Ward Round Notes

Connective tissue disease mind map To make image bigger right click and click open in new tab. 

The position of NG tubes are most accurately ascertained by x ray. A chest x ray should be done if there is any doubt about the tubes positioning or if there is suspicion that the tube has moved. To confirm the placement of an NG tube on an x ray the NG should: Be in the midline Bisect the carina go through the diaphragm at the midline The tip should be below the diaphragm

When thinking about prescribing it can be difficult to know which side effects and contraindications are important to remember. I have therefore compiled a list of common things to look out for when prescribing (which is by no means exhaustive/complete). Common or noteworthy drug side effects and contraindications:  Tramadol increases seizure risk in patients with epilepsy, and patients on SSRIs, MOAIs and Tricylic antidepressants. They also increase the risk of Seretonin syndrome with SSRIs. Do not give B blockers and  calcium channel blockers mainly targeting the heart (verapamil, diltiazem) together as this can cause bradycardia and arrhythmias. Avoid B blockers in asthmatics. NSAIDS may also cause bronchospasm and should be avoided if an asthmatic patient has not used NSAIDs before or is symptomatic. NSAIDs also cause irritation to the stomach lining and should be avoided/given cautiously in patients with a history of GI bleeding, peptic/duodenal ulcers and dyspe...

Open/Closed Open or compound fractures are exposed to the environment and therefore more likely to become infected and lead to complications. Because of this open fractures are often managed differently. Open fractures can be categorised by the gustilo classification depending on the extent of damage to the surrounding tissues: I - Low energy with wound less than 1cm. II - greater than 1 cm with moderate soft tissue damage. III - Wound greater than 1 cm with severe soft tissue damage Where - Bone and part of bone Describe which bone and where on the bone the fracture is, long bones are usually divided into distal (away from body), middle and proximal(closer to body)3rds of the bone,or can be described as a mishaft fracture if the fracture is in the middle. Other bones have particular landmarks which are more prone to fractures or relevant to management. For example, hip fractures can be described as intracapsular or extracapsular fractures.

Technical issues - projection, AP film, patient rotated or inadequate inspiration.  Masses - Thyroid, Lymphoma, teratoma, neurogenic tumour.  Achalasia  Scoliosis Paravetebral abscess from tuberculosis Thoracic aortic aneurysm Ellis H, Calne R, Watson C, Lecture Notes General Surgery, 11th ed. Oxford, Blackwell Publishing 2006 Radiology Masterclass, Mediastinal abnormalities [online] available at: http://radiologymasterclass.co.uk/tutorials/chest/chest_pathology/chest_pathology_page9.html [accessed:02/11/2014] Van Sambeek R, Anterior mediastinal masses, [online] available at: http://eradiology.bidmc.harvard.edu/LearningLab/respiratory/sambeek.pdf, [accessed: 02/11/2014] Image: http://en.wikipedia.org/wiki/Achalasia#mediaviewer/File:Achalasia2010.jpg [accessed: 02/11/14]