FOAMdation

Decompensated liver disease and cirrhosis are common pathological states present on the gastroenterology ward. It is important to understand the basic principles of management and aetiology as a junior doctor in these complex and unwell patients.  Dr Liz Sweeney is a specialist hepatology registrar at the Royal Liverpool Hospital. In this episode, she talks to us about decompensated liver disease and cirrhosis with key advice to junior doctors working in hospitals Speak soon, Ollie Wright GET IN TOUCH! Either through the comments section or email foamdation@gmail.com if there are any comments or corrections or if you want to be involved with future topics. RATE US on iTunes to help others find the resource more easily! SHARE US with others you think would benefit or even your training leads to help us distribute the resource further! Twitter: @FOAMdation

Acute alcohol withdrawal and alcoholic hepatitis are common scenarios presenting to the Emergency Department (ED) and the ward. Recognition, investigation and management principles are imperative to prevent serious complications.  Alcoholic hepatitis accounts for 3.3 million deaths worldwide and reports show an average mortality of 6.7% with acute alcoholic hepatitis, rising significantly with increased severity. It is characterised by acute inflammation of the liver due to excessive recent alcohol intake concomitant with COAGULOPATHY and JAUNDICE. Dr Liz Sweeney is a specialist hepatology registrar at the Royal Liverpool Hospital. In this episode, she talks to us about acute alcohol withdrawal and alcoholic hepatitis with key advice to junior doctors working in hospitals.   Speak soon, Ollie Wright   GET IN TOUCH! Either through the comments section or email foamdation@gmail.com if there are any comments or corrections or if you want to be involved with future topics. RATE US on iTunes to help others find the resource more easily! SHARE US with others you think would benefit or even your training leads to help us distribute the resource further! Twitter: @FOAMdation

Atrial Fibrillation is the most common arrhythmia and it can often feel like an on call shift is dominated by patients with AF when it is not controlled. Patients with AF present to Emergency Departments and acute medical takes frequently and it complicates many surgical patient admissions too. On the face of it, it is simple to manage with well-defined treatment options. However, the actual decision-making can feel unfamiliar and less straightforward when the picture becomes more complicated. Professor Kahled Albouaini is a Consultant Cardiologist at the Royal Liverpool and Broadgreen University Hospitals, Liverpool. In this episode, he takes us through AF and simplifies many of the concepts and treatment options. As a bonus, we have a second VIDEO episode entitled "The Many Faces Of AF" that takes you through some of the ECG findings in AF and how to approach them. Consider in each patient the four pillars of AF: Trigger - assess for, investigate and treat any underlying causes Rate (or rhythm) control - initiate beta-blockers and increase as needed Anti-coagulation - assess stroke risk and bleeding risk Echocardiogram - assesses the burden of AF, LV function and the presence of a thrombus Thank you to Professor Albouaini for his help in producing this resource. You can check out his cardiology resources on facebook by searching for Cardiology Cases UK or take a look at his site that offers basic and advanced courses in cardiology: www.cardiologycases.co.uk   Speak soon Gareth @garEMlyn GET IN TOUCH! Either through the comments section or email foamdation@gmail.com if there are any comments or corrections or if you want to be involved with future topics. RATE US on iTunes to help others find the resource more easily! SHARE US with others you think would benefit or even your training leads to help us distribute the resource further! Twitter: @FOAMdation  

Difficult conversations are exactly that: difficult. They may be difficult for numerous factors that are related to the subject matter, the patient, their relatives and friends and yourself. The first time you go through one of these conversation, you may feel drained, raw and emotional or you may not feel affected at all. Dr James White is not just a GP but also an anaesthetic registrar in training who regularly works across critical care and has held numerous roles in medicine. The podcast goes through some different situations that may form a continuum of discussion from the delivery of a test result and possible life-changing diagnosis, the discussions that may take place when faced with an acutely unwell patient and end of life and DNACPR decisions. The episode discusses theprocess in more detail with input from a discussion on Facebook.   GET IN TOUCH! Either through the comments section or email foamdation@gmail.com if there are any comments or corrections or if you want to be involved with future topics. RATE US on iTunes to help others find the resource more easily! SHARE US with others you think would benefit or even your training leads to help us distribute the resource further! Twitter: @FOAMdation

