ACUTE & CRITICAL CARE MODULE – PHASE 3B

The Medical School Phase 3b MB ChB

Acute and Critical Care Handbook 2017

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CONTENTS Introduction and aims 1

Learning Objectives 3

Assessment 6

Location of Clinical Placements 7

Queries 8

Acute & Critical Care Contacts 9

Hospital Contacts 10

Student Support 11

Student Self-Certification Forms 11

Extenuating Circumstances 11

Extenuating Circumstances for Exams 11

Students with a Disability 11

Support on Attachment 12

Careers Advice 12

Emergency Medicine Assessment 13

Critical Care Assessment 15

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ACUTE & CRITICAL CARE MODULE LEAD: Dr Juliette Fraser & Dr Martin Rowlands INTRODUCTION Welcome to the ‘Acute and Critical Care’ (ACC) Attachment in the 3b Module. Previous students have found this attachment ‘instructive’, ‘exciting’ and ‘fun’. We are confident your experiences will match these comments from the students preceding you! Management of the acutely ill patient involves many different clinicians and overlaps different clinical areas. We feel it is more helpful not to separate EMERGENCY MEDICINE and the other critical care areas (Resuscitation Rooms, High Dependency, Intensive Care Units and Anaesthetic Departments) as many of these clinical problems move across different areas and this helps you see things as a continuum. Please remember that it is extremely important that you are on or ahead of time during your ACC attachment. Important parts of our job involve pre-op assessments, preparation and checking equipment and drugs. Aims of Module This clinical module aims to introduce the senior student to the clinical assessment and management of acute and critically ill patients in the challenging settings where these patients are appraised and treated. These aims and objectives will be addressed during the module and consist of: Lecture time in lecture week which will cover specific core subjects and give information on more generic clinical and basic science knowledge. We warmly recommend you attend these lectures as they will provide an excellent guide for you. Please check Minerva for Lecture Details - Time, Venue etc. For your attachment in ACC you will be allocated to a set hospital along with your fellow students. The ACC module lasts for 8 weeks and is divided into two separate phases of 4 weeks. Sub group 1 students start with 4 weeks in Critical Care with the Anaesthetic Department and then do 4 weeks Emergency Medicine with the EMERGENCY MEDICINE Department. Sub group 2 students start with 4 weeks in Emergency Medicine with the EMERGENCY MEDICINE Department and follow up with 4 weeks in Critical Care with the Anaesthetic Department in your allocated hospital. So, to put it another way, after four weeks the groups swap over to complete the 8 weeks experience. Your allocations at STH and the 4 ATH’s can be found on Minerva. Specific reporting details are shown below as they differ from Hospital to Hospital. Reporting to your allocated unit and Clinical Lead in each hospital is on day 1. During this time you will have the opportunity to assess and follow patients presenting with acute and peri-operative problems. These problems will be based on the appropriate core clinical problems as outlined below.

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Tutorials These are an integral part of this module and are in the clinical setting or as stand alone time (see timetable). Case based scenarios will be posted on Minerva and set to allow you to work through them, leading to the tutorial as needed. Additional tutorial time may be put aside to explore specific pre and perioperative care issues. Practical Skills This attachment has many opportunities for practical skills. They will be presented as observational and hands on. Where appropriate, you will be encouraged to perform practical skills expected of F1 doctors e.g. intravenous cannulation & airway skills, mixing and giving drugs and running through an IV line, to name but a few. The 4 weeks in A & E is broadly organised in the manner outlined above. Overall clinical charge is with the Consultant lead who will arrange attachment with appropriate other staff: nurse specialists, F2, SpR or senior doctors. By definition, emergency medicine is unpredictable thus a degree of flexibility from students is expected i.e. attachments may involve evening work to optimise your clinical experience.

