Oxford Handbook for the Foundation Programme

691 Pages·2014·8.43 MB·English

by  Tim Raine, James Dawson, Stephan Sanders, Simon Eccles

Emergency topics

Arrests
Adult resuscitation b p228
Obstetric resuscitation b p238
Neonatal resuscitation b p236
Paediatric resuscitation b p234
Trauma resuscitation b p232
Emergencies
Abdominal pain b p288
Aggressive behaviour b p364
Anaphylaxis b p470
Bradyarrhythmia b p256
Breathlessness b p270
Burns b p466
Chest pain b p240
Clotting abnormalities b p404
Coma b p338
Diabetic ketoacidosis (DKA) b p326
Disseminated intravascular coagulation (DIC) b p405
GI bleed b p298
Hepatic encephalopathy b p312
High INR b p404
Hyperglycaemia b p324
Hyperkalaemia b p385
Hyperosmolar non-ketotic state (HONK) b p326
Hypertension b p262
Hypoglycaemia b p322
Hypokalaemia b p385
Hypotension b p472
Hypoxia b p270
Limb pain b p444
Liver failure b p312
Overdose b p492
Paediatric seizure b p345
Psychosis b p365
Rash b p410
Red eye b p426
Reduced GCS b p338
Renal failure/kidney injury b p372
Shock b p476
Shortness of breath b p270
Stridor b p284
Stroke b p350
Tachyarrhythmia b p248
Seizures b p344

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Normal values

Despite national eff orts to standardise laboratory testing and reporting,1
exact ranges vary between hospitals, these fi gures serve as a guide.

Haematology see b p566

Hb–men
130–180g/L
WBC
4–11 x 109/l
Hb–women
115–160g/L
• NØ
2.0–7.5 x 109/l
(40–75%)
MCV
76–96fl
• LØ
1.3–3.5 x 109/l
(20–45%)
Plts
150–400 x 109/l
• EØ
0.04–0.44 x 109/l
(1–6%)
Ferritin
12–200micrograms/l B12
197–866pg/ml
TIBC
42–80μmol/l
Folate
2–20micrograms/l

Clotting see b p567

INR
0.8–1.2
APTTr
0.8–1.2
PT
11–16s
APTT
35–45s
Fibrinogen
1.5–4.0g/l
D–dimer
<0.3mg/ml
(<300ng/ml)

U+Es see b p568

Na+
133–146mmol/l
Ca2+ (adjusted)2.2–2.6mmol/l
K+
3.5–5.3mmol/l
PO43–
0.8–1.5mmol/l
Urea
2.5–7.8mmol/l
Mg2+
0.7–1.0mmol/l
Creatinine
70–150μmol/l
HCO3–
22–29mmol/l
Osmolality
275–295mOsmol/kg Cl–
95–108mmol/l

LFTs see b p569

ALP
30–130units/l
Bilirubin
3–21micrograms/l
ALT
3–35units/l
Albumin
35–50g/l
GGT
10–55units/l
Total protein 60–80g/l

Other

Amylase
0–120units/l
CRP
<5mg/l
Fasting glucose
3.5–6.0mmol/l
ESR
<20mm/h
Immunoglobulins 24–37g/l
CK
25–195units/l
Cholesterol
<6mmol/l
LDH
70–250units/l
Triglycerides
0.5–1.9mmol/l
PSA
0–4ng/ml

