Thursday 26 April, 2007

Summary of treatment of asthma in adults

Posted in Emergency, Emergency Dept., General Practice, Medicine, Michael Tam, Resources, Wards at 0:28 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Resources

Asthma Management Handbook 2006 (National Asthma Council Australia) [1.1 Mb]

The management of asthma is clearly and in excruciating detail described by the National Asthma Council of Australia. Last year, the NAC published the 2006 update to the Asthma Management Handbook (1) which for all intents and purposes, should be considered the “gospel” of asthma management. Nevertheless, I have a number of criticisms against the publication. According to its own introduction, it is designed as an evidence-based guideline of asthma management aimed at general practitioners. However, I question whether more than a handful of GPs would actually read the entire 157 pages of the handbook! The lack of summary pages on management is unhelpful.

This article was written to address some of the deficiencies by distilling the management of asthma in adults into digestible chunks.

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Wednesday 7 March, 2007

Collect blood in the serum tube first

Posted in Emergency Dept., General Practice, Michael Tam, Procedures, Wards at 22:00 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Vacutainer system

This short article is relevant for those people or institutions that use vacuumed tubes for venepunction and does not apply to using a needle and syringe.

One of the disadvantages of using a vacuumed tube system for directly withdrawing blood is that there is always a possibility that the needle dislodges or that the vein collapses before all the necessary tubes are filled.

For a long time, this would involve an apology from myself to my patient and a second venepuncture to collect the necessary blood. This is actually a reason that to this day, I still prefer using a plain needle and syringe (despite the increased needlestick risk) for patients with either difficult access or who require blood in many tubes.

However, this is a trick that I learnt from experience:

Always collect blood in the serum tube first.

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Monday 26 February, 2007

Google-based medicine

Posted in Advice, Emergency Dept., General Practice, Michael Tam, Rants, Wards at 23:00 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Warning: This article is as much tongue-in-cheek as useful advise.

As much as we aspire to EBM (evidence-based medicine) I suspect that many of us perform “GBM” (or Google-based medicine)!

Google has become an invaluable tool as part of my day to day practice. Indeed, I find certain aspects of practice irritating without access to the internet (e.g., the current general practice I’m working in as well as the occasional hospital ED that is restricted by a firewall).

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Wednesday 7 February, 2007

Physical examination begins with the hands

Posted in Advice, Emergency Dept., General Practice, Medicine, Michael Tam, Wards at 22:25 by Michael Tam

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All too often for JMOs, physical examination of the hands is forgotten. In situations other than test conditions, most people “go for the money” – jumping immediately to the body system expected to have the problem. This is perhaps understandable in the time poor hospital environment.

Nevertheless, I feel that all physical examination should always begin with the hands. Even if there are no specific physical signs, the hands can tell you much about the patient:

  • Are they warm and well perfused?
  • Is the patient nervous and sweaty?
  • Do the hands tell you something about the patient’s occupation and lifestyle?

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Tuesday 6 February, 2007

How to write a PBS prescription

Posted in Emergency Dept., General Practice, Medicine, Michael Tam, Resources, Wards at 23:05 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Resources

Application for approval to prescribe medications under the Pharmaceutical Benefits Scheme (by a registered medical practitioner)

The is the Medicare Australia application form for a prescriber number [118 Kb]

Writing an R/PBS (repatriation/pharmaceutical benefits scheme) presciption (aka “external” script for hospital based JMOs) is easy and simple when you know how. Incredibly (looking retrospectively), I don’t think that anyone actually went through with me how to write one. I’m sure there were more than a handful of community pharmacists shaking their heads (or their fists) at my dodgey scripts when I was a resident in ED!

This article is aimed mostly at interns and residents on how to write a community R/PBS prescription.

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Monday 29 January, 2007

How to do a good hospital discharge

Posted in Advice, Emergency Dept., Michael Tam, Rants, Wards at 21:44 by Michael Tam

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Consider a discharge of a patient from hospital (be it a ward or emergency department admission); what is the goal? You are trying to achieve a smooth transfer of care from the hospital team to the general practitioner. Thus, this article has an alternative title:

“How not to annoy the general practitioner with hospital discharges”

As a hospital JMO (the “turfer“), discharging a patient back into the community is often a relief. For the general practitioner who is on the receiving end (the “turfee”), there can often be many things that are frustrating and annoying. Having worked on both sides of the system, this article is about how to discharge patients without annoying the general practitioner (too much), and thereby, improving continuity of care.

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Develop your “outside” interests

Posted in Advice, Emergency Dept., General Practice, Michael Tam, Wards at 21:15 by Michael Tam

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Cycling is fun!

As a junior medical officer, your time is often not your own. Between work, study, medicine related projects (e.g., research papers, presentations), family, meals and sleep there is often precious little time left!

Do not sacrifice your interests and hobbies for medicine as a junior medical officer. These “outside” interests makes you a holistic rounded person and in doing so, gives you a better understanding of humanity. This can only make you a better doctor.

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Sunday 3 December, 2006

Opioid analgesic dose conversions

Posted in General Practice, Medicine, Michael Tam, Wards at 19:37 by Michael Tam

Original article by: Michael Tam :: Printer friendly

morphine

Opioid analgesics are the cornerstone to treatment and control of severe pain. Equivalence of dose potency is not absolute and care must be taken in changing analgesics. In general, it is safer to use a lower regular dose with breakthrough analgesia rather than to convert immediately to the “equivalent” dose.

It is important nevertheless to know the approximately dosage conversions.

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Monday 27 November, 2006

Topical corticosteroids

Posted in Dermatology, General Practice, May Su, Wards at 22:18 by May Su

Original article by: May Su :: Printer friendly

Topical corticosteroids are used for a variety of dermatological conditions – dermatitis (atopic eczema), psoriasis, or in conjunction with anti-fungal agents for severe tinea.

There is a confusing array of topical steroid preparations available in Australia. The question is which to use, and when.

Potency is dependent on the type of corticosteroid, the vehicle it is applied with (i.e., lotion, cream or ointment) and whether an occlusive dressing is used.

Potency is directly proportional to the risk of side effects associated with their use. It is preferable to use the lowest potency agent required to effect treatment.

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Sunday 19 November, 2006

Management of obesity

Posted in General Practice, May Su, Medicine, Wards at 15:51 by May Su

Original article by: May Su :: Printer friendly

As medical students and doctors we know that obesity is bad. It leads to all sorts of problems – hypertension, hypercholesterolaemia, diabetes, ischaemic heart disease (and other vasculopathies), arthritis, obstructive sleep apnoea, gastro-oesophageal reflux disease. Certainly there is a much higher mortality and morbidity associated with being overweight or obese.

We have been aware of the term “metabolic syndrome” (also known as syndrome X, insulin resistance syndrome) since the 1970s. This is characterised by a group of metabolic risk factors in one person leading to an increased risk for diabetes type II, and for vascular disease such as ischaemic heart disease or cerebrovascular disease (1) (2). The biological reasons for why it occurs is poorly understood, however we are aware that abdominal obesity and increased insulin resistance plays a key factor.

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