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Learning Objectives: During the Acute & Critical Care attachment students will cover the following Core curriculum problems in Acute and Critical Care:

2 Bleeding 9 Pain 12 Lacerations 13 Trauma/injuries 16 Loss of consciousness 36 Burns 45 Cardiac arrest/sudden death 46 Chest pain 49 Cyanosis 50 Low blood pressure 56 Shortness of breath 61 Acute abdominal pain 90 Abnormal blood sugar 91 & 92 Abnormal electrolytes Others Depending on case mix during attachment

You will have the opportunity to see patients with and/or receive clinical teaching in any or all of the following clinical conditions: Massive blood loss, head and spinal injuries, minor and poly-trauma, coma, burns, septic and other causes of shock, acute asthma, heart failure, pulmonary and fat emboli, “acute abdomen”. There will also be a variety of acute and elective surgical procedures illustrating acute physiological and pharmacological changes. You should gain the following Medical science knowledge Pharmacology of local anaesthetic agents. An overview of commonly used anaesthetic agents including sedatives and the principles of their use. Determinants of intracranial pressure and cerebral perfusion. Pharmacology and therapeutics of analgesics. Pain management Role of invasive monitoring. Use of fluids in resuscitation (including blood and blood products). Pathophysiology of cardiac and respiratory failure. Oxygen therapy. Renal pathophysiology. Electrolyte imbalance and its significance in morbidity/mortality. Role of high dependency & intensive care units. Preoperative assessment.

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You should gain experience in the following Clinical skills Assessment of wounds. Administer fluid resuscitation. Manage compromised airway. Manage nausea & vomiting. Assessment of pain and sedation scores. Construct a pain management plan. Demonstrate good prescribing practice. Interpretation of blood gases You should gain experience in the following Practical skills Mixing of drugs including antibiotics. Taking blood pressure measurements, ECG and phlebotomy. Intravenous access Prepare intravenous infusion Use non invasive monitoring (pulse oximetry, capnography) Sample arterial blood. Administer oxygen therapy Assess conscious level and localising signs Working in a team environment Minor wound suturing Insertion of urinary catheter Use of defibrillator Detailed Tutorials in Acute and Critical Care problems There are four ‘teaching support’ tutorials on Minerva which have been selected and thought out to facilitate your learning of the core features of the Acute and Critical Care module. They are not marked formally and have been designed to be discussed in a tutorial setting. Additional Learning Resources Additional learning resources will include case based scenarios which will be released over the module. These should be researched as requested on your timetable as they will lead to further discussion with the School. Please check with Minerva for any local timetables, including tutorials. This is pertinent when at STH. Please note that any EMERGENCY MEDICINE tutorials will be organised separately and you will be notified of these by the department during your Emergency Medicine attachment. Theatre Shoes Please note that as theatre shoes are in short supply we’d suggest buying an inexpensive pair of ‘crocs’ without holes or some such shoes which you can keep as your own. As theatre Shoes are not being returned at the Northern General Hospital, your Ucard will be held as a deposit until the shoes are returned.

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READING LIST

Key Topics in Anaesthesia – T.M.Craft and P.M. Upton ISBN No. 1-872748-90-2

Handbook of Clinical Anaesthesia – Brian J Pollard ISBN No. 0-443-07259-0

ABC of Intensive Care – Singer & Grant ISBN No. 0727914367

Care of the Critically Ill Surgical Patient (2nd Edition) – Iain Anderson ISBN No. 034810483

ABC of Resuscitation

Advanced Life Support Manual

Musculo-skeletal problems in Emergency Medicine – Wadrope & English ISBN No. 0192628631

The Management of Wounds and Burns – J Wardrope & J Edhouse ISBN No. 0192629999 ECG Interpretation of Emergency Medicine – F Morris, D Crossman, Butterworth Heinnemann

Oxford Handbook of Accident and Emergency Medicine (3rd Edition) – Jonathan Wyatt, Robin Illingworth, Michael Clancy ISBN No. 0199206074

Oxford Handbook of Acute Medicine – Punit Ramrakha, Kevin Moore ISBN No. 0198520727

