The patient is a year-old right-handed woman with a history of chronic headaches who complains of acute onset of double vision and right eyelid droopiness three days ago. History of present illness: When she looked up at the clock on the wall, she had a hard time making out the numbers. At the same time, she also noted a strange sensation in her right eyelid.
Click on Graphic to download "Resident Case Presentation and Anesthetic Planning Outline" file 42 KB July 17, The following is an outline and general information I hope will be helpful to you in organizing your case presentations for discussion with your attending.
It is more detailed than will be appropriate in some instances, and less detailed than appropriate for complex cases. Try not to present your case while by reading down the Epic screen. Avoid doing it on the fly until you are more experienced and very comfortable with the patient and plan.
Call before 9 PM. If you are here late, try to arrange to make this call before you leave to save you precious evening time. Most attendings will gladly support this especially when you are here late and especially when you are not on call and here late.
Text paging your contact info is helpful as both you and the attending may be out of the hospital and out and about as well. Read the Jaffe text to understand the key elements of a surgical procedure and anesthetic. Usually there are just a few key things that will be of special concern. It is a useful way to advance your knowledge base one surgery and one patient at a time.
Plus, the memory is stickier when fear of your attending and the case are both at work.
Force yourself to work your way through to the end of this outline. Typically you will find yourself stalling after presenting the history. Think through all elements of the anesthetic from start to finish.
Roll with the punches as best you can and look on the positive side—you will learn multiple ways to do the same thing. Eventually you can choose how you think it is best done. Learn how to access Epic offsite—you can do a lot from home. However, there are times, not all that often, that you will need to come in and see the patient.
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Always almost anyway… give the age and sex of the patient, what procedure they are scheduled for, as well the surgeon sand mention anticipated duration of the case if long, atypical, or unpredictable.
Consider mentioning the start time and room number, especially if different that usual, i. Briefly review relevant prior surgeries, type of anesthesia used, and complications or other relevant points regarding past anesthetic or surgical experiences. Include the common PONV as well as catastrophic failed intubation, anaphylaxis, etc.
Discuss relevant past medical history, preferably in order of severity, especially cardiovascular and pulmonary conditions. Each disease process or condition should be discussed in terms of its severity, duration, treatment, and relevant work up such as recent dobutamine stress echo and the results.
I like to discuss pertinent substance abuse including alcohol and tobacco here. If a patient only drinks occasionally and I do not feel this is pertinent, then I do not mention it. This is a style point to some extent, but also encourages you to have decided ahead of time what is relevant, and to detail all medical conditions at one time, rather than spread out in your presentation.
For the same reason, anything pertinent in the review of systems such as serious reflux or snoring I like to mention if the PMHX.
If you are unfamiliar with a medication — look it up. This is how you will keep up to date on the continual roll out of new medications. If they do not, then one can discuss it here. I always mention vital signs or at least that they were normal. I like to know the height and weight or better yet, the BMI of a patient and oxygen saturation if abnormal.
I always mention the airway class, as well as any other relevant features such as TMD, or oral opening, distorted anatomy prior XRT, tumor, etc.
I usually mention the lung exam. I usually mention the heart exam. I usually then only mention other pertinent or abnormal features of the exam such as poor IV access, scoliosis, or ascites, etc. Discuss all abnormal or unexpected lab data not already discussed in the PMHX.
If all the data is normal, you can simply say, for example, "The ECG and blood studies were normal.
This is the most important part of the presentation, and one frequently not given enough attention or forethought, especially when beginning residency.
There are many ways to approach this part. At a minimum, be prepared to summarize relevant medical conditions and their treatment. He has an excellent exercise tolerance, a negative stress echo, and is already on a beta blocker.
In the beginning of your residency your plan, at a minimum, should include consideration of premedication, intraoperative monitoring, use of regional techniques if appropriate, IV access and fluids, induction, maintenance, emergence if GA is used, and postoperative issues such as destination home, ICU, etc, and pain control.This is an ophthalmic case study for medical students involving a patient complaining of red, itchy eyes.
One of the most often talked about topics in aromatherapy is ingestion. Without naming brands, there is a plethora of unsafe advice floating around the internet and .
Welcome to the Pediatric Section @ mtb15.com! This section provides articles and abstracts describing the benefits of chiropractic care for children. 44 | Page Example Write Up #1: A Patient with Diarrhea Problem List Active Problems Duration 1. Diarrhea and Right Lower Quadrant Pain 10/24/08 – present.
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