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Okay, I'd like to welcome all the listeners to On The Wards. We're going to talk about intravenous fluids with Associate Professor David Gaddis. Welcome, David. Thanks for having me, James. David's an intensivist at RPA, and we thought we'd talk about intravenous fluids because I know as a junior doctor it's something ... |
Both of those things, and in a volume, it's often said 25 to 30 mils per kilo per day. So this is two litres for an 80 kilo sort of person in terms of maintenance fluids. So I think the first thing to say is customise it, customise the fluids you're going to give, particularly to the more vulnerable patients. Be aware,... |
It's not a fluid you'll probably see much in the wards. But no, some colloids are expensive, some of them have side effects, some of them are harmful. So given that the stated benefits in general are probably quite modest, I think that crystalloids being the mainstay for a resuscitation of hypotensive patient is a comp... |
Welcome to the next series of our RPA Podcasts and we've got Dr. Jay Yohendron, an author of the VMO at RPA. Welcome, Jay. Thank you. So we're going to talk about the red eye, which is a common presentation in the emergency department. So we imagine you're a junior doctor. Sure. You're in the emergency department, you ... |
Once you've looked, if you don't see any infiltrate and you're concerned that this patient might have a corneal abrasion or a corneal ulcer, a fluorescein staining is always important. And once you put the fluorescein on, you obviously need to turn the blue light on. And when the blue light's on, you can actually turn ... |
Then if they're a contact lens wearer, you need to be very careful. So always check for infiltrates. Then in terms of corneal foreign bodies or history of trauma with a red eye, the other red flag would be not to miss a penetrating eye injury. So again, one of the clues would be the shape of the pupil. So if there is a... |
Okay, that sounds good. Okay, well thanks Jay for coming. Jay, come and get a wrap up on the red eye. Pleasure. Thank you for inviting me. |
Welcome to On The Wards. It's James Edwards and today we're talking about decision-making capacity and I have the pleasure of having Ms. Claudia Wolfe here with us today. Welcome, Claudia. Thank you. Claudia is a clinical neuropsychologist working at St. Vincent's Hospital in Sydney. We're going to talk a bit about dec... |
For more complex sort of cases where it's more grey and the person is not sort of grossly cognitively impaired, again I would suggest discussing with your consultant but in those sorts of circumstances it might be helpful to get some sort of specialist or expert in to have a go at teasing this all apart because it's co... |
Welcome to On The Wards, it's James Edwards and today we're talking paediatrics and I'd like to welcome Dr Chris Elliott and Dr Kylie Yates. Welcome. Hi James. Chris and Kylie are both consultant paediatricians at tertiary hospitals here in Sydney. We're going to talk particularly about communication and we'll start wi... |
So that comes back to my point before about finding out what is the parent's reason for presenting and then helping reframe that for the parents that, OK, you've got a fever, but, you know, on an ABCD that Chris mentioned on a previous podcast, they're actually still quite active, they're still drinking, they've got no... |
So when someone calls me I want to know one of three things. Do I need to come now? So is it an emergency that requires me to assess the child? Am I just being told about an admission which doesn't require much input from me at that point possibly? But I need to think about are we on the same page for that? Or I want t... |
Yeah. I think all consultants, registrars over the phone, really enjoy more structure in handovers. Because I think the idea of the other end of the phone, if you know their structure, you know what's coming next as well. So you can kind of... If something has been missed, you kind of go, well, he or she would have tol... |
Welcome to On The Wards and the second part of our two-part interview in which Dr Bruce Way discusses undifferentiated shock with intensivist Dr Robert Hisler. All right, we might move on to the next case. So this is a 78-year-old man who's on cardiac ward. He's been admitted for, well, they're unsure what the diagnosi... |
And I think the basic principles are make sure it's safe and then do it. And when you do it, you should do it rapidly and you should give enough of a volume that you're going to notice a difference one way or the other. I do think that part of that assessment for making sure that it's safe is having a look at the patie... |
That can be an inexorable spiral of death once you start to enter it. And it's not all that common, but it can happen if you just continue to feel very aggressively inexably, without paying any attention to what's happening to those filling pressures. So those would be the two main risks. The most common one would be t... |
Okay, welcome to On The Wards. It's James Edwards and today I have the pleasure of having Dr. Kate George and Dr. Angus Ritchie. We're going to be talking about collaborating with general practice and Kate's a general practitioner working in Leichhardt and Angus Ritchie is a nephrologist working at Concord Hospital. We... |
