Wardround 23v8

Endocrine emergencies. Well done. I had given YA 10/10 in my notebook for his talk on acute hypoadrenalism, so I was forced to give Thyrotoxic storm by EM a 10+. I think you have grasped what is needed.

Many of the emergencies discussed can be misdiagnosed as other common conditions and considering the possibility is just as important as knowing what to do.

I will share with you that my soul shudders each time someone recommends "routine bloods". I can cope with "x, y and z should be routine bloods in the investigation of...". Be specific.

For next Friday the assignments are based on skin infections:
Infection following animal bites
Lower leg cellulitis (A)
Cellulitis in the immunocompromised host. (S)
Necrotising fasciitis (Y)
Facial cellulitis (N)
Shingles

requirements: Concise, unrushed, precise, sources quoted, USEFUL.

For Tuesday you have been given a grey case to consider. By the way, what is a grey case and how should you deal with it? Prize 9virtual) to the best definition of a grey case.

The reading for a week on Tuesday will be The boards and executives of drug companies could catalyse action against the AIDS epidemic by immediately reducing the costs of HIV drugs in poor countries to zero. Donald Berwick BMJ 2002;324:214-218

Interesting topics

Pneumocystis pneumonia see uptodate

Adult onset Still's disease

Neurofibromatosis

MJM

Wardound 16v8

Our discussion paper last week was The reading for discussion on Tuesday will be DNR or PEACE. J Crampton. BMJ 2008;336:1015. An interesting discussion ensued. If you would like to read more on the subject could I suggest you take a look at Decisions relating to cardiopulmonary resuscitation A joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing from October 2007

For next Tuesday the reading will be Liz Wager: Training and the placebo effect.

Our talks this week were about poisoning, and overall I think they were well researched and presented as spoken mini-essays. I would like you, now, to think about these talks in a different way. The aim is to teach/train/educate your audience. This differs from writing an essay (or giving presentations, which are much the same thing) as you have done in the past. Those were to assess your ability to collect and critically appraise information. I want you to take that information and teach me and your colleagues. And by teach, I mean convert me from someone who could not do something into someone who can. Your handout is for that purpose as well.

Bear that in mind for this week's two minute talks on endocrine emergencies:

Hypoglycaemia A
Thyrotoxic Storm E
DKA N
Adrenal crisis Y
Phaeochromcytoma crisis S

Interesting topics

Antibiotics and seizures


MJM

Wardround 9v8

Our discussion this week, in the absence of a paper to read, was about improving practice by Morbidity and mortality meetings. We will now run an M&M meeting on the last Thursday of each month. There is an M&M folder in the Nurses office. All deaths for the month should be listed there. The GAJ team will review MJM patients and vice versa. The Necessary patients notes will need to be pulled the week before.

Our two minute talks were about the investigation of malignancy of unknown origin. A useful discussion I think. We heard about the more common cancers nad discussed how that should guide our history, examination and investigation. The use of tumour markers produced further discussion, which can I think be generalised to the use of many tests in medicine.

For next week:

The reading for discussion on Tuesday will be DNR or PEACE. J Crampton. BMJ 2008;336:1015

Read it, think, and share your thoughts.

The two minute talks for Friday will be about Poisoning:

Paracetamol (ST)

Carbon Monoxide (NV)

Methanol (EM)

Tricyclics (YA)

The usual advice. Keep it concise and precise, quote your sources and make a handout. Having heard your talk I should be able to manage a poisoned patient. The handout should be visual rather than textual. Example.

Interesting Topics

Group A streptococci

Do you know what streptococcal toxic shock is? UpToDate also has some good articles on the subject.

MJM