Project Magnum Opus

PRELUDE
    I am writing this to become a better doctor. To be able to function at the level of a consultant. There is no fixed syllabus. There are only outlines of topics that a consultant kinda needs to know about. It seems like an impossible task, but medicine is ultimately based on real life, and it cannot deviate from that. Medicine changes, but human beings do not evolve that quickly. I have 10 years of experience behind me, along with studying for the exams, which are based on real life, and will stay true to reality.

    This project is an integration of all previous study documents for consultant level exams, namely my collection of clinical decision making tools and copypastable templates, ECG archives, ABG archives, and collections of structured assessments and multiple choice questions.

    This aims to be the final set of notes in my career. It will be updated as appropriate and once complete I will look into versioning and QI.

APPROACH
    The topics are wide, and the knowledge required could be extremely focused at times. Remembering lists is meaningless. Everything has to be in working memory, well understood and structured to allow for rapid access on the floor. Quick. Intuitive. Practical. To achieve the required amount of practical working knowledge, basic principles are to be employed. The structure is similar to that of the International Baccalaureate diploma, in that each theme is broken up into chunks with a progression of concepts and logical themes.

    The separation of themes differ from traditional textbooks and references as they are oriented around clinical relevance and application. Compartmentalizing information in clinically relevant areas of working memory is a key goal of this project.

    As this project focuses on real life, many topics are deliberately superficial and to the point. There are also some topics that end up being oddly specific and detailed as they are relevant to clinical practice.

  • Chunking. Breaking up each topic in to bite sized pieces that could be integrated into working memory. Each topic should be reviewable in about 1 hour.
  • Minimising cognitive load.
  • Pictures / diagrams / illustrations / questions*
  • Each topic has to flow in a logical progression of thinking – from fundamental concepts to complex themes.
  • Each topic starts with a question or clinical scenario – because that’s how real life works.
  • Cutting out the noise: Information relevant to practical real life clinical decision making is to be included.
  • Portability – if a presentation needs to be done on one of the themes, easily copy-pastable into a powerpoint.

APPENDICES
A. ED Templates (link v18.10.21)
B. List of therapeutic interventions.
C. Blood Gas Analysis (link v18.10.21)
D. ECGs


*COPYRIGHT NOTICE
I do not profit from this project – it is my contribution to FOAMED. Images and diagrams are taken from my personal notes that were collected/curated from various presentations, lectures, handouts, and google images. I honestly do not know where I got most of these images from. If you would like your images to be removed from any document, please contact me. Similarly, any integrated questions are derived from openly available ACEM trial questions. If you are the author of a trial question/SAQ and would like your question removed (or credits given), do get in touch.
Email: ez%ra&li#mm(at)gmail(dot)com. (remove the symbols).

**DISCLAIMER
FOR EDUCATIONAL PURPOSES ONLY. I do not claim to be the authority on any topic covered. Opinions expressed may or may not be the correct answer for a given clinical situation. This is not a guide to clinical practice. This is not a textbook. Information provided needs to be interpreted in the clinical context of current medical literature and standard practice. It is not written for the layperson.

 

Topics

  • Administration – General (link v 2.10.21)
    • Consent
    • Mandatory Reporting
    • Dealing with complaints / Open Disclosure
    • Risk and Error
      • Mitigating Risk
      • Managing Performance of Juniors
    • Equipment purchase
    • Triage
    • Cultural Competency

 

  • Administration – Quality Control
    • The Quality Cycle (PDSA)
    • Quality Standards and ED Indicators
    • Key Performance Indicators
    • Did Not Wait
    • Patient Flow / Overcrowding.
      • Solving Access block
    • Time based targets
    • Short Stay Units

 

  • Administration – Disaster Management
    • Hospital Disaster Planning
    • Prehospital Care and Retrieval Medicine
    • CSSCATTT
      • Command & Control
      • Site arrangement
      • Safety issues
      • Communication
      • Assessment (METHANE)
      • Triage Sort and Sieve
      • Treatment
      • Transport

 

  • Anaesthethics
    • Analgesia
      • Opiate Equivalency
    • Local Anaesthethics
    • Intravenous Regional Blocks
    • Procedural Sedation
    • Regional Nerve Blocks

 

  • Burns
    • Types of burns
    • Determining burn surface area
    • Management of burns
    • Referral criteria for burns
    • CO toxicity
    • Cyanide Toxicity

 

  • Burns: Non Heat Related
    • Chemical Burns
      • Corrosives
      • Hydrofluoric Acid
    • Electrical Burns

 

  • Cardiology – ECG Primer
    • ECG Basics.
    • Coronary circulation, Conduction.
    • LAFB
    • LPFB
    • RBBB
    • LBBB
    • Bifascicular block
    • Trifascicular block
    • AV blocks
      • Type 1
      • Type 2 Mobitz I
      • Type 2 Mobitz II
      • Complete Heart Block

 

  • Cardiology – Acute Coronary Syndrome
    • Risk stratification.
    • STEMI
    • NSTEMI

 

