first aid for the wards presentation with dr. tao le
TRANSCRIPT
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Tao T. Le, MD, MHSAssistant Clinical Professor
Chief, Section of Allergy & ImmunologyUniversity of Louisville
Senior EditorFirst Aid Board Series
USMLERx Test Bank Series
Firs t A id for t he Wards:The Real ly Shor t Vers ion
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Overview
Common Ward Mistakes
The Team
A Day on the Wards The Admission
Key Tasks
Survival Tips Getting Off to a Fast Start
Q&A
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Comm on Mis tak es
Not understanding roles,responsibilities, expectations
Not seeking timely feedback
Not using appropriate texts andreferences
Not knowing how to be a teamplayer
Inefficient organization andexecution of daily work
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The Team
Attending/Chief Resident Intern
Sub-intern Nurse Ward clerk Pharmacist Other staff You
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Typ ica l Inpat ien t Medic ine Day
Prerounds: 7-8 am
Work rounds: 8-9:30 am
Work time: 9:30-11 am
Attending rounds: 11-noon
Conference: noon-1
Afternoon work: 1-?
Signing out
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Typic a l Inpat ient Surgery Day
Prerounds: 5-6 am
Work rounds: 6-7:30 am
Preop prep: 7:30-8 am
Surgery/floor work: 8-5
Conference: noon-1
Afternoon rounds: 4-5:30
Postrounds work: 5:30+?
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Tak ing Cal l
Overnight call
Short call
Typically Q4
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The Admiss ion
The Call
Reviewing objective data
Medical record review Interviewing the patient
Physical exam
Putting it all together Reviewing case with the
resident/intern
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K ey Not es and Orders
Admit orders Admit to Diagnosis Condition
Vitals Allergies Activity Nursing orders Diet
IV fluids Medications Special studies Labs
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K ey Not es and Orders
Admission notesOnset
Progression
ProvocationPalliationQualityRegion
RadiationSymptomsSeverity Time course
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K ey Not es and Orders
Progress notes
Procedure notes
Daily orders
Prescriptions/DC orders
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Docum enta t ion T ips
Get everything co-signed
Date/sign all pages
No documentation = noreimbursement
Illegibility = no documentation
Use only appr. abbrev.
q.d." vs. q.i.d vs. once daily
To CYA, never CYOA!
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Oral Present at ions
Formal presentations
5-7 minutes (surgery: 2-3 min.)
Should tell a story
CC/HPI/PE/Labs sets the stage
A&P delivers the climax
Bullet presentations
1 minute 15-20 facts
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Dai ly Ward Ac t iv i t ies
Procedures
Patient/family
communications Consults
Data collection
Reading up on patients
Walking supply cart
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Survival Tips
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Ef f ic ien t T im e and Pat ien tManagement
Commit all tasks to a to-do list
Prioritize tasks
Organize tasks by location Maximize hospital information
system
Keep scut essentials on board
Always be early!!
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Organizat ional Aids ( Per ipheralBra ins )
Clipboard
Binders
Data sheets Note cards
iPhone/iPad/Android
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Evaluat ions
Critical for deans letter
Know the evaluation criteria
Clinical performanceShelf exam?
Know who is evaluating you
Clarify expectations Ask for feedback early on
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Di f f ic u l t Si t ua t ions
Needlesticks
Abusive/inappropriate house
officers Inappropriate procedures
Gunner classmates
Patient death
Sexual harassment
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Di f f ic u l t Si t ua t ions (cont .)
Difficult/violent patients
Difficult family members
Narcolepsy Personal/family illness
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Get t ing Off t o a Fast Start
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Sc hedul ing Rot at ions
Avoid most likely specialty infirst/last block
Avoid back-to-back toughrotations
Do easy rotation before
desired specialty rotations
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Choosing Rot at ion Si t es
County
VA
Academic/university center Community/private hospital
Outpatient clinic
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Before t he Rot a t ion
Classmates
FA Wardsspecialty chapter
FA USMLE Step 2CK FA Step 1 relevant content
FA Wardsrecommended
pocketbooks/texts/software
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Your Sec ret Weapons
Enthusiasm/hustle
Time
Basic science knowledge Low expectations