She was going to need to be placed in a nursing home. And so that's the kind of coordination that I think we have a lot of trouble trying to do from within the hospital system and where it was really effective working with a GP who knew that family and a much better outcome than trying to break the news over the phone ... |
Welcome to On The Wards. My name is Jules Wilcox and today we're talking about compassion with Dr. John Scott. Welcome, John. John is an ED consultant up at Gosford. And he's been working there for a number of years. He's a naturally optimistic, outgoing, energetic person. And he was quite shocked to find himself burnt... |
So she went away feeling like she'd been heard and her life, hopefully, was one step closer to getting better. And she wasn't going to bounce back in again and again with chest pain. Exactly. Yeah. So, yeah, economic benefits from it as well for our system. But for me, it made a big difference because I felt really gre... |
Well it certainly improved your functional scores as well and halved the number of painkillers that you needed as well. Yeah, yeah, that was fascinating that one. Yes, that was, well there was one, wasn't it, like preoperative stuff? Oh, the preoperative, definitely, yes. That was another study, I think, yeah, where th... |
I think it still had more of an effect than that. In terms of preventing cardiovascular risk factors and stroke, cardiovascular mortality from stroke and ACS, compassionate effects had a better effect than aspirin. Yeah. Which is our mainstay. So that's just huge. There were just so many studies in there. It doesn't ma... |
I've relived it hundreds, if not thousands of times in my mind since, and I cannot tell you how much I still remember and appreciate every small aspect of compassion from everyone involved that day. From every carefully chosen word, every supportive inflection and tone, every warm touch or moment of silence and support... |
Welcome to On The Boards, it's James Edwards and today we're returning to one of our original podcasts, tips and tricks for for Junior Doctors on Indwelling Catheters. And we'd like to invite Dr. Nari Ahmadi to speak. Welcome back, Nari. Thank you, James. Nari gave one of our first podcasts on Tips and Tricks on Cathet... |
That's the other problem. People who are impatient, they keep pushing it and they create a false lumen just where the urethra turns. Because the urethra is so supple and the tissue is very sort of fragile, if you push hard, especially with the silicone catheters, a false lumen gets created. So all the subsequent cathet... |
And are there any other particular times where we should escalate to a more senior doctor? Yeah, so essentially if some patient has had a urethral reconstruction surgery, if someone's had radical prostatectomy recently, someone who's had, you know, radiation to prostate, any treatments to bladder or prostate that might... |
And when you put a catheter in and decompress the system, these patients usually produce a lot of urine, and a lot of urine and a lot of urine very fast. And they do lose a lot of electrolytes. And it takes a little while for the kidneys to recover and learn to re-concentrate the urine. So in these cases, you have to m... |
Welcome to a thought-provoking discussion. My name is Dr. James Edwards. Today we'll be discussing diagnostic error and this is an initiative of our partnership between On The Wards and Avant and I have the pleasure of welcoming today Dr. Mark Graber. Good morning James. Mark is a leader in the field of patient safety ... |
Communication is a big one. I mean, I think, you know, so many times I think we see claims and complaints where we wonder, you know, was the diagnosis missed because of an inadequate history? But also very frequently we can't tell whether that history was adequate or not because the documentation wasn't great. And I ca... |
But what the IOM envisioned is first there would be this partnership between the physician and the patient. So that's kind of a new team concept. And the nurses involved would also be part of the team. The nurses know a lot about our patients. They spend a lot of time with our patients. They are in an ideal position to... |
Welcome to On The Wards, it's James Edwards and we're back again with another podcast. Today we're back with one of our favourite presenters, Shafqar Inam, who's our Haematology Registrar at RPA and Concord, currently working at the Red Cross. Welcome back. Good to be here. So today we're going to talk about thrombosis... |
Longer-term complications of DVTs include post-thrombotic syndrome, which is pain and swelling of the leg after resolution of the initial clot. This might be helped by compression stockings. Of course, the decision needs to be made down the track about the cessation of anticoagulation treatment, so ensure that the pati... |
Welcome to a thought-provoking discussion. My name is Dr. James Edwards. Today we'll be discussing diagnostic error and this is an initiative of our partnership between On The Wards and Avant and I have the pleasure of welcoming today Dr. Mark Graber. Good morning James. Mark is a leader in the field of patient safety ... |
Mark, another word that we hear a lot is bias, and we want to talk a bit about cognitive biases. What are they? Yeah, so biases are the downside of all those 150 heuristics that we started talking about. So generally the heuristics are wonderful and they get us through our day, but each one has got a drawback. So, for ... |