Blood gases see b p584

pH
7.35–7.45
PaO2
10.6–13.3kPa
Base excess
±2mmol/l
PaCO2
4.7–6.0kPa

1 See �www.pathologyharmony.co.uk

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OXFORD MEDICAL PUBLICATIONS

Oxford Handbook for the
Foundation
Programme

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Published and forthcoming Oxford Handbooks
Oxford Handbook for the Foundation Programme 4e
Oxford Handbook of Acute Medicine 3e
Oxford Handbook of Anaesthesia 3e
Oxford Handbook of Applied Dental Sciences
Oxford Handbook of Cardiology 2e
Oxford Handbook of Clinical and Laboratory Investigation 3e
Oxford Handbook of Clinical Dentistry 5e
Oxford Handbook of Clinical Diagnosis 2e
Oxford Handbook of Clinical Examination and Practical Skills 2e
Oxford Handbook of Clinical Haematology 3e
Oxford Handbook of Clinical Immunology and Allergy 3e
Oxford Handbook of Clinical Medicine – Mini Edition 8e
Oxford Handbook of Clinical Medicine 9e
Oxford Handbook of Clinical Pathology
Oxford Handbook of Clinical Pharmacy 2e
Oxford Handbook of Clinical Rehabilitation 2e
Oxford Handbook of Clinical Specialties 9e
Oxford Handbook of Clinical Surgery 4e
Oxford Handbook of Complementary Medicine
Oxford Handbook of Critical Care 3e
Oxford Handbook of Dental Patient Care
Oxford Handbook of Dialysis 3e
Oxford Handbook of Emergency Medicine 4e
Oxford Handbook of Endocrinology and Diabetes 3e
Oxford Handbook of ENT and Head and Neck Surgery 2e
Oxford Handbook of Epidemiology for Clinicians
Oxford Handbook of Expedition and Wilderness Medicine
Oxford Handbook of Forensic Medicine
Oxford Handbook of Gastroenterology & Hepatology 2e
Oxford Handbook of General Practice 4e
Oxford Handbook of Genetics
Oxford Handbook of Genitourinary Medicine, HIV and AIDS 2e
Oxford Handbook of Geriatric Medicine 2e
Oxford Handbook of Infectious Diseases and Microbiology
Oxford Handbook of Key Clinical Evidence
Oxford Handbook of Medical Dermatology
Oxford Handbook of Medical Imaging
Oxford Handbook of Medical Sciences 2e
Oxford Handbook of Medical Statistics
Oxford Handbook of Neonatology
Oxford Handbook of Nephrology and Hypertension 2e
Oxford Handbook of Neurology 2e
Oxford Handbook of Nutrition and Dietetics 2e
Oxford Handbook of Obstetrics and Gynaecology 3e
Oxford Handbook of Occupational Health 2e
Oxford Handbook of Oncology 3e
Oxford Handbook of Ophthalmology 2e
Oxford Handbook of Oral and Maxillofacial Surgery
Oxford Handbook of Orthopaedics and Trauma
Oxford Handbook of Paediatrics 2e
Oxford Handbook of Pain Management
Oxford Handbook of Palliative Care 2e
Oxford Handbook of Practical Drug Therapy 2e
Oxford Handbook of Pre-Hospital Care
Oxford Handbook of Psychiatry 3e
Oxford Handbook of Public Health Practice 3e
Oxford Handbook of Reproductive Medicine & Family Planning 2e
Oxford Handbook of Respiratory Medicine 3e
Oxford Handbook of Rheumatology 3e
Oxford Handbook of Sport and Exercise Medicine 2e
Handbook of Surgical Consent
Oxford Handbook of Tropical Medicine 4e
Oxford Handbook of Urology 3e

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Oxford Handbook for the
Foundation
Programme

Fourth edition

Tim Raine

Clinical Fellow, Wellcome Trust
Clinical Lecturer, Gastroenterology, University of Cambridge,
Honorary Registrar, Addenbrooke's Hospital, Cambridge

James Dawson

Consultant Anaesthetist, Nottingham

Stephan Sanders

Assistant Specialist at University of California, San Francisco

Simon Eccles

Consultant in Emergency Medicine, St Thomas Hospital, London
1

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1

Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom

Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
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© Oxford University Press 2014

The moral rights of the authors have been asserted

First edition published 2005
Second edition published 2008
Third edition published 2011
Fourth edition published 2014

Impression: 1

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and you must impose this same condition on any acquirer

Published in the United States of America by Oxford University Press
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Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
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v

Contents

Detailed contents
ix

Preface
xvii

Acknowledgements
xviii

Symbols and abbreviations
xix

Introduction
xxxiv

10 tips on being a safe junior doctor
xxxvi

10 tips on being a happy doctor
xxxvii

1 Being a doctor
1

2 Life on the wards
65

3 History and examination
123

4 Prescribing
167

5 Pharmacopoeia
181

6 Resuscitation
223

7 Cardiovascular
239

8 Respiratory
269

9 Gastroenterology
287

10 Endocrinology
321

11 Neurology and psychiatry
337

12 Fluids and renal
371

13 Haematology
391

14 Skin and eyes
409

15 Emergency department
433

16 Procedures
509

17 Interpreting results
565

18 Appendices
599

Index
615

Common adult drug doses
646

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To every doctor who’s ever stood there thinking:
‘What on earth do I do now?’

