Monday, 9 March 2015

Tutorial 9 March 2015

Website.
Contact us.

There is some information on the website about communication.
http://www.drcog-mrcog.info/Topics%20not%20in%20the%20textbooks.htm.

1
How to prepare. Picking a course.
2
Barriers to communication. What communication barriers exist between me and the trainees attending the tutorial? We can use this as a basis to consider the communication problems between us, patients and colleagues.
3
Role-play: how to introduce oneself.
4
Labour ward scenario 1.
5
Role-play: Healthy, nulliparous. Brother with cystic fibrosis. Pre-pregnancy counselling.


Labour Ward Scenario 1.

Sunday 13.00 hours.

Labour Ward.

1
Mrs JH
Primigravida. T+8. In labour. 6 cms.
2
Mrs AH
Primigravida at T. In labour. 5 cms.
3
Mrs. BH
Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3.
4
Mrs SB
Primigravida. 32/52 gestation. Admitted 30 minutes ago. Abdominal pain + 200 ml. bleeding. Nephrostomy tube in situ - not draining since this morning. Low placenta on 20 week scan.
5
Mrs KW
Para 1. In labour. Cx. 5 cm. Ceph at spines.
6
Mrs KT
Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor.
7
Mrs TB
Para 1. T+4. Clinically big baby. Cx fully dilated for 1 hour. Type 1 decelerations.
8
Mrs RJ
Primigravida. Epidural. RIF pain. Cx fully dilated for 1 hour. Shallow late decelerations. OT position. Distressed ++. BP /105. ++ protein. Urine output 50 ml in past 4 hours.
9
Mrs KC
Transfer from ICU. 13 days after delivery of 32 week twins. Laparotomy on day 7 for pelvic pain and fever. Infected endometriotic cyst removed. IV antibiotics changed to oral.

Gynaecology ward.

8 major post operative cases who have been seen on the morning ward round and are stable. Husband of patient who has had Wertheim's hysterectomy asking to see a doctor for a report on the operation.

1
Mrs JB
10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding.
2
Ms AS
19 years old. Nulliparous. Just admitted with left iliac fossa pain. Scan shows unilocular 5 cm. ovarian cyst.

Medical staff:

Consultant at home. Registrar - you.
Senior House Officer with 12 months experience.
Registrar in Anaesthesia.
Consultant Anaesthetist on call at home.

Midwifery staff:
Senior Sister.          Trained to take theatre cases. Able to site IV infusions and suture episiotomies and tears.
3 staff midwives. 1 trained to take theatre cases. Two able to site IV infusions.
1 Community midwife looking after Mrs. KW.
2 Pupil Midwives.

We did not get a chance to discuss labour ward scenario 2, but you can use it for practice.

 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. 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.


8 comments:




  1. This is real take it serious, who will believe that a herb can cure herpes, i never believe that this will work i have spend a lot when getting drugs from the hospital to keep me healthy, what i was waiting for is death because i was broke, one day i hard about this great man who is well know of HIV and cancer cure, i decided to email him, unknowingly to me that this will be the end of the herpes in my body, he prepare the herb for me, and give me instruction on how to take it, at the end of the one month, he told me to go to the hospital for a check up, and i went, surprisingly after the test the doctor confirm me negative, i thought it was a joke, i went to other hospital was also negative, then i took my friend who was also suffering from herpes to the Dr Osas, after the treatment she was also confirm herpes free . He also have the herb to cure cancer. please i want every one with this virus to be free, that is why am dropping his email address, doctorosasherbalhome@gmail.com
    or you can kindly contact him directly on his mobile line on +2349039537920. do email him he is a great man. the government is also interested in this DR, thank you for saving my life, and I promise I will always testify for your good work

    ReplyDelete
    Replies
    1. ATTENTION YOU ALL. i wish to inform you all

      that after all the herbal doctor that i contacted, Dr Monday (nativeherbalclinic@gmail.com) was the

      only one that cured my Herpes Virus with his Herbal Medicine.

      i have contacted about 4 different herbal doctor and i was just been SUCKED. well thats the past.

      Am very happy now that am cured finally by Dr Monday.

