EARLY INFORMAL APPRAISAL AT LISTER

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The team here are generally happy I am settling in well but there are some areas which I have to work on according to a lead consultant:

To increase the speed of my consultation I need to tune in more to the A&E mindset (having come from a geriatric post I am used to taking time and observing patients over days but obviously in A&E the aim is to be focused as well as safe and the time frame is over 30 minutes or so):

Clerking

1. From the Presenting complaint e.g. Chest Pain make a worst case scenario differential e.g. ACS / PE as well as a most likely scenario e.g. LRTI and then use focused exam and history to look for supporting evidence e.g. temperature, cough and risk factors e.g. diabetes, family history.

2. Clearly document relavent social history (e.g. baseline transfers/mobility or smoking/occupational history), PMHx and DHX (including allergies, OTC medications, and important medications that might influence decision making e.g. warfarin or ace inhibitors)

Treating

1. Always check the guidelines - treat accordingly to NICE / BTS etc.

2. Don't go in "guns" blazing e.g. giving 1L fluid or 3 back to back nebulisers; try to give a bolus of treatment e.g. 250ml fluid or 1 set of ipratropium/salbutamol and then reassess -  physiological parameters such as HR/BP or Peak flow and THEN decide to step up or continue treatment.

General Advice

LISTEN - try to read around using own resources, then formulate a specific plan then go and ask a senior after documenting it all: then when you get a plan from a senior though you should listen carefully and apply diligently it is no excuse for not using your own clinical acumen. If you have any alarm bells ringing/worries or concerns always raise your opion if relevant and this will develop your discussions towards creating a safe effective management plan for the patient.