Acute Kidney Injury (AKI) is a disease process that carries a significant mortality impact. The complications that accompany AKI can be difficult to manage and may require specialist input if resistant to treatment. The management of AKI also changes when faced with some special situations. Dr Aled Lewis is a Consultant Nephrologist at Glan Clwyd Hospital, North Wales. In this second part focussed on AKI, we discuss the complications of AKI, their management and some special situations that may alter the management of AKI.   Speak soon Gareth @garEMlyn GET IN TOUCH! Either through the comments section or email foamdation@gmail.com if there are any comments or corrections or if you want to be involved with future topics. RATE US on iTunes to help others find the resource more easily! SHARE US with others you think would benefit or even your training leads to help us distribute the resource further! Twitter: @FOAMdation

Acute Kidney Injury (AKI) I is a medical emergency that has received significant media attention in recent years. It has a significant impact on long term outcomes for patients.   Gareth speaks with Dr Aled Lewis, a Consultant Nephrologist at Glan Clwyd Hospital, North Wales about AKI and the general approach towards diagnosis and management.   Read the accompanying blog post at www.foamdation.com   Part 2 will follow shortly which cover specific complications and special situations.   GET IN TOUCH! Either through the comments section or email foamdation@gmail.com if there are any comments or corrections or if you want to be involved with future topics. RATE US on iTunes to help others find the resource more easily! SHARE US with others you think would benefit or even your training leads to help us distribute the resource further! Twitter: @FOAMdation

Head injuries are not just common to the Emergency Department, but common occurrences when covering the wards as a junior doctor. They can present a challenge both in assessment and investigating appropriately.   Gareth talks to Dr Mike Aisbitt, a Consultant in Emergency Medicine and Paediatric Emergency Medicine at Southport and Ormskirk NHS Trust about how to assess a patient with a head injury, who needs a CT scan and consideration of the medication they take including Warfarin, DOACs and Clopidogrel (?!)   Visit www.foamdation.com for the accompanying blog post discussing the topic. GET IN TOUCH! Either by the website òr email foamdation@gmail.com with any comments or corrections or if you want to be involved with future topics. RATE US on iTunes to help others find the resource more easily. SHARE US with others you think would benefit or anyone who can help distribute the resource further. Speak soon  

How do I manage a patient with diabetes who is going for surgery? Should I start  vsriable rate insulin infusion? When does there normal treatment get restarted?    Scott speaks to Dr David Ewins, Consultant Physician in Endocrinology and Diabetes about the subject, going into depth about how exactly to manage the different regimes of glycaemic control patients may present to you. They discuss some of the common pitfalls in the management of the surgical patient with diabetes and how to tackle these.   Visit www.foamdation.com for the accompanying blog post discussing the topic. GET IN TOUCH! Either by the website, or email foamdation@gmail.com with any comments or corrections or if you want to be involved with future topics. RATE US on iTunes to help others find the resource more easily. SHARE US with other you think would benefit or anyone who can distribute the resource further.   Speak soon.

Over 280000 falls occur in acute, community and mental health hospitals across England and Wales each year. These falls can increase length of stay, prevent return to previously independent living and at worst result in injuries and death. Gareth talks with Dr Josh Deb-Barman, a speciality doctor in Elderly Care Medicine and Stroke Medicine at the Ciuntess of Chester Hospital. The episode is longer than normal and may take a couple of sittings to listen to. The subject is deep and complex and well worth thinking about carefully. Visit www.foamdation.com for the accompanying blog post discussing the topic. GET IN TOUCH! Either by the website òr email foamdation@gmail.com with any comments or corrections or if you want to be involved with future topics. RATE US on iTunes to help others find the resource more easily. SHARE US with others you think would benefit or anyone who can help distribute the resource further. Speak soon

Bowel obstruction is a common surgical presentation and in the presence of ischaemia carries a mortality up to 40%. What makes the diagnosis? How good are the investigations? Gareth talks to Miss Nicola Eardley, Consultant General and Colorectal Surgeon at Chester, about the important steps in the diagnosis and management from history and examination to imaging and further management. Check out the accompanying post for discussion points and references used in producing this episode. Rate us on iTunes if you liked what you heard and follow us on Twitter @FOAMdation. Please get in touch via www.foamdation.com or email foamdation@gmail.com if you have any comments or suggestions. If you like what you hear then share us so others can get the benefit too!

