Wardround 23ii7

This week’s two minute talk theme was hyponatraemia. My prize for the best talk goes to DF, a well structured and informative two minutes with a good handout to boot. I would summarise the subject by saying virtually all hyponatraemia is due to ADH excess. The challenge is to identify whether the ADH excess is appropriate or inappropriate. Checking plasma osmolality will alert you to the presence of pseudohyponatraemia or the presence of hyperglycaemia. Urine osmolality is the quick check for ADH secretion - if the osmolality is below 100 in a setting of hypo-osmolar plasma then ADH is suppressed, as in psychogenic polydipsia. Urine sodium excretion will help to differentiate appropriate and inappropriate ADH if other clinical clues have not already made the penny drop.

We briefly discussed the paper Clinical craft: a lesson from Liverpool. D M Gore. Journal of Medical Ethics 27:74-75 (2001). The author comments that Any clinician is a practitioner of a craft; assessing a patient by history and examination, addressing diagnostic possibilities, counselling patient and relatives. Many clinicians have technical craft skills on top, surgeons in particular, but no clinician practises well with technical skill alone. Our basic clinical and ward-management skills tend not to be celebrated as they might; they're not particularly exciting, novel or high-tech. .... But we also need a certain amount of pride to keep up our morale. This last sentence, true of every craft, is one which we should keep in mind.

Next week's two minute talks will be the ECG. You have your assignments. I will not be there to hear the talks but will be happy to hear them the following Tuesday if you are up to it. Remember to keep the talks concise yet precise. If you give too much information, none will be remembered.

The read and think for the coming week is In a stew. Michael A Lacombe. American Journal of Medicine. 1991;91:276-278.

Interesting topics

Hemiplegia following a sneeze


MJM

Wardround 17ii7

This week we discussed the bone profile (calcium, phosphate, magnesium, vitamin D). Can I ask each of you to post one sentence in the comments section with the most useful/interesting fact from your talk please.

The next two minute assignments are on hyponatraemia. The aim, remember, is to give a practical and memorable talk on your given subject in just two minutes. You have to be harsh in keeping the information to the most essential. The test of success is that at the end of the discussion we should be able to diagnose and treat the condition.

Sodium homeostasis (RT)
Investigation (GB)
Causes 1, Causes 2 (up for grabs)
Treatment (DL)
Encephalopathy (DF)

The reading for next week is Clinical craft: a lesson from Liverpool. D M Gore. Journal of Medical Ethics 27:74-75 (2001).

Interesting topics
Cough Headache
Lewy body dementia

MJM

Wardround 9ii7

This week saw a new batch of trainees so we were kinder than usual. No prepared talk was required...just an unprepared one was asked for. For next week however we are back to the usual routine.

Next Week’s tutorial topic is the bone profile: so two minutes please on:
Calcium
Phosphate
Magnesium

Remember, just two minutes. Keep it concise yet precise, quote your sources and produce a handout. I think it is time to re-introduce the weekly prize (intellectual kudos only).

The reading for next week is The road to recovery. Is it time to bid farewell to the drug reps? David Psetsky

Read it and think. Share your views.

Interesting topics this week
PEG tubes

Just a short blog this week since I have been struck down by a FLI. (Oh how I enjoyed guessing which cytokines were producing each symptom. Damn you Il-1)

MJM