Medlink Conference – Day 2 Venue: University of Nottingham
Clinical Skills
I learnt the basics on how to use an Ophthalmoscope, an Otoscope and a Stethoscope.
An Opthalmoscope is used to look at the retina of a patient’s eye and an Otoscope is used to look inside their ear. I was able to practise using each of these pieces of equipment. When using the Opthalmoscope the patient and the doctors refractive index has to be considered and added together to create and image which will be in focus. You will also have to careful to ensure that you aren’t shining a being hit light in a patient’s eyes for a long time as this many cause discomfort. The two main conditions that an cause problems at the back of the eye are diabetes and high blood pressure.
In order to use the Otoscope I was taught a little bit about the anatomy of the ear: everything up until the ear drum is the Outer Ear; the Stapes, Incus and Maleus are the three main bones that make up the Middle Ear and everything else is the Inner Ear. When using this equipment you have to be careful that you aren’t causing discomfort to the patient by pressing too hard. I am also able to appreciate the skills and training needed in order to be able to diagnose somebody by looking at their ear as the middle ear cannot be seen, but a doctor has to look at signs on the ear drum to predict what may be happening further inside.
Auscultation is the use of a Stethoscope to listen to sounds inside the body. I learnt that as well as the heart, a Stethoscope can also be used to listen to the lungs and the bowel. The typical sound that should be heard when listening to the heart is a Lub-dub and this is of the valves closing. The ‘Lub’ is referred to as s1 (Distole – caused by the heart filling) and ‘dub’ is s2 (Systole – caused by the heart emptying). Any other sound between s1 or s2 is due to a condition known as heart murmur. I learnt that there are four different places in which a doctor can listen to the heart, these are the points of where the valves are and can be remembered using the mnemonic All Patients Trust Me: Aortic Valve, Pulmonary Valve, Tricuspid Valve and the Mitral Valve.
As well as the heart, I also was able to learn a little about the lungs: there are 3 lobes in the right lung and 2 lobes in the left lung and a crackle sound in the lungs is caused by liquid. I was given the opportunity to practice these skills on my peers and then able to listen to some sounds of people with real heart and lung conditions. I noticed how similar the sounds were and that a lot of practice and dedication would be needed to train yourself to differentiate between them and make the correct diagnosis.
Pre Hospital Emergency Care – HEMS (Helicopter Emergency Medical Service)
I found this lecture incredibly interesting as it was on an aspect of practical Medicine which I hadn’t really thought about before. I learnt about the challenges and rewards of pursuing such a career as well as some of the skills needed in order to practice within this field.
This field of Medicine very much relies on speed as people will be in critical conditions and require immediate attention in order to have the best chance of survival. The team have 90 seconds to gather any rela net extra equipment, get into the helicopter and get it flying. I thought this number really stressed the vitality of speed if you work in the HEMS. At the start of a call, the team must play the role of an air crew and try to navigate and get the helicopter to the location as quickly as possible. Upon reaching the destination they must play the role of a doctor and judge from 25 ft above the ground whether the situation was an emergency or not. If it is they must make an emergency landing, by quickly judging the surroundings and considering the consequences of certain conditions in that area, such as trying not to block the road, trying not to land on wet mud as it could cause the helicopter to sink.
As well as some of the skills needed, I also learnt about some of the services provided by the the Pre Hospital Care Team such as adavnaced airway support. An example of this is when there is blisters on the surface of a patient who has suffered from a burns accident. These blisters indicate that there is blisters on the inside which will restrict the airway and lead to death in fifteen minutes. The team are also able to carry out an emergency thoracotomy after a stabbing. I was really affected by some of the case studies and images of patients that I was shown and this enabled me to recognise the significance of possessing resilience and emotional strength in this career. You will have to deal with death regularly and will also see people in frightening states, but you must be able to cope with that in order to be able provide them with the level of emergency care that is required.
One of the case studies which I was told was of a farmer who had been using a digger near a lake and the whole dogger had sunk along with him. When the crew managed to get him out, he was pronounced ‘dead’, but they still attempted resuscitation. Due to this early intervention, after seven days he left hospital physically and neurologically intact. I thought this was a remarkable and inspiring story which just demonstrates the difference doctors can make if they truly do their job. Another really inspiring story was of a two year old girl who was attacked by a dog. When the doctor came to the scene she was completely unconscious; there was blood on the walls, floor and ceiling; she was covered in bite marks and part of her spine bones were showing due to the dog biting her neck. I saw a photograph of her coming to see the doctor who treated her a year after the accident. I thought it was the most adorable, beautiful and inspiring photo ever and just demonstrated the rewards of such a career.
Life of a Medic 