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New House Officer's Orientation Guide



New House Officer's Orientation Guide
by Dr. M. Tauseef Omer
F.C.P.S. Resident
Paediatrics Medicine & Neonatology
Mayo Hosp.,Lhe.


Cleared M.B;B.S.  !
You thrived Well.
Now its time to link your previous theoretical knowledge & clinical skills with newer and better clinically oriented knowledge ! Medical World is so big , & So is the hospital where you are joining as HO- Mayo Hospital. This little guide will help you orient yourself to the working environment of Mayo & also to what is required from you.

House job can help you decide what is the most suitable Specialization for you.At the end of your Rotations you may be able to figure out if you are a doctor for bone repairs, or cutting n stitching bowels, or to handle crying babies , or the one who reads x rays and watches TV with ultrasound probe in hand!
Or , before your House job begins , you may visit wards of your "interest" , meet senior doctors- see their working routine and environment and decide about the field you wish to specialize in , and then Plan your house job Rotations accordingly. Its better that you decide prior to start of house job about your areas of interest since you have already have much exposure to Wards in clinical years.

Before you Begin- REVISE
Basic Evaluation of :
      Dehydration (and t/m)
Shortness of Breath
      Chest Pain
      Stomach Ache
Head Ache
Fits
Fever and its management
      CPR protocol in adult and child
      Diagnosis of Acute Appendicitis , Acute Cholecystitis
      Pneumonia
      Asthma
      Hepatitis
      Treatment of :
                 Gastroenteritis, Dysentry, Upper Resp. Tract Infections, UTI , Malaria , Enteric Fever
Reading CBC , RFTS, LFTS, S/E reports.
Clinically Picking up Pneumothorax and Acute Abdomen.
Basics of CXR , X ray Abdomen Erect ,
Picking Myocardial infarction changes in ECG
How to Effectively Ambu Bag the patient.   (resource)
How to take Blood Pressure
How to draw venous and arterial blood samples  (Resource VENOUS) (Resource ARTERIAL)
How to counsel the Fussy Attendants to make them admit that their patient is about to die but your team is trying the best to save the pt.
For Paeds Medicine House Officers we have Mayo Paediatricians Manual downloadable from here https://drive.google.com/open?id=0B_5xThxaEfU6WWVkOUJ6R21iN2s&authuser=0

---------- Other Than the above mentioned topics, I assure you that all you need is to KEENLY observe,take history, examine your patient,  and be connected with your senior. If you wish to read book, give foremost preference to any book of Physical Examination.

The Doctors Talk

OD - once daily
BD, 12hrly - twice daily
TDS, 8hrly - three times a day
QID or  QDS, 6hrly - four times a day
C/O complaining of
H/O - history of
D/W - discussed with
HEENT - head, ears eyes nose and throat
PERLA - pupils equal and reactive to light & Accomodation
JACCO - jaundice, anaemia, clubbing, cyanosis, oedema
NAD - no abnormality detected
N - Normal
NPO- Nothing Per Oral
DKA - diabetic ketoacidosis
URTI- Upper Respiratory Tract Infection
LRTI- Lower Respiratory tract Infection
SSTI - SKin and Soft Tissue Infection
GCS - Glasgow coma scale
LOC - loss of consciousness
ASOC Altered State of Consciousness
CXR - chest X-ray
MSU - mid-stream urine
C&S - culture and sensitivity
ATD  - After Test dose
i/v intravenous
s/c subcutaneous
PO per oral
t/m  treatment
o/e  on examination
Rx  medication
--------------- you ll learn more of these with time ! & advising a DRUG on chart is like computer programming ! Just in 24-48 hours with your seniors you'll grasp the idea ! For example , if you wish to advise 1 gram injection Ceftriaxone twice daily by intravenous route to your patient, you ll write on chart this way :  (so that the Staff nurse administers medicine accordingly)

inj Ceftriaxone X  1g X i/v X  B.D   (ATD)

