Diagnosis: perforated viscus, the xray appearance and story would go with a likely diagnosis of perforated peptic ulcer, although any perforated hollow organ could cause this picture of free gas under the diaphragm (remember to differentiate it from gas in the hiatus of the stomach)
Priorities: physiological resuscitation/fluid therapy, pain relief, antibiotics. 2 further things to think about, DVT prophylaxis and the prescription of normal medication. Now please prescribe these on a standard drug and fluid chart John Smith dob 12.5.1970 X12345 Answers in a couple of days
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Information before leaving the surgery
Q1. What 4 questions would you like to ask Naomi?
1. Smoking ? - She has smoked 10 cigarettes/day 15 years. 2. Headaches/migraines? - She has never experienced migraines. 3. Personal Hx or FHx of VTE, breast cancer, HTN or diabetes? - She has no personal or family history of VTE, breast cancer, high blood pressure or diabetes. 4. Problems with gallstones or gallbladder? - She had her gallbladder removed in 1995. Q2. Which 2 investigations would you perform? (remember you are in GP) You take her weight and check her blood pressure.
Q3. Please prescribe Naomi Banks an appropriate oral contraceptive. Patient details; Name: Naomi Banks DOB: 12/5/1979 Address: 123 Rose View Sunderland SR47TP She is 36 year old. She has three children; she gave birth to her last child 2 years ago. Since then she has been using condoms but would now like to switch to an oral contraceptive.
(Some of her close friends have had a bad experience with both the implant and the coil, and she has heard that the depo-provera injections can make you gain weight.) Q1. What 4 questions would you like to ask Naomi? Q2. What investigations/examinations would you like to do....remember you are in GP? More Drug calculations....again I think you will all get more from this if you actually prescribe the the drugs/fluids/additives on a real drug chart
1. The fluid protocol in your hospital for children is as follows. Maintenance fluids: 4ml/kg/hr first 10 kilo, 2ml/kg/hr 2nd 10 kilos, 1ml/kg/hr subsequent weight. Prescribe maintenance fluids Maintenance for 5, 11, 18, 25 and 30 kg children on a drug chart
More Drug calculations....again I think you will all get more from this if you actually prescribe the the drugs/fluids/additives on a real drug chart
1. You are looking after an adult admitted with DKA. The protocol asks for an Insulin infusion at 0.05 units/kg/hour via 50 ml syringe driver. Describe HOW you would set up the infusion. 45kg adult. Prescribe this on an infusion/additive chart
We can discuss this at the drop-in session. More calculations coming soon Drug Calculations:
Drug calculations are part of the PSA.....and part of your work as an F1 next year. Increasingly electronic means are used to reduce human error with drug calcs, but for the time being you need to be able to do the calcs yourself. As with the previous problem I suggest that you do these calculations and prescribe them on the appropriate paperwork.....good luck, answers early next week MC
More calcs next!! |
Mark CarpenterI am an intensive care doctor and educator at City Hospitals Sunderland/Newcastle University Medical School ArchivesCategories |