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Assessment Attendance in the module will be assessed. Anaesthetics Component It is expected that during your 4 week anaesthetic attachment you will perform and witness a number of practical procedures (section A + B). Can you please fill in the appropriate box upon performing/ witnessing the procedure? In addition you should see a large number of patients undergoing anaesthesia for a wide variety of surgical cases. In section B could you please list 20 cases you have seen, along with the anaesthetic technique used and one key learning point from the case. In section C, there is a list of teaching topics suitable for discussion during the quieter moments in theatre. I would expect you should cover a minimum of 4 topics during the 4 week attachment. It would be beneficial if you read around the topics beforehand. Section D requires you to list a minimum of 4 teaching sessions that you received in theatres. In section E, you will need to take 5 focussed histories and examinations on 5 pre-operative patients. Finally, in section F you will need to write a drug card including a variety of meds and fluids as listed in the proforma. At the end of the 4 week attachment could you complete this form and forward it to your module supervisor (please make a copy of the form as backup!). The module supervisor should sign the form and return it to the medical school.

Emergency medicine Component

All students are expected to submit a completed attachment assessment proforma for this part of the module, following their attachment.

Your emergency medicine supervisor should sign the assessment form. This is required for all students based at all sites.

Guidelines – Signatures on report forms

All students intending to join the medical profession must be aware of the importance of accurate record keeping and the need for ethical conduct in connection with signatures. Please be aware that the forgery of a signature is a very serious disciplinary matter. It is likely to lead to the student being charged under the discipline Regulations of the University. The University Discipline Committee will take a serious view when deciding the penalty for such misconduct.

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The School of Medicine and Biomedical Science may, in addition, be obliged to advise the GMC that a student found to have forged a signature is not of good character. The student could then be refused registration as a doctor.

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LOCATION OF CLINICAL PLACEMENTS: Teaching will take place in the Departments of Anaesthetics and Emergency Medicine in the following hospitals: Northern General Hospital Royal Hallamshire Hospital Barnsley Doncaster (please note some students may be placed at Bassetlaw for the Critical Care element of this module) Chesterfield Rotherham Overview of week Timetables for the week will be provided on the first day of your attachment. REPORTING INSTRUCTIONS Northern General Hospital (NGH) (Critical Care Attachment): Please see the individual student booklet published on Minerva 1 week before your module start. Royal Hallamshire Hospital (RHH) (Critical Care Attachment): Please report to Dr Juliette Fraser/Dr Martin Rowlands at 09.30 am in the Anaesthetic Department on C Floor of the Royal Hallamshire Hospital when you will receive a short introduction. Northern General Hospital (NGH) (Emergency Medicine Attachment): Please report to Dr Mohamed Gossiel, at 2.00pm in the Emergency Department, Northern General Hospital on the first MONDAY of your attachment Please check Minerva 1 week prior to your placement start date to select your rota. Barnsley District General Hospital (BHNFT)(Critical Care and Emergency Medicine Attachment): Please report to Everild Hindley at 9.00am in the Postgraduate Education Centre at Barnsley District General on the first day of your attachment. Doncaster Royal Infirmary (DRI) (Critical Care and Emergency Medicine Attachment): Please report to Mr Elliott Wilson at 08.45 am at the Education Centre at Doncaster Royal Infirmary on the first day of your attachment. Please note that some students may be allocated to Bassetlaw Hospital for Anaesthetics teaching. Details will be sent in due course. Chesterfield Royal Hospital NHS Foundation Trust (CRH) (Critical Care and Emergency Medicine Attachment): Please report to Marzena Dudziec at the Education Centre at 8.45am, at Chesterfield Royal, on the first day of your attachment. Rotherham District General Hospital (RDGH) (Emergency Medicine Attachment): An email will be sent to all students prior to commencement of the attachment with specific reporting instructions. Please ensure that you check your email for this the week before.

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QUERIES Specific queries regarding the core content should be addressed to the teachers concerned. Whilst every effort is made to produce an up-to-date handbook changes to the timetabling are inevitable. Please refer to the Phase notice boards on the Minerva system for up-to-date information. Acute & Critical Care Module Co-ordinator: Dr Juliette Fraser [email protected] Dr Martin Rowlands [email protected] Phase 3b Administrator Mrs Karen Dewsnap The Medical School Tel. 0114 2225526

[email protected]

Phase 3b Clerical Officer Miss Casey Smallwood The Medical School Tel. 0114 2225530

[email protected]

mailto:[email protected]