      I contacted

      Dr Monday just last week when i was confused on who to contact, and he

      gave me an online Details center to fill. i filled the form with my

      details and he wrote back to me that it will take (3 Weeks) for

      me to get cure. To my greatest surprise, after two weeks i

      go for a medical check up to confirm my STATUS. and i went to 6

      different hospital and i was tested NEGATIVE. so i decided to inform the

      general public so that you wont waste time sharing tears and losing

      hope.

      you can email him Dr Monday on his email: nativeherbalclinic@gmail.com

      or visit Www.nativeherbalclinic.webs.com

      PLEASE contact to avoid disappointment

      Delete
    2. I GOT CURED FROM HERPES WITHIN 14 DAYS, AFTER USING DR Ojoka HERBAL MEDICINE. am out here to testify about how Dr Ojoka cured my (HERPES SIMPLEX VIRUS) i visited different hospital but they gave me list of drugs which were expensive to treat the virus but to no avail. I was browsing through the Internet searching for remedy on HERPES and i saw comment of people talking about how Dr Ojoka them. when i contacted him he gave me hope and send a Herbal medicine to me which i first thought wont solve anything but later i gave it a try and it seriously worked, my HERPES result came out negative. I am so happy as i am sharing this testimony. My advice to you all who thinks that their is no cure for herpes and also no genuine spell caster that is Not true just contact him and get cured today Dr Ojoka spell shrine can cure all kinds of sickness.Remember delay in treatment leads to death email him (dr.ojokarootandherbal@gmail com}. HE IS ALSO SPECIALIZED IN THE TREATMENT OF VARIOUS AILMENT 1 HIV/AIDS VIRUS 2 CANCER DISEASE 3 TUMOR DISEASE ETC 4 HEPATITIS 5 KIDNEY PROBLEM 6 MASTURBATION 7 WEAK ERECTION EMAIL HIM TODAY whatsapp him +2348144172934 check his blog: https://perfectherbalcure.blogspot.com/  check his blog: https://penisherbalenlarge.blogspot.com/ FB page https://www.facebook.com/Sayo-Herbal-Healer-100145798345000/  




























































      I GOT CURED FROM HERPES WITHIN 14 DAYS, AFTER USING DR Ojoka HERBAL MEDICINE. am out here to testify about how Dr Ojoka cured my (HERPES SIMPLEX VIRUS) i visited different hospital but they gave me list of drugs which were expensive to treat the virus but to no avail. I was browsing through the Internet searching for remedy on HERPES and i saw comment of people talking about how Dr Ojoka them. when i contacted him he gave me hope and send a Herbal medicine to me which i first thought wont solve anything but later i gave it a try and it seriously worked, my HERPES result came out negative. I am so happy as i am sharing this testimony. My advice to you all who thinks that their is no cure for herpes and also no genuine spell caster that is Not true just contact him and get cured today Dr Ojoka spell shrine can cure all kinds of sickness.Remember delay in treatment leads to death email him (dr.ojokarootandherbal@gmail com}. HE IS ALSO SPECIALIZED IN THE TREATMENT OF VARIOUS AILMENT 1 HIV/AIDS VIRUS 2 CANCER DISEASE 3 TUMOR DISEASE ETC 4 HEPATITIS 5 KIDNEY PROBLEM 6 MASTURBATION 7 WEAK ERECTION EMAIL HIM TODAY whatsapp him +2348144172934 check his blog: https://perfectherbalcure.blogspot.com/  check his blog: https://penisherbalenlarge.blogspot.com/ FB page https://www.facebook.com/Sayo-Herbal-Healer-100145798345000/  

      Delete



  2. This is real take it serious, who will believe that a herb can cure herpes, i never believe that this will work i have spend a lot when getting drugs from the hospital to keep me healthy, what i was waiting for is death because i was broke, one day i hard about this great man who is well know of HIV and cancer cure, i decided to email him, unknowingly to me that this will be the end of the herpes in my body, he prepare the herb for me, and give me instruction on how to take it, at the end of the one month, he told me to go to the hospital for a check up, and i went, surprisingly after the test the doctor confirm me negative, i thought it was a joke, i went to other hospital was also negative, then i took my friend who was also suffering from herpes to the Dr Osas, after the treatment she was also confirm herpes free . He also have the herb to cure cancer. please i want every one with this virus to be free, that is why am dropping his email address, doctorosasherbalhome@gmail.com
    or you can kindly contact him directly on his mobile line on +2349039537920. do email him he is a great man. the government is also interested in this DR, thank you for saving my life, and I promise I will always testify for your good work.

