#patient assessment

[er-cryptid]

[careeroptionsinc]

Embarking on a career as a Certified Nursing Assistant (CNA) is a noble and rewarding journey. For prospective students eager to understand the intricacies of the profession, there is a CNA school in Illinois to choose from. Having a glimpse into the daily life of a CNA can also provide invaluable insights.

[answermywearyquery]

the theerapanyakul kids: how close are you with each other?

loan’s kinnporsche 2nd anniversary: favourite familial relationship: the theerapanyakul kids (insp: ½+½)

[luinhealthcare]

Does Hyrule mind teaching how to assess a patient??👉👈

"You... want to learn how to assess patients?" Hyrule asked hesitantly.

Wild shrugged. "What if I want to be an EMT?"

"You also said you wanted to be a chef in the hospital."

"I can do both, you know."

Hyrule laughed. "I suppose so. Well... we'll need a patient for this to work."

Wild immediately snatched Sky, who yelped as his friend snaked a hand around his wrist. "Sky's the patient, heaven knows he needs to be looked over anyway."

"Look who's talking, Mr. I-Have-Seizures-and-Don't-Tell-Anybody," Sky grumbled as he was manhandled to sit between the other two.

"Well, everyone knows now."

Hyrule and Sky gave Wild a scalding look. Adequately apologetic, Wild shrugged sheepishly.

"Anyway," Hyrule sighed, shifting his focus to Sky. "Assessments come in different forms. You've got a primary and a secondary assessment. Primary is kind of a general overview and checking for life threatening stuff, secondary is in-depth on what the issue actually is. Make sense?"

Wild nodded.

"Great!" Hyrule continued with a smile. "Okay. Sky's our patient. Sky, you got shot once, right?"

Sky nodded, and Wild balked. "He what?!"

"It was a long time ago," Sky waved a dismissive hand.

"Okay, so that's our scenario," Hyrule said, standing. "We're dispatched for a 21-year-old male with a GSW--"

"That means gunshot wound, right?"

"Yeah. GSW, conscious patient. That's all we've got. So, you get on scene, and the very first thing you do is check for scene safety. If the scene isn't safe, we're not going in. First thing you're taught in EMS - your own safety comes first, because if you're shot you can't help the patient. It's you, your partner, then the patient."

"How often do you actually listen to that rule?" Sky asked, raising an eyebrow.

"That's not what we're learning today," Hyrule waved off easily. It was pretty common knowledge that while he would never put his partner's life at risk, he'd gotten himself into dicey situations before. But he knew how to get himself out of those situations too. "So, we determine the scene is safe. Next, is our primary assessment. The purpose of this assessment is to check for life threatening things, and an overview of major body systems. Neuro status, bleeding, and your ABCs: Airway, Breathing, Circulation.

"The situation is pretty dynamic, like sometimes you walk up and somebody's got an arterial bleed and spurting blood everywhere, your assessment stops right there and you go fix that bleed. But generally you'll have time to do the entire primary assessment."

"Okay, so neuro and ABCs?"

"Yeah. And the good thing is that most of it happens all at once, you know? You walk up to Sky and he looks at you, then boom, you've got a good neuro - he's awake, he's alert. He may not be oriented, but you can figure that out by just talking to him. And by this point you can tell if there's life threatening bleeding. Then it's ABCs - is his airway patent, or open? Is he breathing, and is he doing so normally? Is his skin warm, dry, and normal tone for him? You can literally do al these things by just walking into the room and looking at him for five seconds. The primary assessment is done really fast and, the more times you do it, basically automatically."

"What would be an example of something being wrong?" Wild askd.

Hyrule glanced at him. "When I got on scene for your crash, you were unconscious and unresponsive--in other words, you were not only unconscious, but nothing would wake you up--and your breathing was gurgling sounding because you had blood in your airway."

Glancing at Sky, Hyrule said, "Sky can give us an example of a not great primary assessment, I'm sure."

Helpfully, Sky immediately flopped off the chair he was sitting on, collapsing to the ground with a crash. Wild laughed, and footsteps rushed from upstairs into the living room.

Twilight immediately froze in the entranceway, eyes wide and fixed on Sky. "Sky, what the--guys what the hell is hap--"

Sky perked up immediately. "Oh, sorry! I'm just helping Hyrule teach Wild!"

Twilight froze a moment and then sighed heavily, pinching the bridge of his nose and grumbling under his breath.

Hyrule smiled, pointing at Twilight. "He just perfectly showed a good primary assessment looks like! He walked in and saw the patient down on the ground, tried to figure out a neuro by calling out to him, and when Sky woke up he immediately could tell he was fine. Neuro intact, not bleeding, had a patent airway because he's talking, breathing normally, and skin looks normal."

"I hate all of you," Twilight groaned, walking out of the room.

"Okay, but by skin looking normal... what does it mean when it doesn't?" Wild asked.

