Podcast: http://soundcloud.com/drtmcf/tutorial-14-april-2011
First we went through the technique applicable to a waiting list prioritisation.
Then we did a labour ward prioritisation. Again to look at technique. We had done this before, but it was one of the early tutorials and many people missed it.
The scenarios we used are below.
If you want my versions of the answers, send me an e-mail with your versions.
Waiting List Prioritisation.
Your consultant is away.
The waiting-list manager comes to see you.
The following patients have been listed by junior staff.
The waiting-list manager wants you to:
confirm the appropriateness of the proposed treatment,
decide the degree of urgency,
confirm the appropriateness of the proposed venue,
decide any special requirement(s) for each patient.
Name | Age | Clinical Problem | Proposed operation | Venue | Special Needs | Urgency |
JK | 5 | chronic discharge. ? foreign body | EUA | Main theatre | ||
JM | 32 | 1ry. infertility | Laparoscopy + tubal patency tests | Main theatre | ||
GN | 77 | Vulval cancer. Coronary thrombosis x 2. Unstable angina. | Radical vulvectomy agreed at MDT. | Main theatre | ||
RU | 55 | PMB x1. Weight 20 stones. 1 stone = 14 lb. 1 kg = 2.2 lb. So, 1 stone = about 6.3 kg. I think they would give you kg in the exam. | D&C. | DCU. | ||
LD | 32 | Menorrhagia. Fibroids. Anaemia. | Vaginal hysterectomy. | Main theatre. | ||
DT | 22 | Does not want children. | Lap. Steril. | DCU | ||
HB | 14 | Unwanted pregnancy at 10.52. | TOP | DCU. TOP list. | . | |
JY | 44 | GSI. | Anterior colporrhaphy. | Main theatre. | ||
JS | 23 | Vaginal discharge. Cervical ectropion. | Diathermy to cervix. | DCU | ||
DT | 55 | 3 cm. ovarian mass. | Laparoscopy ? proceed to Hyst + BSO. | Main theatre. | ||
EV | 32 | CIN3. | Cone biopsy. | DCU | ||
UW | 34 | Endometriosis | Laparoscopic ablation | DCU | ||
HT | 88 | Cystocoele/ rectocoele/ 2nd. degree uterine prolapse | Manchester Repair. | Main theatre. | ||
KN | 58 | Haematuria | Cystoscopy | DCU | ||
JW | 18 | Menorrhagia & copes badly with menstrual hygiene. Has Down’s syndrome. Sexually active. | Hysterectomy | Main theatre | ||
TB | 30 | Menorrhagia. 2nd. degree uterine descent. Been sterilised. Jehovah’s witness. | Vaginal hysterectomy and repair. | Main theatre. | ||
BM | 55 | Stage Ib cancer cervix. Been discussed at MDT. For Wertheim’s hysterectomy. Factor V Leiden. VTE on Pill. On warfarin. | Wertheim’s hysterectomy. | Main theatre. | ||
NU | 60 | Recurrent rectocoele. | Posterior colporrhaphy. | Main theatre. |
Scenario 2.
Monday. 0900 hours. You have just come on duty.
1 | Mrs A | Para 0+0 | 25 yrs | 41 weeks. In labour 12 hours. Cx 8 cm. No progress for 4 hours. "Dips" reported on CTG |
2 | Mrs B | Para 1+2 | 31 yrs | 28 weeks. Just admitted. "Show" + contractions |
3 | Mrs C | Para 5+3 | 40 yrs | In labour 8 hours. Cx 6 cm. dilated |
4 | Mrs D | Para 1+3 | 27 yrs | 37 weeks. Diabetes. Admitted ½ hour previously. Previous Caesarean section. |
5 | Mrs E | Para 1+2 | 32 yrs | 40 weeks. Previous 9 lb. baby. In the second stage for 1 ½ hours. |
6 | Miss F | Para 0+0 | 15 yrs | 34 weeks. Concealed pregnancy. In labour. Just admitted. Undiagnosed breech presentation |
7 | Mrs G | Para 1+2 | 26 weeks. Admitted with severe abdominal pain | |
8 | Mrs H | Para 2+1 | 39 weeks. In early labour. | |
9 | Mrs I | Para 1+0 | Delivered two hours previously by Caesarean section for severe pre-eclampsia. Diastolic BP / 110. Urine output 50 ml. since delivery | |
10 | Mrs J | Para 1+0 | Normal delivery + PPH >1,500 ml. one hour ago |
Medical staff:
Consultant: in his Rooms.
You: Registrar.
Foundation Year 2 six months’ experience.
Registrar in anaesthetics.
Midwifery staff:
Senior Sister.
Two staff midwives.
One community midwife.
Two student midwives.
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