrote: »

I'm surprised to hear this. Admittedly I've never delved into the literature on it but from observation it's seemed to work great for me. Must have a gawk at that so.

http://www.thecochranelibrary.com/userfiles/ccoch/file/CD003235.pdf

Some festive toilet reading for you

Sitric

brumindub wrote: »

Hi, just wondering if anyone has any good suggestions for intern handbooks, oxford handbook of clinical medicine excluded. Thank You.

The oxford handbook for the foundation program is superb for intern call.

brumindub

Sitric wrote: »

The oxford handbook for the foundation program is superb for intern call.

Yup. Have it. I actually prefer that to OHCM.