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Your first day as a doctor watch

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    (Original post by No Future)
    eta: sorry, I didn't read your post properly

    Any results?
    I'm not sure! I stopped working in the lab about 6 months ago and tbh he is probably still collecting data.

    Its more the clinical trials i'd be interested in though!
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    Well I now won't be flying somewhere after (those luckily very far away) finals!

    Interesting scenario again, good to get you thinking about these things, so keep 'em coming!
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    (Original post by electricjon)
    CASE 6

    You are a few weeks into your first job as a surgical F1, and are about to start your first weekend on-call. You are waiting for your senior registrar to turn up so that you can start the morning ward round together. She is a few minutes late but that's okay - you are closely acquainted with her, as when you attended medical school together, she, then in her final year, mentored you as a fresher.

    Running on to the ward, she apologises for being late and starts to prepare for the ward round. She looks a bit of a mess - scruffy, dishevelled. She smells of cigarette smoke and is not acting her usual self, she keeps sniffing and wiping her nose before she examines her first patient, a young gentleman 2 days post appendicectomy. His blood results show that his potassium levels are dangerously low. Appearing rushed and stressed out, she grabs his fluid chart and writes him up for a litre of IV saline with 40mmol of supplementary potassium to be given stat.

    What would you do next?
    Query the prescription with her.
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    (Original post by electricjon)
    CASE 6

    You are a few weeks into your first job as a surgical F1, and are about to start your first weekend on-call. You are waiting for your senior registrar to turn up so that you can start the morning ward round together. She is a few minutes late but that's okay - you are closely acquainted with her, as when you attended medical school together, she, then in her final year, mentored you as a fresher.

    Running on to the ward, she apologises for being late and starts to prepare for the ward round. She looks a bit of a mess - scruffy, dishevelled. She smells of cigarette smoke and is not acting her usual self, she keeps sniffing and wiping her nose before she examines her first patient, a young gentleman 2 days post appendicectomy. His blood results show that his potassium levels are dangerously low. Appearing rushed and stressed out, she grabs his fluid chart and writes him up for a litre of IV saline with 40mmol of supplementary potassium to be given stat.

    What would you do next?
    Tell her to go away (politely) and calm down / collect herself before going near a patient surely?
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    (Original post by digitalis)
    Query the prescription with her.
    You point out the error. Looking embarrassed, she changes the infusion rate to 8 hourly and moves on to the next patient.
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    (Original post by thegodofgod)
    Tell her to go away (politely) and calm down / collect herself before going near a patient surely?
    She ignores you - "Don't be silly" she says. "Let's get on with the ward round shall we?"
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    (Original post by electricjon)
    She ignores you - "Don't be silly" she says. "Let's get on with the ward round shall we?"
    Schweet. Yes let's, a good ward round is a speedy round.
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    Well if you know her already you can surely ask her if everything's alright, saying that she doesn't seem herself.

    I'm guessing those are the wrong fluids to prescribe? Probably should know the answer to that
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    (Original post by Mushi_master)
    Well if you know her already you can surely ask her if everything's alright, saying that she doesn't seem herself.

    I'm guessing those are the wrong fluids to prescribe? Probably should know the answer to that
    She says "I'm fine."

    Giving someone 40mmol of potassium rapidly would induce a cardiac arrest and probably kill them.
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    (Original post by electricjon)
    She says "I'm fine."

    Giving someone 40mmol of potassium rapidly would induce a cardiac arrest and probably kill them.
    ahh - this explains why potassium chloride's used in lethal injections
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    (Original post by electricjon)
    She says "I'm fine."

    Giving someone 40mmol of potassium rapidly would induce a cardiac arrest and probably kill them.
    Right, had no idea of appropriate concentrations for stat doses.

    Well, tell her she's obviously not - stating what she's just done. Should certainly rectify that one quickly.
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    (Original post by thegodofgod)
    ahh - this explains why potassium chloride's used in lethal injections
    Indeed. Not that I condone it, other drugs used in lethal injection are thiopentone (a barbiturate that induces coma), or pancuronium (which paralyses muscles).
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    (Original post by Mushi_master)
    Right, had no idea of appropriate concentrations for stat doses.

    Well, tell her she's obviously not - stating what she's just done. Should certainly rectify that one quickly.
    She says "I know that was a bit bad. Thank you for pointing that out to me. I'm just a bit tired. The nursing staff would have picked up on it anyway."
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    (Original post by electricjon)
    She says "I know that was a bit bad. Thank you for pointing that out to me. I'm just a bit tired. The nursing staff would have picked up on it anyway."
    She's a reg, she should certainly not be making mistakes like that (neither should anyone!); and who says you can rely on the nurses to notice (), and of course if that fluid goes up she's absolutely accountable.

    Rectify that mistake - continue on the ward round with her but keep an eye on her? Not sure contacting a senior here is appropriate just yet - try and get her to talk and ask why she's tired.
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    Report her to the GMC board.
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    (Original post by Dekota-XS)
    Report her to the GMC board.
    In the middle of a Saturday morning ward round?
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    (Original post by Mushi_master)
    She's a reg, she should certainly not be making mistakes like that (neither should anyone!); and who says you can rely on the nurses to notice (), and of course if that fluid goes up she's absolutely accountable.

    Rectify that mistake - continue on the ward round with her but keep an eye on her? Not sure contacting a senior here is appropriate just yet - try and get her to talk and ask why she's tired.
    You ask her what's going on. "Nothing." She replies. "It's really none of your business, but if you must know, I went out last night and I haven't had much sleep. Can we drop it alright?"

    The next patient is an elderly lady 1 week post-cholecystectomy. She is complaining of chest pain and has a temperature of 39.5c. Your registrar says "She can go home with some paracetamol" and moves on to the next patient.
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    (Original post by electricjon)
    You ask her what's going on. "Nothing." She replies. "It's really none of your business, but if you must know, I went out last night and I haven't had much sleep. Can we drop it alright?"

    The next patient is an elderly lady 1 week post-cholecystectomy. She is complaining of chest pain and has a temperature of 39.5c. Your registrar says "She can go home with some paracetamol" and moves on to the next patient.
    Tell her that of course what she does is her own business, but you can't drop the fact that she's not safe for the patients. Reiterate the point on the lady spiking the temp, saying those aren't mistakes you'd be expecting her to make. Suggest she goes home sick? Perhaps now being a time to call a consultant and see what they suggest?
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    (Original post by Mushi_master)
    Tell her that of course what she does is her own business, but you can't drop the fact that she's not safe for the patients. Reiterate the point on the lady spiking the temp, saying those aren't mistakes you'd be expecting her to make. Suggest she goes home sick? Perhaps now being a time to call a consultant and see what they suggest?
    She's getting quite angry now. She raises her voice. "Excuse me?! What the hell do you know?! You're a newly qualified F1! I have years more experience than you so just button it and let's finish this ward round."
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    (Original post by electricjon)
    She's getting quite angry now. She raises her voice. "Excuse me?! What the hell do you know?! You're a newly qualified F1! I have years more experience than you so just button it and let's finish this ward round."
    Tell her you know that she's making unsafe decisions, and it seems out of character - you certainly don't want to see a patient injured or to see her had up against the GMC if you can help it.

    Man it's hard to be diplomatic with a keyboard
 
 
 
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