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ix

Detailed contents

Preface xvii

Acknowledgements xviii

Symbols and abbreviations xix

Introduction xxxiv

10 tips on being a safe junior doctor xxxvi

10 tips on being a happy doctor xxxvii

1 Being a doctor 1
The Foundation Programme 1
The Foundation Programme 2
Applying to the Foundation Programme 4
The FP curriculum and assessment 8
Starting as an F1 11
Before you start 11
Your fi rst day 12
Occupational health 13
What to carry 14
How to be an F1 15
Getting organised 17
Being effi cient 18
Communication 19
Patient-centred care 19
Communication and conduct 20
Breaking bad news 22
Cross-cultural communication 23
Outside agencies 24
Quality and ethics 25
Clinical governance/quality 25
Medical ethics 26
Patient confi dentiality 27
Capacity 28
Consent 29
When things go wrong 30
Medical errors 30
Complaints 31
Incident reporting 32
Colleagues and problems 33
Hating your job 34
Relaxation 35
Causes of stress 35
Boring but important stuff 36
Pay and contracts 36

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x
DETAILED CONTENTS

Making more money 38
Money and debt 40
NHS entitlements 42
Your career 43
Specialty training 43
Specialty training applications 44
Career structure 45
Specialty training options 46
Specialty training competition 48
Choosing a job 50
Specialties in medicine 51
Your curriculum vitae 52
Post-Foundation Programme CV 54
Interviews 56
Membership exams 57
Continuing your education 58
Audit 59
Presentations and teaching 60
Teaching medical students 63
Research and academia 64

2 Life on the wards 65

The medical team 66
The multidisciplinary team 68
Daily ward duties 69
Ward rounds 70
Being on-call 72
Night shifts 73
Writing in the notes 74
Common symbols in the notes 76
Anatomical terms and planes 77
Forms 78
Discharge summaries (TTOs/TTAs) 78
Fitness to work notes 80
Referrals 81
Referral letters 82
Investigation requests 84
Radiology 85
Common ward dilemmas 86
Pain 86
Thinking about death 90
Palliative care 91
The dying patient 92
Death 94
Nutrition 102
Nutritional requirements 103
Diffi cult patients 104
Aggression and violence 105
Needle-stick injuries 106
Surgery 107

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xi
DETAILED CONTENTS

Pre-op assessment 107
Bowel preparation 109
Surgical terminology 110
Preparing in-patients for surgery 111
Booking theatre lists 112
Surgical instruments 113
The operating theatre 114
Post-op care 116
Post-op problems 117
Wound management 118
Common elective operations 119
Stomas 121

3 History and examination 123
Basic history 124
Basic examination 126
Recording your clerking 127
Medicine 128
Cardiovascular 128
Respiratory 130
Gastrointestinal 131
Neurological 132
Endocrine 137
Skin 138
Oncological/haematological 140
Surgery 141
Breast 141
Eyes 142
Head and neck 144
Musculoskeletal 146
Urological 154
Other specialties 156
Female reproductive system 156
Obstetric 158
Psychiatric 160
Neonatal examination 163
Paediatric 164

4 Prescribing 167
Prescribing – general considerations 168
How to prescribe – best practice 169
Drug interactions 171
Reporting adverse drug reactions 171
Special considerations 172
Controlled drugs 173
Enzyme inducers and inhibitors 174
Endocarditis prophylaxis 175
Night sedation 176
Steroid therapy 177
Topical corticosteroids 178
Empirical antibiotic treatment 179
Clostridium diffi cile (C. diff ) 180

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