"Your skin can tell a story," Hyrule explained. "If you're diaphoretic, which means sweating, something is likely wrong. Though it depends on context - if your patient's sweaty but they were just exercising, it makes sense. If Sky's sweaty on the ground after being shot, he's in shock. If the skin is cool, the body isn't circulating well - that can sap the color right out of your skin - the lighter your skin tone the more notable it is, but darker skin tones can become paler too. A lot of times with darker skin tones you'll want to look at their palms or their lips, that'll help you determine it. Another color is grey - that usually means cardiac and it's bad. So skin can tell you a lot!"

"How did my skin look?" Wild questioned, curious.

"Pale," Hyrule immediately answered. "Anyway. Sky's your patient. Look him over."

"Okay," Wild blew out a breath, approaching Sky and kneeling beside him. "So he's unconscious, that's my neuro so far."

"Can you arouse him at all?"

Wild poked Sky in the neck. Sky flinched. Wild poked again and Sky giggled. Wild's eyes widened in realization, and a mischievous smile crossed his face.

"Wild, wait--"

Sky started laughing hysterically as his friend tickled him, wiggling and trying to shove him away.

"Get--off of m--Wild you jerk--"

Hyrule chuckled. "Well, we're not taught to tickle our patients, but that works."

[getphysicalexam]

czOJQxsmMdg

[lannisterdaddyissues]

god why am i so fucking stupid. having adhd is truly a curse and i hate bearing it

[coochiequeens]

But the TQ+ cult continues to deny that children are transed

Dr Helen Webberley said that her licence had been revoked on a technicality

ADRIAN SHERRATT FOR THE TIMES

James Beal, Social Affairs Editor Friday July 19 2024

The General Medical Council has revoked the licence to practise of a controversial British doctor whose offshore clinic treats transgender children.

Dr Helen Webberley, 55, will lose her licence in Britain from Friday but will remain on the GMC’s register, following the decision by the medical regulator.

The decision was made by the GMC after she did not comply with a registered doctor’s legal obligation to revalidate their licence every five years.

Webberley runs GenderGP, an online company registered in Singapore, which facilitates access to puberty blockers and hormones for adults and children.

She told The Times that the decision would not prevent her from continuing in her role at GenderGP and said that she did not personally treat the patients.

Michael Webberley was struck off in 2022 for prescribing hormones to patients as young as nine without proper assessments

Webberley said: “I fought incredibly hard to keep my licence, both for myself and also for the community, because it’s important to set precedent. Now to have it taken away on a technicality, if you like, is very heartbreaking, but I will continue my work as I have done.”

GenderGP assesses adults and children with gender dysphoria and connects them to doctors outside Britain, in the European Economic Area (EEA), for prescriptions for hormones.

This means UK children as young as eight can access puberty blockers, despite the Cass Report, a review of trans healthcare led by the paediatrician Dr Hilary Cass, concluding there was no good evidence for prescribing them.

Webberley was suspended from practising medicine in 2022 after she was found to have committed serious misconduct by a Medical Practitioners Tribunal Service panel over her treatment of three trans children. She successfully appealed against the decision at the High Court in 2023.

Dr Hilary Cass’s review found there was no good evidence to support the global clinical practice of prescribing hormones to under-18s to pause puberty

TIMES PHOTOGRAPHER RICHARD POHLE

Webberley said that she had not used her licence to practise since 2017, when investigations into her conduct by the GMC began. She said that she could not revalidate her licence because she could not find a “responsible officer”, or suitable person, to vouch for her fitness to practise.

Doctors are required to notify the GMC of a designated body and responsible officer to do this.

Webberley said: “The difficulty is … I no longer have a connection with an NHS trust or a GP surgery. I don’t have a responsible officer. It’s also very difficult to get that connection after what I’ve been through.”

She says she was offered the chance to take an exam in order to revalidate her licence, but declined because they “don’t have one for doctors working in transgender medicine”.

Michael and Helen Webberley are now thought to be living in Spain while their business is registered in Singapore

The GMC then withdrew her licence, which it can do if it determines that guidance to revalidate has not been complied with “without reasonable excuse”.

Webberley, from south Wales, said that she would carry on her work at GenderGP.

She said: “I’m not allowed to directly treat and manage individual patients [but] I’m not treating them.

“Treatment means sitting down with somebody, making a diagnosis, making a treatment management plan, prescribing medication, following up investigations and results.

“With GenderGP we have a whole team of professionals who do that. I don’t treat patients individually. They [the GMC] don’t have a regulatory role in my wider work.”

A GMC spokesman said: “Every licensed doctor must take part in the revalidation process, which provides assurance that they are keeping their knowledge up to date, are fit to practise and that no concerns have been raised about them.

“Doctors who do not have a connection to a designated body or suitable person are able to revalidate in a number of ways, including by passing a written multiple choice test called a revalidation assessment.

