Explaining management/ treatment
Station: Consent for blood transfusion
- Intro self etc…
2.
- Benefits of blood transfusion: (3)
- Potential risks (4)
- 2 extra
You’ll be checked regularly - look for (5) - Potential alternatives (4)
- What does the transfusion involve? (3)
- How patient might feel after the transfusion (3)
- Obtain consent (1)
- Introduce self and role/ PPE/ get DOB/
Explain purpose of conversation - ICE
- Benefits of blood transfusion:
- relieve symptoms caused by anaemia
- prevent damage caused to organs associated with anaemia
- *earlier mobilisation/ quicker recovery after an operation, acute illness or injury - Potential risks
- Allergic Reactions: Mild/ minor, anaphylaxis, ABO incompatibility
- TACO - fluid overload (hx of heart failure?)
- Infection from blood bourne virus- Hep B and C, HIV < 1 in 1 mill
- *antibodies against the blood making further transplants harder (can react)
- If preg - can make your baby anaemic
- You can no longer donate blood
You’ll be checked regularly and Symptoms to look out for/ report:
- Fever, pain at site, abdo pain, breathing difficulty, general newly unwell
- Potential alternatives (4)
- iron (IV or oral)
- *cell salvage (usually used in surgery, filtered given back)
- erythropoetin (stim Hb)
- do nothing - What does the transfusion involve? (3)
- check your blood group + ID checked
- given in bag 2-4 hours
- check temp, BP, pulse regularly - How patient might feel after the transfusion (3)
- fever - paracetamol and slow
- pain or bruise from cannula
- *contact staff or GP if you feel ill in 24 hours, breathing difficulty etc. - Obtain consent (1)
- any allergies?
Explaining management/ treatment
Station: Explaining gastroscopy
- Intro self etc.
2.
3.
4.
5.
6.
7.
9.
- Introduce self and role/ PPE/ get DOB/
Explain purpose of conversation - ICE
- Quick patient history S+S (establish reason for endoscopy)
- Description of Endoscopy
- This flexible tube with camera inserted into mouth, down food tube and visualises the stomach lining as well as small bowel. Take biopsy - Why people get endoscopy
- Patients with reflux - Barrets Oesophagus
- Dysphagia
- Haematemsis
- Hiatus hernia
- unexplained weight loss
- unexplained iron def. anaemia
What are we looking for?
- Oesophageal or gastric cancer
- Peptic/ duodenal ulcers
- Oesophageal varices - Pros and Cons
Benefits
- able to see if there is cancer - early diagnosis early tx.
- can take biopsy to test it
- much more accurate than other tests as can phsyically see it
Negatives
Common
- Teeth injury
- Can be uncomfortable - BUT YOU ARE ABLE TO BREATH!
- Cause nausea
- minor bleeding
Rare but severe
- damage to oesophagus/ stomach - can perforate
- not 100% accurate - can miss things - may need a re-scope
- sedation risks
- Alternatives
- Barium swallow - not suitable for all and not as accurate - Preparing for endoscopy
Medications: Will receive direct instructions before
- Blood thinners
- PPI (2 weeks before)
- Food - none 6 weeks before
- Water clear fluids until 2 hours before - On the day
Will be consented before - lie on left lateral - throat spray or IV sedation - mouth piece in - scope down - last 20-30 mins - take biopsies
Explaining management/ treatment
Station: Counselling colonoscopy
+ Questions on bowel cancer screening
- Intro self etc…
- (get it in the consultation early)
- Explain the procedure:
- Explain why it is being done and who its done in (6)
- Potential alternatives (1) but its negatives
- What does the colonoscopy involve? (3)
- Prepping for the colonoscopy (5)
- risks of procedure/ side effects
common SE - (4)
risks - (5) MENTION THESE!
- Introduce self and role/ PPE/ get DOB/
Explain purpose of conversation - ICE
I - know anyone who’s had it before?
C- Concerns and Expectations (Is there anything you want to focus on during this discussion today?) - Explain the procedure:
A long thin tube with camera to look at lining of the large bowel - inserted into the back passage or anus, able to take biopsy and remove any suspicious polyps or masses if they see any. - Explain WHY it’s done
- To look for cancer but also used to monitor other conditions such as crohns or UC. People usually get the procedure done if present with:
- Blood in stool
- Change in bowel habbit
- iron def anaemia
- unexplained weight loss
- Persistent abdominal symptoms with raised faecal calprotectin or CRP
- Also used as a screening tool to catch cancers early - Potential alternatives (1)
- CT virtual colonsocopy which uses x-rays to create image to look in the bowel - not as detailed and unable to get biopsies - What does the colonoscopy involve? (3)
- 20-40 mins, lie in left lateral,rectal exam then scope, CO2 to inflate and see, might be asked to adjust position throughout, polyps may be removed this is not painful. - Prepping for the colonoscopy
- will receive a letter with specific details
- low fibre diet for 203 days before
- high fluid intake
- moviprep - be close to atoilet all day!
