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Westmead Hospital Medical Officers' Consult Handbook

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Westmead Hospital Medical Officers' Consult Handbook Westmead Hospital Medical Officers’ Consult Handbook 1st Edition (v1.9) 2016 Westmead Hospital Medical Officers’ Consult Handbook Chapter Page 1. Anaesthesia 1 2. Bone Marrow Transplant 2 3. Breast Surgery 3 4. Cardiology 6 5. Cardiothoracic Surgery 7 6. Colorectal Surgery 10 7. Dental Health – Emergency and General Practice Dentistry 11 8. Dermatology 13 9. Diabetes Management Service 15 10. Ear Nose & Throat Surgery 17 11. Endocrinology 19 12. Gastroenterology & Hepatology 21 13. Genetic Medicine 24 14. Geriatric Medicine 26 15. Haematology 28 16. Head & Neck Cancer Clinic Dental Service 31 17. Head & Neck Surgical Oncology 32 18. Immunology 34 19. Infectious Diseases 36 20. ICU 37 21. Kidney Transplant Medicine 39 22. Neurology 40 23. Neurosurgery 42 24. Obstetrics & Gynaecology 45 25. Ophthalmology 47 26. Orthopaedics 50 27. Oral & Maxillofacial Surgery 52 28. Palliative & Supportive Care 54 29. Plastic Surgery 57 30. Psychiatry 59 31. Radiation Oncology 61 32. Rehabilitation Medicine 64 33. Renal & Dialysis Medicine 66 Westmead Hospital Medical Officers’ Consult Handbook 34. Respiratory & Sleep Medicine 68 35. Rheumatology 71 36. Sexual Health 73 37. Toxicology 76 38. Transplant Surgery 77 39. Trauma 79 40. Upper GI Surgery 80 41. Urology 82 42. Vascular Surgery 84 Westmead Hospital Medical Officers’ Consult Handbook SPECIALTY: Anaesthesia 1. Common reasons for consults: o Review prior to surgery or procedures requiring anaesthetic support o Assistance with intravenous access 2. Simple steps in obtaining an Anaesthetic consult: o Contact the anaesthetist in charge on pager 8460 o State your name and position o State reasons for consult o Specify what procedure and when it is scheduled for 3. Please state significant comorbidities particularly cardiovascular, respiratory, musculoskeletal, airway issues o Include results of investigations appropriate to disease o Be able to answer these 2 questions: can patient lie flat? Can patient walk up 2 flights of stairs? 4. Submit a consult form to the Anaesthetic Department after contacting 8460. Include clinical details of patient as well as name of person obtaining consult and contact details in the form. Note: • Please keep the phone conversation with 8460 brief and to the point • We will only review patients without an anticipated operation/procedure date in exceptional circumstances • Please be legible and do not use abbreviations RETURN TO INDEX Page 1 of 88 Westmead Hospital Medical Officers’ Consult Handbook SPECIALTY: Bone Marrow Transplant 1. Common questions/reasons for consults to this Specialty o Malignant haematological disease requiring curative treatment o Fever o Diarrhoea 2. General clinical information/questions relevant to consults to this Specialty o Essential • What is the underlying disease • Date of transplant • Was the transplant from themselves (autologous) or from another person (allogeneic) • What drugs were given (conditioning) just prior to the transplant 3. Common question-specific information required o How high has the fever been in the last 24 hours o Is fever associated with rigor/chills or hypotension o How many times has diarrhoea occurred over the last 24 hours o Is there associated abdominal pain or cramping 4. Family/social history relevant to consults to this Specialty o Essential • Is the patient married and does he/she have children and if so what ages? Have they seen the patient within the last few days? 5. Medications relevant to consultations to this Specialty o Prednisone o Cyclosporine or tacrolimus o Mycophenolate o Any antibiotics 6. Investigations relevant to consultations to this Specialty o Last (today’s) full blood count o Biochemistry and liver function tests o Most recent cyclosporine/tacrolimus level in blood o CXR Any recent positive blood cultures, stool or urine cultures RETURN TO INDEX o Page 2 of 88 Westmead Hospital Medical Officers’ Consult Handbook SPECIALTY: Breast Surgery 1. Common questions/reasons for consults to this Specialty o Breast Abscess o Breast Lump/Lesion o Nipple discharge o Mastalgia 2. General clinical information/questions relevant to consults to this Specialty o Essential • Findings on examination of breast: Site/size/skin change/tenderness/mobile/fixed/palpable/impalpable • Findings on examination of axillae (ie lymphadenopathy) • Last mammogram/breast ultrasound (incl. date and results) • Previous history of breast disease (incl. date, diagnosis and treatment) • Family history of breast/ovarian cancer (need to include approximate age of diagnosis as well) • Smoking history • Systemic symptoms (fever, nausea, weight loss etc) o Helpful • Medical/Surgical history • Medications • Pregnancy history 3. Common