    ReplyDelete
  3. HELLO everybody am from New Zealand I wanna thank the great DR ABOR for curing me from herpes virus and hiv with the help of his herbal medicine am very happy, I never thought I would ever be cured because of the condition the doctor give to me, until a friend of mine direct me to this man called DR ABOR who healed me totally from herpes virus and hiv, he is a good man and he also cast spell, you can reach him with IRABORSPELLHERBALHOME@GMAIL.COM
    and he also cure HEPATITIS A B C
    and ANY TYPE OF CANCER, LUPUS, HPV, LOOKING FOR BABY, ERECTION EJACULATION
    and HIV AIDS
    he also cast spell to get your EX BACK
    you can reach him on via IRABORSPELLHERBALHOME@GMAIL.COM OR WHATSAPP my agent or call +393512728432

    ReplyDelete
  4. ATTENTION YOU ALL. i wish to inform you all

    that after all the herbal doctor that i contacted, Dr Monday (nativeherbalclinic@gmail.com) was the

    only one that cured my Herpes Virus with his Herbal Medicine.

    i have contacted about 4 different herbal doctor and i was just been SUCKED. well thats the past.

    Am very happy now that am cured finally by Dr Monday.

    I contacted

    Dr Monday just last week when i was confused on who to contact, and he

    gave me an online Details center to fill. i filled the form with my

    details and he wrote back to me that it will take (3 Weeks) for

    me to get cure. To my greatest surprise, after two weeks i

    go for a medical check up to confirm my STATUS. and i went to 6

    different hospital and i was tested NEGATIVE. so i decided to inform the

    general public so that you wont waste time sharing tears and losing

    hope.

    you can email him Dr Monday on his email: nativeherbalclinic@gmail.com

    or visit Www.nativeherbalclinic.webs.com

    PLEASE contact to avoid disappointment

    ReplyDelete
  5. Hello everybody,
    I don't just know the reason why some people is finding it difficult to believe that there is a cure for herpes, I have been suffering from herpes since last three years with my boyfriend but today I am happy that am cure from it with the herbal medicine of Dr Aba the great healer,I was browsing the internet searching for help when I came across a testimony shared by someone on how Dr Aba cure his herpes I was so much in need of getting his treatment but after all Dr Aba brought a smile to my face with his herbal medicine. I am so much happy today that we have someone like this great healer out there, so my people out there kindly contact this great healer on his email address: dr.abaherbalhome@gmail.com please sir keep your good work cause there are people out there who is in need of your healing medicine.once more contact him now: dr.abaherbalhome@gmail.com you can call him or whatsApp his number +2348107155060

    ReplyDelete
  6. ALL THANKS TO DR ODIA WITH HIS HERBAL ROOT AND HERBS AM COMPLETELY CURED FROM FIBROID
    I can’t believe this. A great testimony that i must share to all fibroid patient in the world. i never believed that their could be any complete cure for fibroid with out going for surgery ,i saw people’s testimony on internet on how Dr ODIA prepare herbal root and herbs that shrink there fibroid naturally. i had to try it too i contacted him on: odiaherbalcenter@yahoo.com. and him told me how to get his herbal medicine, and you can,t believe that in just few weeks i started using it all my pains stop gradually . Right now i want to tell you all that i just give birth to a baby boy last month,and on till now' i have not had any pain, and i just went for text last week and the doctor confirmed that there is no trace of any fibroid in my system. after 8 year of suffering from fibroid am now free, Glory be to God for leading me to this great Dr ODIA I am so happy as i am sharing this testimony. My advice to you all who thinks that their is no herbal cure for fibroid that is Not true ,just contact him and get cure his email odiaherbalcenter@yahoo.com and you will be free and free forever, Try it and you will not regret it because it truly works. i hope to see your testimony soon.

    ReplyDelete