- dont eat anything on the day and only clear fluids up until procedure - Risks of the procedure and side effects
Patients will be offered a sedative or Entonox (‘gas and air’)
- Nausea, bloating , crampy abdo pain, minor rectal bleeding - Allergic reaction to sedation equipment or materials used
- Heavy bleeding
- Bowel perforation caused by the colonoscope (seek med advice if severe abdo pain or bleeding after)
- Incomplete examination requiring a repeat test
- Small risk of missed pathology
Bowel Cancer Screening
Test =
How often =
To who? (including age) =
FIT test also recommended to (3)
Test = FITT test ( blood in stool)
How often = 2 yearly
To who? (including age) = Men and women aged 60-74
FIT test also recommended to (3)
1. patients >= 50 years with unexplained abdominal pain OR weight loss
2. patients < 60 years with changes in their bowel habit OR iron deficiency anaemia
3. patients >= 60 years who have anaemia even in the absence of iron deficiency
Breast Cancer Screening
Test =
How often =
To who? (including age) =
Referral to familial breast cancer screening (screening offered from a younger age if…6)
Test = mammorgram
How often = 3 years
To who? (including age) = 50-70yo
- first-degree female relative diagnosed < 40 y/o or
- first-degree male relative diagnosed with breast cancer any age
- first-degree relative with bilateral breast cancer where the first primary was diagnosed at younger < 50 y/o
- two first-degree relatives, or one first-degree and one second-degree relative, diagnosed with breast cancer at any age
- one first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative)
- three first-degree or second-degree relatives diagnosed with breast cancer at any age
Breast cancer referral guidelines
defo refer if
1.
2.
consider referral if
1.
2.
What is the triple assessment?
- > = 30yo with unexplained breast lump
- > =50yo with unilateral nipple symp - bleeding, discharge, retraction, other
consider in…
1. skin changes that suggest breast cancer
2. aged 30 and over with an unexplained lump in the axilla
triple assessment:
1. Hx and Exam
2. Imaging - mammorgram in >30, <30 is USS
3. Cytology - fine needle first and then core biopsy
Cervical Cancer screening
inhaler technique
- wash spacer once a week and leave it to air dry
- salbutamol can cause palpitation, tremor
- wait 30s between each puffk
Counselling on PSA
2.
3.
4.
5.
- Summarise
Normal levels of PSA
1. 50 - 59yo =
2. 60 - 69yo =
3. >70yo =
PSA testing should be offered to:
1.
2.
- Get symptoms
- ICE - what would you like to focus on during the consultation? Know anyone who’s had it done?
- What is the PSA?
- Its protein thats produced by the prostate and helps liquification of semen. Most lost in semen but some leaks into blood
- if raised CAN be an indicator of having prostate cancer
- It’s not a reliable test:
Can be raised and not have cancer - false positive
Can be normal and have cancer - false negative
It also naturally rises with age - How do you take the test - blood
However: Can be raised due to - Prostate cancer
- BPH
- Infection of the prostate (within last 6 weeks)
- UTI
- 48 hours since last ejaculated
- Vigorous exercise - Lots of cycling - 48 hours
- Urinary instruments - catheter - 6 weeks
- What happens next:
If normal - all good
If raised - very invasive tests - scan prostate and take biopsy. Very uncomfortable and has its own risks - Can you summarise what we’ve talked about
- Give leaflet!
Normal levels of PSA
1. 50 - 59yo = 3.0ng/ml
2. 60 - 69yo = 4.0ng/ml
3. >70yo = 5.0ng/ml
PSA testing should be:
Considered in men with suspected prostate cancer.
Offered to men older than 50 years of age who request a PSA test.
PSA should reach lab in 16 hours
Prostate Cancer extra
Investigations
1.
2.
Prostate cancer management
1.
2.
3.
4.
Investigations
1. mutli-parametric MRI
2. TRUS - Trans-rectal US
Management
CT TAP - staging and biopsy for grading
- Conservative/ palliative- depending on age, functional status and fitness of patient - comorbidities and life expectancy
- medical - GnRH agonist (Gosrelin) or testosterone blockers
- surgical - radical prostectomy
- Radiotherapy
Paediatrics Non-Accidental Injury
- Intro self etc etc
- Alarm Bells start ringing
- Get a clear mechanism of injury! - PBINDS
PM Hx
Med + allergies
Family History - BIG SOCIAL HISTORY!
- Who’s at home
- Any social service input
- Pets/ aniamls in the house
- smoking in the house
- recreational drug use
- Partners/ anyone else come in to the house regularly and has contact with the children - Indirect questions:
- Is everything ok at home?
- Is your partner supportive?
If the woman is pregnant:
- Are you being looked after properly?
- Is your partner taking care of you? - Direct Questions
- Do you ever feel frightened of your partner?
- Have you ever been in a relationship where you have been hit or hurt in some way?
- Are you currently in a relationship where this is happening to you?
How can it present?
Abnormal fractures -usually spiral fracture! (4)
5 more!
Inter-cranial injuries (3)
Abnormal fractures -usually spiral fracture!
- humeral
- radial
- femoral
- rib fractures
Bite marks - human
Shaken baby - retinal haemorrhage
Hand shaped bruises or bruises on soft/ non-bony areas
Injury in non-mobile children
Any scold or burn
Inter-cranial injuries
- < 3yo
- No clear reason
- multiple sub-dural haemorrhage