Ethics Review :
***Do NO Harm.
***Do the Right Thing.
***Wear too Good a Dress, with so bright a Face, that you leave no other option for your Patient to have immense confidence in You regarding  Your skills and Management !
***Think for patient benefit while staying in the limits of your services , and asking for services of others/other departments/NGOs.
***Regard Patient as the top most priority , but after your own self.
***Respect your patients Religious beliefs.
***Never abuse-back a patient/attendant . Be very careful regarding what YOU utter, maintaining your AUTHORITY at the working place.
***Examine Opp sex patient only in the presence of Chaperone, & be at distance with them.
***Do not Hate your patient. Is he I/V drug abuser with gangrenous leg and foul smelling discharge? So what- He is your patient - seeking your expertise & trusting you in this regard,Not seeking your emotions.
***Do not JUDGE your patients. Do not let their POVERTY /  RICHES make you their JUDGE. Do not let their DISEASE develop good or bad feelings towards them.
***Keep Secrets of your patients that they tell you. Maintain full Privacy and Confidentiality.  A research says that out of all kinds of professionals and individuals , only Doctors are the best secret keepers. Lets maintain this with dignity.
***Respect your fellow doctors. Always be of help to them.
***Is there Nothing you can do for the patient's disease ? Oh well make the patient atleast PAIN Free leaving rest to specialist or senior doctors ! Cant make the patient pain free, utter some SUGARY WORDS to him  then !
***Never be involved in gaining personal benefits from patients ! The only personal benefit you may have is Prayers !
***Always wear GLOVES before handling patients secretions/specimens. Protect yourself from getting patients disease. If you got flu, Wear mask so that you might not transmit the disease.



Before you Begin
DRUGS THAT YOU SHOULD KNOW (atleast) :


DRUG : ACETAMINOPHEN
BRAND NAMES: Panadol ,  Calpol
DOSES:  tab 500mg              (usually advised  4  times per day)
COMMON INDICATIONS:  Analgesic .  Antipyretic
COMMON SIDE EFFECTS: Liver toxicity, Rash

DRUG :  IBUPROFEN
BRAND NAMES: Brufen ,Bludol, Blufen
DOSES: tab 200mg , 400 mg , 600 mg, 800mg        (usually advised 3   times per day)
COMMON INDICATIONS: Analgesic, Antipyretic , AntiInflammatory
COMMON SIDE EFFECTS: heart burn , Rash, Liver Toxicity , Renal Toxicity

DRUG : AMOXICILLIN
BRAND NAMES:  Amoxil
DOSES: cap 250mg,  500mg         (usually advised  3  times per day)
COMMON INDICATIONS: Tonsilitis , Otitis, Skin Infections , Helicobactor pylori Eradication
COMMON SIDE EFFECTS: Anaphylaxis , Diarrhoea/ GI Upset

DRUG :  AMOXICILLIN/CLAVULANATE
BRAND NAMES: Augmentin , Co-Amoxi , Calamox
DOSES: tab 375mg, 625 mg, 1 gm               (usually advised  2 or 3  times per day)
COMMON INDICATIONS: Tonsilitis, Sinusitis , Skin Infections
COMMON SIDE EFFECTS: Anaphylaxis, Diarrhoea

DRUG :  CLARITHROMYCIN
BRAND NAMES:  Claritek , Klaricid , Rithmo
DOSES: tab250mg , 500mg       (usually advised  2  times per day)
COMMON INDICATIONS: Tonsilitis, Sinusitis,  Pertusis, H.pylori Eradication
COMMON SIDE EFFECTS: BAD TASTE , GI Upset, Hepatotoxicity, Glossitis , Heart Burn

DRUG : CEFIXIME
BRAND NAMES: Caricef , Cef-OD , Cefspan
DOSES: (cap 200mg, 400mg) (tab 200mg)        (usually advised  once daily)
COMMON INDICATIONS: UTI ,  Lower Resp. Tract Infections
COMMON SIDE EFFECTS: GI Upset , Rash, Heart burn

DRUG :  CIPROFLOXACIN
BRAND NAMES: Novidat , Ciprox, Ciproxin
DOSES:cap 250 mg, 500 mg       (usually advised  2  times per day)
COMMON INDICATIONS: Infective Diarrhoea, UTI ,Enteric Fever, Lower Resp tract Infections,  Anthrax,
COMMON SIDE EFFECTS: Rash , Bad Taste , Tremors, Palpitations

DRUG :  METRONIDAZOLE
BRAND NAMES: Flagyl, ** Entamizole,** Metodine
DOSES:tab 200mg , 400mg         (usually advised 3   times per day)
COMMON INDICATIONS: Amoebiasis - Giardiasis (DYSENTRY) , H. Pylori eradication , Aspiration Pneumonia
COMMON SIDE EFFECTS: metallic taste ,neuropathy, GI UPSET, Disulfiram like reaction with Ethanol