“There are 12 assessments to choose from, and doctors are encouraged to choose one closest to their most recent area of specialty. We cannot tailor assessments to every doctor’s specific area of practice.

“If doctors do not comply with our guidance on revalidation without reasonable excuse, we may withdraw their licence to practise.”

Webberley and her husband Michael, who set up GenderGP in 2015, are now believed to live in Spain.

As an online business based abroad it is not registered with the Care Quality Commission, but Helen Webberley has denied basing it in Asia to avoid scrutiny.

Michael Webberley, 67, a former gastroenterologist, was struck off in 2022 for prescribing hormones to patients as young as nine without proper assessments.

GenderGP was also criticised in the High Court earlier this year for giving “dangerously high” levels of hormones to a 16-year-old, who was born female but identified as male, that could have resulted in sudden death.

Webberley has called the court claim “untrue”. The Times reported last month that GenderGP, which has more than 10,000 patients, had ditched health advisers in favour of an AI algorithm providing “self-service” treatment.

Behind the story

The health secretary Wes Streeting has indicated that he will seek to make permanent the temporary three-month ban on puberty blockers being supplied to children (James Beal writes).

But Helen Webberley said children at her clinic were still getting hold of them.

Laws to ban the drugs being supplied by private or offshore clinics were passed by Victoria Atkins, Streeting’s predecessor, in emergency legislation before the general election.

They are due to expire on September 3, but the Labour government suggested last week that it would, subject to court proceedings, renew the ban with a view to making it permanent.

It followed the Cass Report, which found there was no good evidence to support the global clinical practice of prescribing hormones to under-18s to pause puberty or transition.

However, Webberley, in an interview with The Times last month, said patients at her offshore clinic were going abroad, using foreign doctors and chemists, to side-step the ban.

She said: “The parents of young people who are affected by this ban will find another way. The last thing is that they will allow their child to stop the puberty blocker and start going through puberty. That’s going to really really affect them mentally and physically.

“I know mums and dads who are just going on holiday to get their puberty blocker instead. They’re going to wherever they’re going on holiday this year.”

Distancing GenderGP, her clinic, from their actions, she said: “We don’t have to find those opportunities, the parents find those ways of managing it.”

Now the revelation that she has lost her GMC licence to practise may increase concerns about her clinic, which operates out of reach of regulators such as the Care Quality Commission.

It follows disclosures that GenderGP had created an AI algorithm to make treatment recommendations rather than using health advisers.

However, given the state of transgender healthcare in the UK, with long waiting lists for treatment, it may not deter transgender patients from turning to GenderGP.

[nexus-nebulae]

me as a kid: i have all these problems

every adult around me: you're not old enough to know what's wrong with you, you're fine

me as an adult: i still have all these problems

my doctors after i finally got the opportunity to choose them myself: oh my fucking god why have you never gotten help for all these problems. you should have seen me 10 years ago

[dreamlogic]

[orcinus-veterinarius]

When you’re a doctor now so they start giving you ASA 3+ level patients on your anesthesia rotation

[er-cryptid]

[nerdgirlnarrates]

I know it’s very early in residency both for me to have this opinion and to be judgmental about it, but my god progress notes should contain a real assessment. It sucks on crosscover to not have a good idea of why a team is doing the things they’re doing and then to have to make decisions about a patient I barely know with little information. Here’s an example: Mr. A is being treated for cellulitis. He is also getting a very thorough workup for osteomyelitis for reasons I can’t discern—is it his clinical picture? Is it some risk factor I’m unaware of? The imaging so far has been negative, so I’m not sure why it’s still being pursued. Then I’m paged that he’s having excruciating pain. I’m not sure how suspicious to be for underlying osteo—was the team very concerned and just waiting for a change in his picture, or was the additional workup CYA medicine? Should I give Tylenol or would it be better not to mask a fever so we can see if the antibiotics are working while we wait for the remaining imaging to be read? I’m sure an even slightly more experienced resident would not be fazed by this, but I honestly find it very frustrating. Like at least tip me off at signout as to what you’re thinking. But since you can’t anticipate every question I’ll be asked or everything that will come up, it’s probably best to write a good assessment. I’m only asking for a sentence or two on what you’re thinking. It really really really does help me understand where the patient is at. In conclusion, this shit is of the devil:

Mr. A is a 50 y/o M with PMHx of HTN, BPH admitted for cellulitis.

#cellulitis

- doxycycline 100 mg PO BID

- negative XR

- negative US

- MRI pending

[derelictheretic]

just had to reorganise the comm trello board and my brain bc I have been out of it ahsahsjshs

[longlegsnamjoon420]

Got a strong feeling none of these schools I applied to are going to call me but the cardiac floor job is def gonna call me. Siiiiighhhhhhh

[getphysicalexam]

OGfquHKhl8I

[lannisterdaddyissues]

someone get me off this damn site i have an exam tomorrow at 1030am i gotta study 😭😭😭😭😭