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CONTACT INFORMATION Acute and Critical Care Module Student Enquiries: Please contact Karen Dewsnap or Victoria Hattersley in the School Office Module Lead: Dr Juilette Fraser & Dr Martin Rowlands, Consultant Anaesthetist, Royal Hallamshire Hospital Email: [email protected] & [email protected] Specialist Leaders: Dr Mohamed Gossiel, EMERGENCY MEDICINE Consultant, Northern General Hospital

E-mail: [email protected]

Dr Ben Edwards, Consultant Anaesthetist, Northern General Hospital Email: [email protected] Administrator/Clerical Officer: Karen Dewsnap/Casey Smallwood, C Floor, The Medical School Tel: 0114 222 5526/5530 E-mail: [email protected] & [email protected]

NAME POSITION HOSPITAL BASE TELEPHONE NO. E-MAIL ADDRESS

Mr Kannan

Palaniappan

Consultant in Emergency Medicine

Chesterfield Royal 01246 512018/513116 [email protected]

Dr Anand Padmakumar

Consultant Anaesthetist Chesterfield Royal 01246 512279/512284 [email protected]

Dr David Walker


Barnsley Hospital 01226 431351 [email protected]

Dr Mark Luscombe

Consultant Anaesthetist Doncaster Royal 01302 366666 [email protected]

Dr George Thomas-Kattappurathu

Consultant Anaesthetist Rotherham District 01709 428332 [email protected]

Dr Juan Ballesteros


Doncaster Royal 01302 366666 [email protected]

Dr Hamish Paton

Consultant Anaesthetist Barnsley District 01226 432743 [email protected]

Dr Steven How


Rotherham District 01709 307104 [email protected]

Dr Fraser & Dr Rowlands

Consultant Anaesthetist Royal Hallamshire Via 0114 271 3082 [email protected] & [email protected]












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Address Contact/ Liaison Officer

Barnsley Hospital NHS Foundation Trust Gawber Road Barnsley S75 2EP

Everild Hindley

Medical Student Liaison Office, Postgraduate Education Centre Tel: 01226 435051 Fax: 01226 432406

Email: [email protected] Bassetlaw Hospital Kilton Hill Worksop S81 0BD

Pamela Whitehurst Postgraduate Education Centre Tel: 01909 502914 Fax: 01909 479541 Email: [email protected]

Chesterfield Royal Hospital NHS FT# Calow Chesterfield S44 5BL

Marzena Dudziec Undergraduate Co-ordinator Tel: 01246 513012

Fax: 01246 512632

Email: [email protected]

Doncaster Royal Infirmary Armthorpe Road Doncaster DN2 5LT

Elliott Wilson Medical Undergraduate Assistant Education Centre Tel : 01302 642054 Email: [email protected]

Diana, Princess of Wales Hospital Mears House Scartho Road Grimsby DN33 2BA

Emma McMullan/Mandy Derringer/Kathryn Hallam Undergraduate Department

Tel: 01472 874111 ext 7380 Email: [email protected]

[email protected] [email protected]

Rotherham District General Hospital Moorgate Road Rotherham S60 2UD

Kay Jaques Medical Undergraduate Office Postgraduate Medical Education Centre Tel: 01709 424122 Fax: 01709 830740 Email: [email protected]

Scunthorpe General Hospital Cliff Gardens Scunthorpe DN15 7BH

Pam Reed/ Louise Coult/ Kathryn Hallam Undergraduate Department Tel: 01724 290071 ext 305806 01724 387938/ 01742 387939 Email: [email protected]

[email protected] [email protected]

Northern General Hospital & Royal Hallamshire Hospital

Andy Atterbury Postgraduate Medical Education Centre Tel: 0114 271 4073 Email: [email protected] [email protected]

Twitter Handle: @STHUnderMed

HOSPITAL CONTACTS














https://twitter.com/STHUnderMed

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STUDENT SUPPORT IN PHASE 3b General Support Students are reminded that support regarding academic, emotional, personal or social difficulties can be sought from their mentor, ILA tutor, Phase Administrator or Phase Director of Studies, in addition to the general support services offered by the University which are set out on the SSiDs webpage and in the Mentor Handbook. Students requiring help with written (international and home students) and spoken (international students and non-native English speakers only) should contact the University’s English Language Teaching Centre: http://www.shef.ac.uk/eltc/ Student Self-Certification Form Students who need to report Medical and other Personal Circumstances resulting in absence or affecting performance for less than 7 working days, must complete a self-certification form. Please note that this form replaces the following University forms: “Special Circumstances Form” Extenuating Circumstances Form

Students reporting absences due to medical or personal reasons that last for over 7 working days, must complete an “Extenuating Circumstances Form”.