Welcome to On The Wards, it's James Edwards, I'm the host of the podcast series On The Wards. And we've got Associate Professor Neil McGill, who's a rheumatologist at RPA, who'll be speaking on a couple of rheumatological topics, the red-hot swollen joint and gout. Welcome, Neil. Thank you, James. So we're going to hav... |
It's usually mistaken for arthritis, but if the pain and the swelling is mainly anterior, if you can't detect an effusion by using the swipe test or the bold sign, if it doesn't seem to be there despite the fact that the whole area is swollen and tender, that possibility should be thought about and that means asking so... |
So keeping it dry for a period of time is a reasonable precaution. So we've got the fluid and we put it in one of the little yellow jars. What do we set it off for? So we send it, most importantly, for a cell count, a gram stain, and for crystal identification, followed by culture. So the results that we can get back e... |
There'll be a train of notes about how to get a mercy position at this conference, although it is for everybody. Look, I'm going to talk about mistakes I see junior doctors make, and it's not junior doctors, it's all people I see in regard to their CVs, and I look at a lot of CVs. I've got a different role, so I look a... |
He does quality assurance ultrasound, make sure we all put our ultrasound data in and our images in and check so as to make sure they're done. He runs the ultrasound committee within our hospital. He also does research on the ultrasound about how it changes our practice. He actually presents papers and presents confere... |
Welcome to On The Wards, it's Jules Wilcox here and today we're continuing our financial wellness theme and we're talking about property investing with Jeremy Calnan. So welcome, Jeremy. G'day, Jules. Great to be here. Yeah, welcome back, I should say. We talked last time in more general terms about investing and econo... |
And that's how property works. If there's a new railway line that goes in, then it makes it easier for you to get to and from the city or other transportation. Then again, that's money that the government spends. As society, we provide that infrastructure and yet Jules gets the benefit of that in increased house values... |
And so this means that essentially when we buy an investment property, we're getting into the accommodation business. And that's probably the easiest way to think of it. So if we're running a business and we've got expenses attached to that, then we get to claim those expenses. And that's really important when it comes... |
But that's how you gain your experience. You're moving about. But just because you're moving about doesn't mean you should forgo the benefits of investing in property. But instead of thinking about, well, okay, I'm going to go and buy what's my family home, why not just buy an investment property? So as Jules said, tha... |
I guess the only other thing I would say as well, and I was talking to one of my interns yesterday and he was talking about property and looking at buying and so forth. Just a slight word of warning in terms of cycles. We're expecting the peak this time to be sort of 26, 27, something like that potentially, Jeremy. I'm... |
Welcome Junior Doctors for another podcast series in 2014. We've just had a podcast on fever on the wards and to go with the, I guess, infectious disease flavour, we've got a podcast on antibiotics and we'd like to welcome Dr Rebecca Davis, an infectious disease physician and microbiologist at RPA. Thanks James. Look, ... |
So you tend to change the dose rather than the duration. So you stay with BD but a smaller dose. Yes, I think there's a bit of variability in that because we know that if the people with worse creatinine clearance, we do increase the dosing interval. So I think, you know, if in my scenario you had to halve the dose, so... |
Welcome to On The Wards. I'm Becky Taylor, an obstetric and gynecology fellow based in Sydney, Australia. And today we're talking about human factors in medicine with Dr. Vijay Roach. Welcome Vijay. Thank you. Vijay is a visiting medical officer in obstetrics and gynaecology in both public and private practice in Sydne... |
And there is not one gynecologist, whether it's in the course of their training and even throughout their career, that has not perforated a uterus doing a DNC or a hysteroscopy or some other procedure. And when it happens, you feel as though you're a complete failure. And yet we know. And people who are older than you,... |
One of the things I thought about, if I walk into a room, I don't have to announce who I am because everyone knows who you are. So you don't have to tell everybody who you are. You don't have to make it clear that you've arrived. You can actually be the quiet person who stands at the back. We had a situation the other ... |
And the reality is that that's now all been converted to Zoom. And that's really boring. And it's often really quite soul destroying, let alone being exhausting. But that's the deal. You know, you can either sort of complain about it and say, it's not fair. And why did that happen to me? Or you can say, that is the dea... |