DRUG : OMEPRAZOLE
BRAND NAMES: Risek, TEPH
DOSES:Cap 10mg , 20mg , 40mg      (usually advised Once or Twice Daily)
COMMON INDICATIONS: Heart burn, GI ulcers, H.Pylori t/m
COMMON SIDE EFFECTS: Dizziness, Diarrhoea, Constipation

DRUG :  METOCLOPRAMIDE
BRAND NAMES: Metomide
DOSES:tab 10mg  (usually advised as when needed but not more than 2times per day)
COMMON INDICATIONS:  Nausea/Vomiting , Diabetic Gastroparesis, GERD
COMMON SIDE EFFECTS: Dizziness, Diarrhoea, Galactorrhoea , Dystonia

DRUG : ARTEMETHER + LUMEFANTRINE
BRAND NAMES: Arceva  ,Co-Mether
DOSES: tab 20/120mg  ,   40/240mg  ,  80/480mg     (usually advised  2  times per day)
COMMON INDICATIONS: Malaria
COMMON SIDE EFFECTS: Dizziness, myalgia, palpitations, fatigue


For Paediatric Drug Doses Refer to Drug Doses Section in Mayo Paediatricians Manual( here )

____________________

Essential Phone Numbers(dial from your ward phone):
0    Dial zero and ask operator to give you line , so that you may dial PTCL number to consult senior/order food etc.
Also,  dial ZERO  to connect to any WARD/DEPT in Mayo ! Just request the operator and you ll be connected.
302  Police Chowki
301  AMS main emergency
250  Central ICU
253  Main Blood Bank
254  Emergency Blood Bank


Metabolic Demands ?
Food Delivery near mayo :
Green Chili (Quickest Delivery- fine Food)
0423 700 2850
0333-460 2680          

Bundu Khan Mall Rd
042 111 444 411

Cock n Bull Shadman
0423 630 5500

Al Fazal ( Good Desi Food )
0423 7358956  

Mc Donalds
042 111 244 622

Red Chili (Slowest Delivery)
0423 722 5500

Salt n Pepper
(042) 35752893



When you are on 24-Hr Call Duty 
EAT WHENEVER YOU CAN.
SLEEP Whenever you get time.

Listen When Nature Calls.
While standing, if you get 5 min to Sit- Then SIT DOWN. Who knows that trauma cases will come
in a moment and you ll have to stand for next 5 hours on O.T table with attending surgeon.
While sleeping, if you re asked to attend a patient , always do so timely !
Find an activity. To drive you & your moods away from patients-books-drugs&drips. The better the doctor
is , the best hobbies he has ! Got no hobby - Find few !


Be courteous to STAFF NURSES , WARD BOYS , GATE KEEPERS.
STAFF nurses have wide experience of working with many & more House Officers like you .
Learn from their experiences, listen to their management TIPS , BUT take decision based only on
your MENTAL PROCESSING !  It falls under the responsibility of Staff Nurses to make
Syringes/DRUGS/ECG machine/SUCTION MACHINES/OTHER EQUIPMENT available in ward .
Request them to provide the required things if not avaialble. 

Install MEDSCAPE in your Cellphone
Its Free. It works Offline. & Will be your excellent guide throughout house job.
Use Medscape to study theory of a disease, DRUG dosage , DRUG Adverse Effects .
& contraindications.

It also has good theory on TECHNIQUES OF PROCEDURES e.g. doing
Lumbar Puncture.


Trade name of any drug/active principle & its price can be searched from Website :
www.druginfosys.com

Finally,There is always room for improvement. Improve yourself. Gain clinical knowledge
and Skill set , and Apply. House Job is for you to observe , observe and observe your patients and then
plan a supervised management !

                                  Keen sensibility is doubtless a virtue of high order, when it does not interfere with steadiness of hand or coolness of nerve; but for the practitioner in his working-day world, a callousness which thinks only of the good to be affected, and goes ahead regardless of smaller considerations, is the preferable quality.
Cultivate, then, gentlemen, such a judicious measure of obtuseness as will enable you to meet the exigencies of practice with firmness and courage, without, at the same time, hardening "the human heart by which we live."
--------Sir William Osler



Good Luck !

___________________________
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