Hyperglycaemia within diabetic inpatients can be a common occurence. Unfortunately, the answer often used is one of just giving a bolus of insulin. However, there are better ways to correct this and one such solution might include the use of a Variable Rate Insulin Infusion (VRIII) as a temporary measure whilst you work to correct the underlying issue. Scott speaks once more to Dr David Ewins, Consultant Physician in Endocrinology and Diabetes, about how to manage hyperglycaemia within the inpatient setting and how to correctly start and discontinue a VRIII.   Check out the website www.foamdation.com where you can get in touch via the contact button. Follow us on twitter @foamdation on find us on Facebook Email foamdation@gmail.com if you have any suggestions, corrections or want to be involved Please rate us on iTunes in order to help others find this resource or share us to anyone you think would benefit!  

Metabolic Acdisosis is the herald of badness occurring within our patients and can be due to either endogenous or exogenous acids. What we really want is a system to use at the bedside when faced with acidosis so we can tailor our treatments based on what the patient needs. Gareth speak with Dr Simon Ridler, Consultant Anaesthetist and Intensivist at Chester about the approach towards solving metabolic acidosis and interpreting the blood gas like a pro. They also discuss a shortened mnemonic of LURK to help you remember the most likely causes of acidosis in in patients you are likely to encounter on the wards as a junior doctor. L: lactate U: unmeasured anions R: Renal failure K: Ketoacidosis   Check out the website www.foamdation.com where you can get in touch via the contact button. Follow us on twitter @foamdation or find us on facebook Email foamdation@gmail.com if you have any suggestions, corrections or want to be involved. Please rate us on iTunes in order to help others find this resource or share us to anyone you think would benefit!  

Starting out as a junior doctore, fresh from medical school is tough. The challenges are large and the responsibility can seem daunting. Never mind the workload, trying to keep yuorself healthy and maintain a good work-life balance is difficult. But help is at hand! In the second part of this episode, Gareth continues talking with Drs Jack Hannah and Katherine Gillespie about their experiences, how to keep a balance and the advice they have for those coming into medicine from medical school.   Check out the post at www.foamdation.com Follow us on twitter @FOAMdation or search for us on Facebook. Or email foamdation@gmail.com if you have any comments or suggestions or feel we need to add something to this!

Starting out as a junior doctor, fresh from medical school is tough. the challenges are large and the responsibility can seem daunting. fear not! In a two part episode, Gareth talks to Drs Jack Hannah and Katherine Gillespie about their experiences and advice they wish they'd had. check out the post at www.foamdation.com Follow us on Twitter @FOAMdation Find part 2 coming after this! Want to add something to this? Email foamdation@gmail.com and we can add what you suggest to this fantastic resource!

Diabetic Ketoacidosis is a life-threatening medical emergency. Prompt recognition and treatment is essential as well as vigilence towards the potential complications. Dr Davd Ewins is a UK Consultant in Diabetes and Endocrinology at Chester and speak with Scott about DKA from diagnosis to de-escalatino of treatment and some potential pitfalls. The mainstay of treatment involves a Fixed Rate Intravenous Infusion, IV fluid replacement with potassium replacement, vigilence for hypoglycaemia and identification and treatment of the underlying cause. When treated effectively, it can be a satisfying condition to treat with patients making a recovery usually within 24 hours. Please rate us on iTunes Visit www.foamdation.com for a more in depth discussion and links to any references used to inform our discussion. Get in touch! Follow us on twittier @FOAMdation, email foamdation@gmail.com or visit our facebook page! Speak soon!  

Gareth speaks with Dr Lishan Liu, an Elderly Care Medicine Registar at Chester about what polypharmacy is, the impact it may have on patients and what tools are available to identify polypharmacy and inappropriate medications and how to conduct a medication review. A run down of the Beer's criteria and STOPP/START criteria can be found at the website along with links to supporting evidence.    Follow us on twitter @FOAMdation, email foamdation@gmail.com or get in touch via the website www.foamdation.com   Speak soon!