Welcome to On The Wards, James Edwards. Today we're talking about one of my favourite topics, fever in the return traveller. And we have the pleasure of having dr indy sandra adura here today he's a infectious disease physician and a clinical microbiologist at from westmead hospital welcome indy thanks james so before ... |
Maybe let's go back to malaria. That's often one that, you know, how many sets of malaria, thick and thin films, do you do kind of serogical testing or antigen testing? Can you just go through malaria for us? So I guess what you need to be aware of is the best tests for malaria are sort of thick and thin films, but the... |
And often, again, there's very little apart from that in terms of other examination findings. We'll now go to management. I guess in the management for the junior doctors, it's usually about escalation and when you call the ID, registrar ID consultant. But before that, in regard to isolation, they come into your ED, yo... |
Welcome to On The Wards, it's James Edwards, and today we're talking about a really interesting concept of deliberate clinical inertia. It's probably not a concept many of you would have heard of, but we've actually got one of the authors of an article that coined the concept, and that is Professor Gerben Kaisers. Welc... |
And that's fair. And I think that sometimes I've been in situations where I see a patient, they have been with us for hours and they've been told one thing and it's really hard to tell the patient they don't need it because then you lose some of that therapeutic relationship as well. So I'm not saying I never do things... |
But if you sometimes didn't need any of those pieces of the puzzle, the reality is we don't really know what is more efficient. And obviously you can't have a detailed academic discussion about every single decision we make. Sometimes we do need pattern recognition as part of our normal daily work. If you go to the war... |
It's the final countdown. And the reason for choosing that song actually ironically follows Claire's song because I had some medical students at Western Sydney, Western Sydney represent, who I had to say during award round, at the end of the third track, let me know the song is winding down. And I bolted down and hit n... |
But it's not true. He sits at the foot of the bed. Now there are some tools you can use to help you identify, particularly for non-malignant patients, who are people who are appropriate for palliative care referral. And so particularly the SPICT tool, which is from Scotland, the Supportive and Palliative Care Indicator... |
But the thing that's really handy is on the back, it actually has some of the words you can use, some of the questions you can ask. So it's really practical. And then what do you say to the carers? And I should flag this is the New South Wales guardianship hierarchy, but we define the person responsible in this state b... |
Now, this is on my bucket list. It's called the Firefalls at Yosemite. It's not a river of lava. It's a normal waterfall. But when the setting sun in the west is coming in at a certain angle with a full moon rising behind the moon, this waterfall lights up perfectly like it's lava. It's amazing. And what we want for ev... |
Welcome to On The Wards, it's Tom Aiton. Today we're talking about human factors in medicine with Mackenzie Little. Mackenzie has recently returned from the Tokyo Olympics where she represented Australia in the javelin, finishing eighth in the world. She's also a medical student at the University of Sydney, currently s... |
It may have lengthened my kind of journey in medicine, but I feel I have absolutely no regrets. So I did those years in the US. I took the GAMSAT. I sat the GAMSAT in Washington, DC. That was the only place in the US where it was available. So I took a flight over, took the GAMSAT there and then came back for interview... |
And I know how silly that sounds when I say it to the doctor because then I come into hospital and there's people who, you know, are having trouble with their ADLs who have really practical, fundamental, basic changes to their life. And I think, yeah, for some reason I'm more drawn to that. Um, and so, yeah, um, that's... |
Welcome to a thought-provoking discussion. My name is Dr. James Edwards. Today we'll be discussing diagnostic error and this is an initiative of our partnership between On The Wards and Avant. And I have the pleasure of welcoming today Dr. Mark Graber. Good morning James. Mark is a leader in the field of patient safety... |
In regard to, I guess, summing up some of the issues you've identified around diagnostic error, do you have any take-home messages? Oh, there's many take-home messages. I think the big one is that these errors are common. We all know about it as physicians. We know about malpractice, but we assume that that's the other... |
Welcome to On The Wards, it's James Edwards and today we're going to talk about asthma and we have Associate Professor Keith Wong. Welcome Keith. Thank you James. Keith's a respiratory physician here at Royal Prince Edward Hospital and we're going to discuss asthma which is a common presentation on ED but it's also see... |
So she's kind of, we think she's got a mild exacerbation of asthma. We've started one sabudamol through a puffer. What do you think is, I guess, the preferred route of giving sabudamol? We can either give a nebulise or inhaler and spacer. What's your preference? I think the general guidelines now recommend a metadose i... |