Copies of these forms for absences can be found by the following this link www.sheffield.ac.uk/ssid/forms/circs. Alternatively, copies are available on Minerva and from the Medical School Reception Desk. Once completed the form must be submitted to the Reception Desk or to your Phase Administrator. Extenuating Circumstances Form for Exams Students wishing to report extenuating circumstances that may have affected performance or attendance of an examination must complete the Medical School’s online Extenuating Circumstances Form that can usually be found on Minerva under Assessment Related Information.

Students With A Disability The School fully supports the GMC’s position with regard to disabilities: ‘students with a wide range of disabilities or health conditions can achieve the set standards’. Nonetheless, certain disabilities may make particular careers, once you have qualified, difficult or, in some cases, impossible. The School is anxious to provide as much support and advice to students with disabilities, throughout their undergraduate course, so that suitable arrangements can be made for the F1 year and, where necessary, appropriate career advice can be given. All students will have an assessment with the Occupational Physician during their first year, and those students who have disabilities will be offered advice and follow up at this stage. Where appropriate, an interim assessment will be offered mid-way through the course. For students who have a disability which might interfere with the full performance of the duties of a normal F1 post, a Post Graduate Dean will arrange a clinical assessment immediately after the Phase 3b Examination. This assessment will determine which aspects of the F1 post might be difficult to undertake, and in most cases it will then be possible to arrange a tailor made F1 post outside of the normal rotations so that the F1 year can be completed successfully. Where a student has an

http://www.shef.ac.uk/eltc/

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illness or disability which will prevent them undertaking a F1 post, appropriate careers advice will be provided at this stage. Students should be aware of the University regulations on health matters. Students are also reminded of the various aspects of the GMC’s document entitled ‘Good Medical Practice’ where the over-riding duty is to protect patients when there is any possibility that your health, conduct or performance is a threat to them. This document also makes clear the necessity to seek and follow advice from a consultant in Occupational Health, or another suitably qualified colleague where your own health and fitness might put patients at risk. Students must not rely on their own assessment of risk to patients. It therefore follows that if a student develops any disability during the course, or if an existing disability worsens, they should let the School know. Students requiring assessment and/or support for a potential learning or other disability can contact one of the above or go directly to the Student Support and Guidance Service: http://www.shef.ac.uk/ssid/disabilities. Support on Attachment Your module leader will help you by arranging formal teaching seminars and bedside tutorial sessions. He/she will also provide guidance with regard to self-directed learning. The following are specific aims for tutors:

To give students guidance in personal study (developing their own initiative to learn);

To give students feedback about their personal progress and offer them assistance if progress is not satisfactory;

To give students practice in communicating information verbally;

To offer a sympathetic hearing and advice to any student who is having academic or other difficulties;

To ensure that the attachment to your firm is :interesting, enjoyable and intellectually challenging;

To enable students to gain experience in a broad range of disease areas by facilitating learning opportunities in those areas outside of your everyday practice;

To provide students with channels to feedback and constructively comment about all aspects of the course.

Careers Advice The Medical School provides a number of careers-related activities to help students pursue a career in medicine. However, if you are considering alternative careers, or would like to talk about your career plans in general, you might find it useful to visit the Careers Service, located at 388 Glossop Road. You can book an initial appointment with a Careers Adviser by contacting the Careers Service on 0114 222 0910. If appropriate, you will then be referred for a longer appointment with Alison Clay, the designated Careers Adviser for the Medical School. Alternatively, email quick queries to the email enquiry service: www.shef.ac.uk/careers/students/emailenquiry.html For further information on the facilities available please visit: www.shef.ac.uk/careers

http://www.shef.ac.uk/eltc/

http://www.shef.ac.uk/careers/students/emailenquiry.html

http://www.shef.ac.uk/careers

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Clinician progress benchmarks – Phase 3b Emergency Medicine

Student Name: ………………………………………………………………………………….

