Monash Health Prevocational (Intern/HMO ... - Monash Doctors



4142630-63157800Monash Health Prevocational (Intern/HMO) Unit Information Unit: Casey General Surgery Contents TOC \o "1-3" \h \z \u PAGEREF _Toc12430237 \h 1Overview of Unit: PAGEREF _Toc12430238 \h 1Orientation PAGEREF _Toc12430239 \h 1Roster PAGEREF _Toc12430240 \h 2Supervision of JMS training PAGEREF _Toc12430241 \h 3Key staff PAGEREF _Toc12430242 \h 3Who to contact for a sick patient: PAGEREF _Toc12430243 \h 4Contacts for leave, over time and Kronos PAGEREF _Toc12430244 \h 4Other Useful contact numbers, access codes or passwords PAGEREF _Toc12430245 \h 4What do you expect the JMS to learn and manage? PAGEREF _Toc12430246 \h 5Common conditions managed by unit PAGEREF _Toc12430247 \h 5Tools to assist in assessing a patient PAGEREF _Toc12430248 \h 5Common procedures found on prompt PAGEREF _Toc12430249 \h 6Potential clinical emergencies PAGEREF _Toc12430250 \h 6Overview of Unit: Casey general surgery unit is part of the Monash Health general surgery service. Both elective and emergency services are provided through our unit. This include common general surgical procedures such as skin lesions, abscess drainage, hernia operation, appendicectomy and cholecystectomy. In addition, we also provide subspecialty colorectal, breast and endocrine surgery services on elective basis.Orientation: Before the start of this rotation, you should ensure that an appropriate handover has been received from the previous interns. At the commencement of the rotation, interns are expected to present to the doctor’s office in Ward A at 0700 to receive handover from the night team. The registrars will arrive at 0730 to start the surgical ward round. On day 1 of your rotation, one of the senior registrars will conduct an orientation to explain about your role in the unit and day to day unit activities. You should also arrange meeting with your intern supervisor Mr Suren Jayaweera at the earliest possible time to go through term expectations and assessment process.There are multiple resources that you can find guidance on management of general surgical patients. These includes but not limited to:Monash Health policies and guidelines under PROMPTTherapeutic guidelines, Australian Medicine Handbook and MIMS online under pharmacy section for medication prescriptionAccess to online medical journals and relevant textbooks through Monash Health libraryIn addition, when you are in doubt, please do not hesitate to discuss it with one of the registrars or consultants on the unit. Roster: The live copy of the roster can be accessed through R: drive. If there are any discrepancies or concerns, these should be raised with Michelle Ah-Fat (Casey Roster Co-ordinator). General Surgery at Casey runs two clinics per week – pre-admissions and post-operative clinic. These clinics are accounted for and are reflected in your roster. It is expected that you attend compulsory intern teaching prior to attending post-operative clinic on Thursday. The weekly timetable for clinics and intern teaching session is as below: MondayTuesdayWednesdayThursdayFridaySaturdaySundayAmPreadmission clinic (start at 0900am)pmIntern Teaching (12:30pm to 13:30pm)Outpatient clinic (Start 13:30pm)The theatre timetable is as below: MondayTuesdayWednesdayThursdayFridaySaturdaySundayAmGeneral SurgeryOrColorectal Surgery General SurgeryorColorectal SurgeryGeneral SurgeryorBreast SurgeryColorectal Surgery (once in 4 weeks)Acute Surgical UnitAcute Surgical UnitpmGeneral SurgeryorColorectal SurgeryorEndocrine SurgeryGeneral SurgeryorEndocrine SurgeryGeneral Surgeryor Endocrine SurgeryTwo theatres:General SurgeryOrBreast SurgeryOrEndocrine SurgeryGeneral SurgeryAcute Surgical unitAcute Surgical UnitAfterhoursAcute Surgical UnitAcute Surgical UnitAcute Surgical UnitAcute Surgical UnitWe have operating theatre every day except on Wednesday and Friday morning. However, once a month there will be a colorectal elective list under Mr James Lim on Friday morning. In addition, there is two theatre list running simultaneously on Thursday afternoon. Emergency cases will be allocated to Acute Surgical Unit (ASU) list every evening after elective list finished. Supervision of JMS trainingAfter commencement of the rotation, one of the senior registrars will conduct a term orientation on day 1 to explain about your role and day to day unit activitiesThe current intern supervisor is Mr Suren Jayaweera. He will be the main contact for mid-term and end of term reviews. You should organise your assessment dates with him as early as possible after starting the rotation. As a general surgical intern, your duties will include:Organise the inpatient list before the start of ward round at 0730am.Documentation of ward round discussion and anise investigations and make referrals in the timely manner.Review patients based on clinical priority, and escalate when in uncertainty.Perform basic procedural skills (e.g. IV cannula, IDC insertion) at an expected levelChase correspondence and investigation results as requested by senior doctorsAssess elective patients in preadmission clinic on Wednesday morningAttend consultant