Scott Williams meets with Prof John Somauroo, Dr Babu Kunadian, Consultant Cardiologists and Karen Randles, Specialist Cardiac Nurse, from the Cardiology department at Chester.   The topic for discussion is Chest Pain. Chest pain can be encountered in the ED and on the wards so understanding how to approach the patient is important. They talk through the ECG criteria used in the UK for both STEMI and NSTEMI diagnosis, the treatment of both and the further, ongoing investigation and management of ACS within a hospital setting.  Check out www.foamdaton.com for further information, including references for the information discussed.  Rate us on itunes and follow us on twitter @foamdation Get in touch if there is anything you want us to cover in the future or any comments you might have! Speak soon!  

Gareth talks to Dr Dominic Cliff, Consultant Anaesthetist with a special interest in acute pain. Dominic talks us through the systematic approach towards acute pain and the various targets for our therapy. He also highlights some potential problems with epidurals on the wards and how you can deal with them without turning off the epidural pump! Finally, he outlines Rectus Sheath Catheters, a novel approach towards post-operative pain relief that eliminates the complications of epidurals. #FOAMed @FOAMdation  

Gareth discusses aspects of starting antibiotics and focussing them in line with principles of antibiotic stewardship with Joy Nicholls, an Antibiotic Specialist Pharmacist at Chester Hospital. also up for discussion are the particulars of prescribing Gentamicin and Vancomycin and how to manage the ongoing treatment and when to take serum drug levels. @FOAMdation @garEMlyn foamdation@gmail.com www.foamdation.com

Just Gareth, on his living room floor, musing about his experiences with referrals over the last few years. We do recommend you find your own style to handle referrals but hope this provides the beginnings to developing it and gives you some advice to tackle problems encoutered

Gareth speak with Dr Sarah White, anaesthetic registrar, about how to assess an acutely unwell patient. The case chosen was deliberately the kind of patient that would make anyone scared in assessing them; they will always have the potential to continue getting worse despite whatever you do and you should always be reassessing the patient to be sure your treatments are effective. At all times remember to ask yourself: do I need help? There are plenty of resources you can look at to gain a better understanding of this, however one definite one to get your hands on is Essentials of Acute Care 2nd Edition.

Gareth introduces Dr Scott Williams, a current ICU clincal fellow andprevious Core Medical Trainee. Together they discuss aspects of life working on a ward that can help junior doctors when working in a wrd environment. Visit the website www.foamdation.com for an exmple of a ward list and the "box system" for guiding how completed your jobs are. Follow us on twitter @foamdtion.com, like us on Facebook and email foamdation@gmail.com with any feedback you have. If you have any suggestions about how to improve the project or any topics you wish to hear covered.

Gareth meet Dr Santokh Singh, Consultant Anaesthetist and Intensivist at the Countess of Chester Hopital. Santokh is also the Sepsis lead for the hospital and currently developing new hospital protocols for the dingosis and mngement of sepsis. The discussion focuses on recent changes to the definitions of sepsis, the use of lactate in sepsis and a way of thinking about the approach to fluid resuscitation of patients with sepsis. The purpose of this episode is to provide basic level advice and guidnce for Foundation Doctors deling with sepsis in the initial stges. Visit www.foamdation.com for links to the evidence and guidelines we discussed. Follow us on twitter @foamdation, fnd us on Facebook an email foamdation@gmail.com in order to give us any feedback.

Greth and Scott discuss the things they feel can help Foundation Doctors thrive in an on call shift. If you have any further suggestions about what can help then please get in touch by commenting, visitiing the website www.foamdation.com, twitter @foamdation or find us on Facebook. You can email us at foamdation@gmail.com. All feedback is welcome and we would like to hear about things that can help us improve and develop the project.

Dr Gareth Thomas describes briefly the reasons why FOAMdation has been established and what it all means.   Follow the blog at www.foamdation.com Twitter  @foamdation Email: foamdation@gmail.com