question-specific information required o Breast Abscess: • Findings on examination of breast/axillae • Last mammogram/ultrasound • Associated nipple discharge • Any history of previous abscess - treatment/where/when • Smoking history • Breastfeeding/number of weeks postpartum • Systemic symptoms o Breast Lump/Lesion: • Findings on examination of breast/axillae • Last mammogram/ultrasound • Associated nipple discharge/inversion • Any previous history of breast disease in general • Family history of breast/ovarian cancer • Medications (particularly HRT) • Results of biopsies (if taken already) • Smoking history o Nipple discharge: • Findings on examination of breast/axillae • Last mammogram/ultrasound Page 3 of 88 Westmead Hospital Medical Officers’ Consult Handbook SPECIALTY: Breast Surgery • Characteristics of discharge - colour/blood-stained/ • smell/spontaneous or on expression only • Any previous history of breast disease in general • Family history of breast/ovarian cancer • Medications (particularly HRT) • Smoking history o Mastalgia: • Characteristics of pain: bilateral/unilateral; Cyclical/constant; diffuse/local; stabbing/burning/ache etc • Findings on examination of breast/axillae • Last mammogram/ultrasound • Any previous history of breast disease in general • Family history of breast/ovarian cancer • Medications (particularly HRT) • Smoking history 4. Background Medical History relevant to consults to this Specialty (e.g. previous contact with Specialty, letters, reports, o/s travel, etc) o Essential . Previous history of breast disease (incl. date, diagnosis and treatment) o Helpful • Hormonal history: . Menopausal status (pre/peri/post) . Age of menarche . Pregnancy history . Current/previous HRT • General medical history • Surgical history • Medications 5. Family/social history relevant to consults to this Specialty o Essential • Family history of breast or ovarian cancer o Helpful • Family history of other cancers • smoking/alcohol history • social supports 6. Medications relevant to consultations to this Specialty o Antibiotics o steroids/immunosuppression o Current/previous HRT o Oral contraceptive pill Page 4 of 88 Westmead Hospital Medical Officers’ Consult Handbook SPECIALTY: Breast Surgery 7. Investigations relevant to consults to this Specialty o Mammogram o Breast ultrasound o Biopsies 8. Essential Investigations required for specific consults o Breast Lump/Lesion • Mammogram • Breast Ultrasound o Breast Abscess: • FBC • Previous culture results (if available) • Breast ultrasound 9. Investigations relevant to consultations to this Specialty (and why) o Imaging of the breast • A breast lesion requires imaging that includes a mammogram and ultrasound • A breast abscess requires imaging that includes an ultrasound only • These are requested if they have not been requested already by the referring team o Biopsies of the breast lesion • The breast team will make an assessment of whether a lesion needs to be biopsied or not if the radiologist has not made this assessment already. RETURN TO INDEX Page 5 of 88 Westmead Hospital Medical Officers’ Consult Handbook SPECIALTY: Cardiology 1. Common questions/reasons for consults to this Specialty o Troponin rise o AF and other cardiac arrhythmias/ECG abnormalities o Syncope o Pre-op assessment o Is this cardiac failure or optimisation of cardiac failure 2. General clinical information/questions relevant to consults to this Specialty o Essential • Proper characterisation of chest pain • ECG and CXR findings • Past ECG if available 3. Common question-specific information required Are they known to a cardiologist/been admitted under a cardiologist before at this hospital? (If so, the registrar for that consultant does the consult) 4. Background Medical History relevant to consults to this Specialty (e.g. previous contact with Specialty, letters, reports, o/s travel, etc) o Essential • Results of previous cardiac investigations ie. Angiogram and TTE and details of previous cardiac procedures/surgery. • Patient’s Cardiologist’s clinic notes 5. Family/social history relevant to consults to this Specialty Level of function and mobility 6. Medications relevant to consultations to this Specialty o Cardiac related meds o Anticoagulants 7. Investigations relevant to consultations to this Specialty o ECG o CXR o FBC, EUC, CMP, LFT, Coagulation studies o TTE o Angiograms 8. Investigations relevant to consultations to this Specialty (and why) TTE: (LV regional wall motion abnormalities/right ventricular dysfunction in trop rise and SOB, LV and valvular function in ?heart failure, structural abnormalities and ventricular function in arrhythmias. 9. Extra tips for acquiring consults Try to assemble the results of previous investigations, old notes (and old ECGs) and specialist clinic letters when trying obtain the consult. Hopefully this will be
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