Dying is a natural process and unfortunately, something that we all come across in our daily jobs, including whilst on call. Despite this, very little time is dedicated during our training towards managing the dying patient. Instead, all the focus is upon saving and resuscitating the patient. The question is though, what do we do
Hypophosphatemia is a serum phosphate concentration < 2.5 mg/dL (0.81 mmol/L). Mild hypophosphatemia is somewhat common and usually isn’t a cause for concern however severe hypophosphatemia can be life-threatening and requires medical treatment. The UK Medicines Information group have provided excellent guidance on how to replace phosphate. Clinical features Causes Investigations Treatment References & further reading By
Alongside strengthening bone, calcium is used in the clotting cascade, in muscle contraction, and in nerve-signalling. As such, low levels can lead to coagulopathy, smooth and skeletal muscle-spasms, heart problems, altered sensation and even seizures. Acute hypocalcaemia that is severe (<1.9 mmol/L) or symptomatic can be life-threatening and necessitates urgent treatment. It is often initially
Constipation is one of the most common complaints in hospital, especially on the geriatric wards.Failure to treat constipation can lead to longer hospital stays and increased morbidity. What’s normal? Anything from 3 times per day to 3 times per week is normal for adults. What causes it?Many things cause constipation, most commonly in hospital, it
When assessing pain, ensure you begin by taking a history to characterise the pain as neuropathic pain, inflammatory pain and oncological pain all respond to different analgesia. SOCRATES is a helpful way to systematically take this history as it will help identify any serious underlying disease that is causing the pain and whether any further
There are certain situations where you need to prescribe IV fluids which vary from fluid resuscitation to maintenance fluids if a patient is nil-by-mouth (NBM) (e.g. pre-operatively, ‘drip & suck’ for bowel obstruction, acute pancreatitis, recent stroke with unsafe swallow). The NICE Guidance CG174 Intravenous fluid therapy in adults in hospital contains an excellent PDF