If they're not improving, then they need to be managed in an intensive care environment, and then most likely they would need to go there. Okay. One thing I didn't mention before about a blood gas. A blood gas is useful in people with asthma? I'd say not in a mild exacerbation. In this severe sort of situation, definit... |
Welcome to On The Wards, it's Jules Wilcox here and today we're talking about emotional intelligence with Professor Kirsty Forrest and Associate Professor Jerry Bishop. Kirsty Forrest is the Dean of Medicine at Bond University. She's an accomplished medical education leader, teacher, researcher and clinician with prove... |
So there is an evidence field building research evidence around emotional intelligence and what it's come from is teams that you work in as well where they've shown that high teams with high emotional intelligence have better patient outcomes and that their evidence evidence is there so patients do better if the the te... |
Is there any plans to do any of that sort of research? We're going to try. But I think as you pointed, there's so many confounders in there. We also happen to have the Institute of Evidence-Based Practice in our faculty, which is led by Paul Glazio and Chris Delmar, who are into those, what we call overuse of medicine.... |
Okay, welcome to On The Wards, it's James Edwards and today I have the pleasure of speaking with Dr. Barbara Depkinski, who's a intercollateral at Prince of Wales Hospital. Welcome Barbara. Thank you. Now we're going to talk about something today that every junior doctor would have prescribed, steroids, and many patien... |
And in regard to use hydrocortisone, why do you use that rather than dexamethasone? Hydrocortisone is readily available on the wards but if the nurse turned around and said I'm sorry there's no hydrocortisone available but there's dexamethasone? Hydrocortisone is readily available on the wards, but if the nurse turned ... |
Today we're having a podcast on transfusional reactions and we invited Dr Ibrahim Tahidi S. Fahani, who's an advanced trainee in haematology, working here at Royal Prince Alfred Hospital and Concord Hospital. He's a clinical associate lecturer at University of Sydney and graduated from the University of Newcastle with ... |
Now, the more severe one, you mentioned some of those blood tests that you would perform. And if you were concerned it was an acute hemolytic reaction, you send off those blood tests. Any else you do part of the management? So, as we alluded to earlier, it's quite important to make sure that no more of that blood reach... |
Okay, I'd like to welcome everyone, all our listeners from on the wards and today we have Dr. Stacey Cienkolowicz, who is one of our neurologists here at RPA. We're going to talk about seizures. Welcome Stacey. We start with a case because seizures are reasonably common in the ward and you're a junior doctor, you're wo... |
Also, if the seizure is only one-sided or one limb, then when we find weakness in that limb, as the tides paresis, that explains things. The other type of seizure, you know, just a tonic seizure, so the person just goes stiff, that also needs to be differentiated from a tonic-clonic where there's contract, relax, contr... |
So it's always important to look at the patient from top to toe to make sure that they're not feeling. Okay, well, thank you, Stacey, for such a fantastic update on seizure management. Thank you for inviting me. |
Welcome to On The Boards, it's James Edwards. Before we start our podcast today, I'll just ask our listeners out there for any topics they think we should cover. We've covered over 70 podcasts now on different topics and we're starting to think what else can we talk about. So any particular topics you'd like us to talk... |
Any other investigations that you would think would be appropriate for a junior doctor considering someone who's hypoxic? Yeah and in fact you could even ask for some of these things to happen even before you got to the bedside so an ECG could already be underway by the time you arrived. And getting a bedside X-ray can... |
Hi, welcome back everyone for our third podcast session of the JMO podcast series. We've got Lauren Troy, one of our respiratory start specialists here at RPA. And we thought we'd have a look at a fairly common problem for junior doctors, the patient who's short of breath post-operatively. So welcome, Lauren. Thank you... |
You could also think about the possibility of other diagnoses such as pneumothorax or pleural effusions or haemothorax. All of those things can be seen on chest x-ray as well, although in the post-operative setting, less likely. Okay. And what's the value during arterial blood gas in a post-operative patient? There are... |
Welcome to On The Wards, it's James Edwards and we're speaking about all things that junior doctors need to know and this one is a big topic and it's something I think everyone finds confronting especially when you do it the first time that's doing an intensive care consult and we have the pleasure today of speaking to... |
But yeah, taking them out of an area where they're being resuscitated to an area where it's harder to do the resuscitation and to monitor them and furthering away from further resources is not advisable. And similarly, you're here, you've run ICU, they said they're coming, you get another five dozen pages of other thin... |