clinic on Thursday afternoon to review post-operative patientsIt is a busy surgical unit, and a high level of time management skill is needed to manage the unit. Also a basic understanding of peri-operative management of patients and possible post-operative complications will be helpful to your performance as a surgical intern. Key staff Unit headMr Foong LohIntern/JMS supervisorMr Suren JayaweeraConsultantsMr Brian HodgkinsMr Chaminda SaranasuriyaMr Chilton ChongMr Cyril TsanMr Daniel FoleyMs Emma LangMr Eric EeMr Hamish ShiltonMr James LeeMr James LimMr Mithra SritharanMs Marjan GhadiriMr Mikhail FisherMr Niyaz NaqashMr Paul Ah-TyeMr Pee Yau TanMs Sarah MartinMs Sherry SalterMr Suren JayaweeraMr William TeohMr Zdenek DubravaMr Zoltan HrabovszkyOperation managerMichelle Ah-FatRegistrarsThere will be three registrars rotating to the unit 2 accredited registrars: 6 monthly rotation1 unaccredited registrar: 3 monthly rotationWho to contact for a sick patient: Your registrar should be the first line person to contact when clinically concerned about a patient.There will be an intake registrar (pager 2667) on site covering the wards/emergency 24 hours a day for 7 days.For non-urgent queries, you can either text or call the intake registrarsFor urgent queries that require immediate answer, call the intake registrar directlyIn the setting of an urgent query but all the registrars are scrubbed in for operation, go to theatre to talk to the registrars directlyIn the rare situation when you cannot contact the registrar by all means, contact the on call consultant directly for urgent situations. Contacts for leave, over time and KronosContact Name Logistical contact for JMSMr Suren JayaweeraOvertime claimsMr Suren JayaweeraOther Useful contact numbers, access codes or passwordsGeneral Surgery Registrar pager2667General Surgery intern pager2407Ward A 81252Ward A Nurse in charge81248Ward A fax number8768 1986Casey HITH doctors81484Gynaecology Registrar82155Endocrine Registrar2485Infectious Disease registrar2471General Medicine consult registrar2538Anaesthetist in charge3053 (speed dial)Anaesthetic/Acute pain service registrar2515What do you expect the JMS to learn and manage?Common conditions managed by unitAbdominal pain for investigationAcute appendicitisHernias: umbilical, paraumbilical, inguinal, femoral, incisionalBiliary pathology: cholelithiasis, cholecystitisSkin lesions and lipomaAbscessesPerianal condition: fissure, fistula, haemorrhoidsBenign breast condition: fibroadenoma, breast lumpBreast malignancyThyroid nodules and multinodular goitreThyroid malignancyBreast surgeries?All post-operative breast patients require breast care nurse and physiotherapy involvement Breast clinic (212 Clayton Rd) follow up or private surgeon in rooms Thyroidectomies (total/partial)Follow total thyroidectomy protocol —> in the endocrine general surgery folder in ward A officeTotal thyroidectomies require bloods done 1 hr post op (testing corrected calcium and PTH)On following day, BD blood tests for corrected calcium until calcium stable and appropriate caltrate dose determinedThyroid clinic (215C) follow up on discharge - ?Priority: 3. Post admission - same spec, no triage requiredTools to assist in assessing a patientThere are online tools and guideline that we follow to assess patients with above conditions, but you are expected to know them as an intern. However, you are expected to known how to manage patient’s diabetic and anticoagulation medications peri-operatively. Please see the below links on PROMPT for the Monash Health guidelines.Always escalate to your registrars if you are mon procedures found on prompt (with links)Periprocedural management of diabetes mellitus Periprocedural management of anticoagulation and antiplatelet medicationPotential clinical emergencies Acute abdomen Presentation: peritonitis with evidence of haemodynamic instabilityEscalate as soon as possible as the patient may need emergency operation.SepsisPresentation: fever with tachycardia or hypotensionLikely need emergency washout or drainage.Post-operative bleedingPresentation: tachycardia or hypotension, local swelling or bruising, peritonitis, May need return to theatre for haemostasis and evacuationPost-thyroidectomy bleed: post-operative neck swellingplease notify the registrar urgently as may need to reopen the wound as soon as possible. Remember, the surgical patients can have background medical issues which can also result in other medical emergencies. Call a MET call if the patient meets the criteria or you are concerned about the patient’s condition while support if not available. You will never be blamed for seeking help.Useful links Histology to chase: all patients that are discharged need to be put on this list and routinely chased Pre-op investigations to chase: regs will put the details of things they need chased pre-op on here, ie pathology (sometimes need to ring the pt to come in to have it done), imaging reports, FNA reports, operation reports etc Progress notes template information on this unit collated by your peers see the rover (link) ................
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