Reg number: ………………………………………………….

Introduction Doctors develop from their first day at medical school until their last day at work. The five scales below set out some of

the key early developmental milestones. All Sheffield students will be assessed following the longer clinical attachments

to help them know which milestones they have achieved and which they are now aiming for. They will also benchmark

themselves against these milestones and have an opportunity to set some relevant objectives.

As an assessor please give enough feedback to show why you’ve benchmarked them as you have, and how to achieve

the next milestone. If you haven’t seen enough of them to say pass the form to a team member who has.

The benchmarks have no ‘pass/fail’ threshold, but the phase leads will contact students whose progress is falling behind

their peers to help them remediate and, if there is no improvement, their progression may be held back..

Benchmarks (see back of form for explanation) For each row (1-5) please circle the highest benchmark the student consistently achieves

1) History-taking novice knows how (general)

knows how (speciality specific) thorough detective

2) Examining novice knows how (general)


3) Interpreting novice knows about conditions forms an opinion seeks evidence for and against

opinion

4) Managing novice knows about tests and

treatments suggests a plan individualises plan

5) Relating to patients novice polite and professional listens and

explains patient-centred

Single most important feedback tip

Areas of concern Separately from general developmental progress, please tick the relevant box if you think this student needs specific

support with any of the following. If possible, please share this concern with the student. We may contact you to ask

for more details.

Resilience □ Relationships □ Conscientiousness □ Demeanour □ Safety □ Other………….........................................□

Assessors signature………………………… email…………………………………………… date…………………….

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Explanation of the benchmarks

1) History-taking

novice knows how (general)


knows the content and process of a ‘clerking’ history; circle

‘speciality-specific’ once these new elements are known too

consistently clarifies important details (purpose or duration of

treatments, details of symptoms ‘bile or no bile’ etc)

history consistently geared to narrowing differential diagnosis

(relevant positives and negatives)



knows the content and process of a ‘clerking’ examination;

circle ‘speciality-specific’ once these new elements are known

too

consistently clarifies important details (is tachypnoea

obstructive or not, is murmur systolic or diastolic)

examination consistently geared to narrowing differential diagnosis (goes looking for the

relevant findings)

3) Interpreting

novice knows about conditions forms an opinion seeks evidence for and against

opinion

knows the important causes of

the presenting complaint

consistently offers a defensible view about the most likely

cause(s)

formulating view affects the order and emphasis of history

and examination



knows tests and treatments for

the important causes of the presenting complaint

consistently offers a defensible investigation and treatment

plan

data gathered during the history and examination used to gear the plan to the individual

patient

5) Relating to patients

novice polite and professional listens and explains patient-centred

consistently enables questions

& takes them seriously; provides explanations

consistently gears questioning, explanations and plans to individual patients (‘puts

him/herself in the patient’s shoes’)

ONCE COMPLETED, PLEASE RETURN THIS FORM TO:

Casey Smallwood, Phase 3b Clerical Officer, Medical School, Beech Hill Road, S10 2RX

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Clinician progress benchmarks (student self-assessment form)

Introduction Doctors develop from their first day at medical school until their last day at work. The five scales below set out

some of the key early developmental milestones. All Sheffield students will be assessed following the longer

clinical attachments to help them know which milestones you have achieved and which you are now aiming for.

The benchmarks have no ‘pass/fail’ threshold, but the phase leads will contact students whose progress is falling

behind their peers to help them remediate and, if there is no improvement, their progression may be held back.

Starting benchmarks (see back of form for explanation) For each row (1-5) please circle the highest benchmark you consistently achieve at the start of the attachment






opinion





Your three key learning objectives If there is a chance to do so discuss these with your supervisor at the start of the attachment.

