BrightMed: Session 1!

 Time has gone quickly, as yesterday was another session back at BrightMed! And, I have to say, they never fail to interest!

This is definitely going to be a long post, so grab your tea or coffee, and get reading!

We began the session by scrutinising the differences between primary care and secondary care. We found various job roles for each, let's take a look at some here:

Primary care:

• General practitioner (GP)
• Family doctor
• Nurse practitioner
• Pharmacist
• Optician
• Dentist

Secondary care:

•  Hospital

• Dermatologists
• Urologists
• Cardiologists

• Specialised clinics
• Speech therapists
• Occupational therapists 

Next, we looked at a multidisciplinary team. One example was poor Mrs Beaton, who was diagnosed with breast cancer. Here are some people who could be at a multidisciplinary team to discuss her treatment:

• Cancer nurse
• Occupational therapist
• Radiologist
• Social worker
• GP
• Pathologist
• Oncologist
• Health care assistant
• Surgeon
• Physiotherapist
• Clinical biochemist
• Pharmacist 

 After this, we discussed how to take a person's history. Do you know the steps?

Here is what they suggested:

Introduction

• Introduce yourself
• Explain why you are there
• Ask for consent

Patient demographics

• General information about the patient (Name, age, etc.)

Presenting complaint

• Briefly, why has the patient arrived today? 

History of presenting complaint

• Details about the presenting complaint

Past medical history

• Past experience of health problems

 Drug history

• List of medicatinos they take
• Allergies?

Family history

• Medical conditions/causes of death within the family

Social history

• Home life and hobbies
• Alcohol consumption and tobacco use

 And then, you're done taking the history!

So, apart from that, what can you check for on examination?

First you need to use the acronym "WIPER" - Wash, Introduce, Permission, Expose, Reposition

Next, you're ready to get hands on (which the patients consent, of course)!

Hands
-Any signs of clubbing?
-Xanthomas (these can signify high cholesterol/lipids)
-Nicotine stains

Arms
-Xanthomatus eruptions
-Pulse (radial) - you can also check for a delay between both wrists, too
-Blood pressure

Neck
-Pulse (carotid)

Face
-Pale conjunctivae
-Corneal arcus (common in the elderly, but in young people it can signify high cholesterol/lipids)
-Xanthalasma
-Nicotine stained teeth
-Cyanosis

Chest
-Pectus exavatum
-Pectus carinatum
-Scars
-Pacemaker
-Auscultation sites (aorta - base right, pulmonic - base left, mitral - apex, and tricuspid - left lateral stermal border)

Legs
-Peripheral oedema (fluid)

Ankle
-Pulse (posterior tibial artery)

Wow! That's a lot of examination!

Next, was Station 3 - Heart Sounds!

First, let's look at the parts of the heart that are involved:

Systolic Vs Diastolic. [Source: http://healthy-ojas.com]

Next, we can take a look at the normal Vs abnormal sounds for a heart:

[Source: Wikipedia]

Curious to what these abnormal sounds can signify?

In simple terms:

Stenosis is a narrowing
Regurgitation is leaking

Here's part one of a very interesting video:



Finally, we looked at ECGs - Electrocardiogram

Which is the "recording of electroactivity of the heart using electrodes placed over the heart, wrists and ankles"

What can effect it?

• Heart rate monitoring
• Arrhythmias
• Disorders in the activation sequence
• Increased thickness
• Myocardial ischemia and infarction
• Drugs 

We monitor them through a series of waves:

Then, we look at the heart's electrical system:

Finally, here's a great video of ECG cardiac arrhythmias



What a day!

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- Geeker