Welcome to On The Wards. This is James Edwards. Today we're discussing the new Sepsis Clinical Care Standard with Dr. Carolyn Hullock and Professor Simon Fidler. This podcast is being brought to you by the Australian Commission on Safety and Quality in Healthcare, following the release of Australia's first national sta... |
I think it was very interesting. Sorry, James, go ahead. No, I thought it was very interesting how you mentioned the consumer and patients. I mean, Caroline, what role do you think patients and consumers have in, I guess, empowering to kind of think about or prompt clinicians to think about sepsis? I think as a senior ... |
I was just going to say, James, the second part of the clinical care standard is actually that the antibiotics should be reviewed within 48 hours. So I suppose that's the anti-measure of administer them within 60 minutes, but make sure they're reviewed within 48 hours, as Simon's referred to. Look, I'll kind of take up... |
Well, thank you so much, Carolyn and Simon, for speaking to our On The Wards audience. I guess I'd like to say also thank you. Congratulations on putting the new sepsis clinical care standard together. Trying to get agreement from so many different people and different perspectives is always a challenge. So it's an inc... |
Okay, welcome to Well and the Wars. It's James Edwards. I'm here again speaking to one of our clinicians at Royal Prince Albert Hospital, Associate Professor Nick Evans. Welcome Nick. Thank you. Nick's a staff specialist in neonatal medicine at RPA and we're going to talk about something that would be of concern, is se... |
It's actually a minority now who go home formula fed. But if you look at breastfed babies, then probably the normal range, it goes down to about a loss of 12%, something like that. If you look at a formula fed baby, then probably 8%, 9%, 10% would be more usual usual and obviously the ten percent reflects the balance b... |
I always say reflux has become the new colic, if you know what I mean. And it used to be 20 years ago, everything a baby did was blamed on colic. And now it's all blamed on reflux. And there's a lot of sort of possible remedies out there for a baby who has sort of ongoing reflux. To me, the most important thing is that... |
Welcome to On The Board, it's James Edwards. Today we're talking about some of the common calls you may get for a rapid response system and what your role as a junior doctor is in these rapid response calls and I'd like to welcome Dr Luke Collette. Welcome Luke. Good morning. Luke's an intensive care fellow at Royal No... |
I'd be giving some fluid, a 250 to 500 ml fluid bolus, and I'd be thinking about additional intravenous access, additional blood tests to recheck his haemoglobin, and then going on getting his drug chart, get a better picture of things I was touching on earlier. Again in those first few minutes deciding whether you nee... |
You've kind of described a story of having a fairly standard scheme of identifying and treating most of these patients. Any other kind of take-home messages on how the Junota can be helpful within these rapid response calls? No, I think I'll just reiterate some of the things I mentioned earlier about being willing to s... |
Okay, we'll welcome everyone to our next podcast session. I'd like to welcome Professor David Sellemeyer. Hi, James. Hi. Well, Professor Sellemeyer's got an outstanding CV, but we've only got 20 minutes, so we won't go into too much detail. But he's a Scandra Professor of Cardiology at University of Sydney, a College o... |
And in the context of one of the things we may talk about in a minute, and that's whether to use beta blockers or not, it's pretty important to try and get a sense of whether the person might have underlying ventricular dysfunction from whatever clues you can get. So I'd say rate, rhythm, broad or narrow complex, and t... |
Obviously a chest x-ray would be helpful. Is there any indication for urgent echoes in patients who come with atrial fibrillation? There are a couple of circumstances where an echo might be incredibly helpful and they're usually where the patient is sicker than you would imagine they should be simply from their atrial ... |
We do tend to give anticoagulation for two weeks, even in people who revert spontaneously. Now, to be absolutely honest with you, James, sometimes if it's been really short-lived and it's a well person, I just give them 10 syringes of clexane and I say, just give this to yourself morning and night for five days because... |
Welcome to On The Wards, it's James Edwards and today I have Associate Professor Darren Roberts back speaking to us about hypernatremia. Darren gave us a fantastic review of hyperkalemia. But hyponatremia we're both discussing can be a bit tricky. We're going to go to a case. You're on the wards and first thing in the ... |
And this would be predicted to be low in the vast majority of cases, which would go with water retention, which would go then with a hyponatremia. In many cases, we also get a urine sample as well. The urine, we can look for the concentration of sodium, and this can tell us about the kidney's response to the hyponatrem... |
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