Finishing benchmarks For each row (1-5) please circle the highest benchmark you consistently achieve at the end of the attachment






opinion





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Explanation of the benchmarks

1) History-taking

novice knows how (general)


knows the content and process of a ‘clerking’ history; circle

‘speciality-specific’ once these new elements are known too

consistently clarifies important details (purpose or duration of

treatments, details of symptoms ‘bile or no bile’ etc)

history consistently geared to narrowing differential diagnosis

(relevant positives and negatives)



knows the content and process of a ‘clerking’ examination;

circle ‘speciality-specific’ once these new elements are known

too

consistently clarifies important details (is tachypnoea

obstructive or not, is murmur systolic or diastolic)

examination consistently geared to narrowing differential diagnosis (goes looking for the

relevant findings)

3) Interpreting

novice knows about conditions forms an opinion seeks evidence for and against

opinion

knows the important causes of

the presenting complaint

consistently offers a defensible view about the most likely

cause(s)

formulating view affects the order and emphasis of history

and examination



knows tests and treatments for

the important causes of the presenting complaint

consistently offers a defensible investigation and treatment

plan

data gathered during the history and examination used to gear the plan to the individual

patient

5) Relating to patients

novice polite and professional listens and explains patient-centred

consistently enables questions

& takes them seriously; provides explanations

consistently gears questioning, explanations and plans to individual patients (‘puts

him/herself in the patient’s shoes’)

ONCE COMPLETED, PLEASE RETURN A COPY OF THIS FORM TO:

Casey Smallwood, Phase 3b Clerical Officer, Medical School, Beech Hill Road, S10 2RX

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Anaesthetics Attachment Logbook – Phase 3b 2017 Name: Registration Number: A. Practical procedures performed by student Please ask the clinician witnessing the procedure to initial the appropriate box. Procedure Minimum

no. required

Supervising clinician’s initials

1 2 3 4 5 6 7 8 9 10

Intravenous cannulation 5

Manage airway with facemask 5

Insert Guedel airway 2

Insert LMA 4

Intubate trachea 0

Draw up drugs for IV administration

5

Run through IV infusion 2

B. Practical procedures observed by student Please tick appropriate box Arterial line

CVC

Epidural

Spinal

Nerve block

Other – please list

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C. Cases observed by student List 20 cases observed with 1 key learning point per case Case

Anaesthetic technique Key learning point

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D. Teaching received in theatre

Please list all topics covered by teaching received in theatre (minimum 4 topics). Below the table is a suggested list of topics to be covered Topic

Taught by

1. Pharmacology of local anaesthetic agents. 2. An overview of commonly used anaesthetic agents including sedatives and the principles of their use. 3. Determinants of intracranial pressure and cerebral perfusion. 4. Pharmacology and therapeutics of analgesics. Pain management 5. Role of invasive monitoring. 6. Use of fluids in resuscitation (including blood and blood products). 7. Pathophysiology of cardiac and respiratory failure. 8. Oxygen therapy. 9. Renal pathophysiology. 10. Electrolyte imbalance and its significance in morbidity/mortality. 11. Role of high dependency & intensive care units. 12. Preoperative assessment 13. Management of post-operative nausea & vomiting 14. Interpretation of arterial blood gases

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Student name:

E. Pre-operative assessment Please see five patients pre-operatively and take a focussed anaesthetic history and perform a focussed examination. It should usually be possible to see the patient on the pre-operative ward (eg TAU) during the theatre list. You should then present the history and examination findings to the Anaesthetist who should have already assessed the patient. You should get “signed off” below by the Anaesthetist for each patient presented. You should discuss during one of your theatre attachments early in the module and prior to assessing any patients. I would recommend that you use the orange preassessment form as a template for this discussion. Key points – eg operation

/comorbidities Anaesthetist signature

Patient 1

Patient 2

Patient 3

Patient 4

Patient 5

F. Prescribing

Anaesthetist signature

Write a drug cardex for a post operative patient

which includes prescriptions for appropriate

analgesia, antiemetics, oxygen therapy,

maintenance fluids and thromboprophylaxis

Module completion Satisfactory Unsatisfactory Signature of module supervisor Date

ACUTE & CRITICAL CARE MODULE – PHASE 3B

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