  • Cardiology – MI / Pericarditis
    • STEMI Types
      • Ant/anteroseptal
      • Lateral +/- Pos
      • Inferior +/- Pos
      • Posterior
    • STEMI Equivalents
      • Wellens
      • DeWinters
      • LBBB Criteria
      • LMCA occlusion
      • 1st Diagonal occlusion
    • STEMI management
      • Thrombolysis timeframes
    • Pericarditis vs STEMI vs BER

 

  • Cardiology - Arrhythmias
    • Bradyarrhythmias
    • Atrial Fibrillation
      • Cardioversion vs Rate Control
        • Stroke Risk
        • Bleeding risk on anticoagulation
    • Supraventricular Tachycardias
    • Wide Complex Tachyarrhythmias
      • VT vs SVT with aberrancy
      • Brugada Criteria.

 

  • Cardiology -  Life Threatening ECG Spot Diagnoses
    • WPW
    • Brugada
    • ARVD
    • HOCM
    • Long QT
    • CPVT
    • RV Strain Pattern
    • Hypothermia
    • Digoxin Toxicity
    • TCA toxicity

 

  • Cardiology Issues
    • Acute pulmonary oedema.
    • Pacemakers
    • Syncope, Approach to.
    • Pericarditis
    • Endocarditis
    • Rheumatic Fever
    • Cardiogenic Shock

 

  • Dermatology – Adult Bullous
    • Herpes Zoster
    • Pemphigus
    • Pemphigoid

 

  • Dermatology – General
    • Psoriasis
    • Erythema Minor
    • Erythema Major
    • SJS / TEN
    • DRESS

 

  • Dermatology – Differential Sieve to segue into other conditions.
    • Purpuric Rashes
    • Viral Exanthems
    • Target Lesions

 

 

  • Dislocations – Upper Limb
    • Glenohumeral (Shoulder)
      • Anterior
      • Posterior
    • Acromioclavicular (AC)
    • Elbow
    • Radial Head (Pulled elbow)
    • Perilunate
    • Lunate
    • Scapholunate
    • Phalanges

 

  • Dislocations – Lower Limb
    • Hip
    • Knee
    • Patella
    • Ankle
    • Foot

 

  • Endocrinology – The Adrenal Axis
    • Physiology
    • Addison’s Primary HypOadrenalism
    • Secondary HypOadrenalism
    • Critical HypOadrenalism
    • Cushing’s HypEradrenalism
    • Pheochromocytomas

 

  • Endocrinology – Glucose
    • Hypoglycaemia
    • Diabetic Ketoacidosis
    • Hyperosmolar Hyperglycaemic State
    • Alcoholic Ketoacidosis

 

  • Endocrinology – Thyroid and Parathyroid
    • Physiology primer
    • Hyperparathyroidism
    • Hypoparathyroidism
    • Hyperthyroidism
    • Thyroid Storm
    • Hypothyroidism
    • Myxoedemic Coma
    • DeQuervien’s Thyroiditis

 

  • Environmental – Altitude and Hypothermia
    • Acute Mountain Sickness
    • High Altitude Cerebral Oedema
    • High Altitude Pulmonary Oedema
    • Hypothermia

 

  • Environmental – Diving and Near Drowning
    • Decompression Illness
      • Pulmonary Barotrauma, Arterial Gas Embolism (AGE), and Decompression Sickness (DCS)
    • Hyperbaric oxygen
    • Managing Decompression Illness

  • Environmental – Hyperthermia and Radiation (link v18.10.21)
    • Differences between heat related presentations
    • Minor heat related presentations
    • Heat Exhaustion and Heat Stroke
    • Radiation Poisoning

  • Evidence Based Medicine
    • Types of errors
    • Study Types
    • Sensitivity, Specificity
    • Negative and positive predictive values
    • Likelihood ratios
    • Number Needed to Treat/Harm.
    • Relative Risk
    • Odds Ratio
    • General Concepts

 

  • Fractures – Scapula, Clavicle and Shoulder
    • Clavicle fracture
    • Scapula Fracture
    • Humerus fractures
      • NEER Classification

 

  • Fractures – Around the Elbow
    • Radial head fractures
    • Supracondylar fractures
      • Gartland classification
    • Condylar fractures
      • Milch Classification
    • Forearm fractures
      • Night stick
      • Monteggia
      • Galleazzi

 

  • Fractures – Wrist
    • Colles
    • Smiths
    • Bartons
    • Radial Styloid
    • Scaphoid

 

  • Fractures – Fingers
    • Metacarpal fractures
    • Bennets
    • Gamekeeper’s Thumb
    • Boutonnieres
    • Mallet finger
    • Jersey finger

 

  • Gastroenterology
    • Gastroenteritis
    • Upper GI Bleeding

 

  • Haematology
    • Anaemia
    • Haemaglobinopathies
    • Haem Oncology
    • Approach to Thrombocytopenia
    • Transfusion Medicine
    • Anticoagulation
    • Coagulation studies
    • Thrombolysis
    • Coagulopathies
      • DIC
      • Haemophilia
      • vWF Deficiency
      • HELLP
    • Thrombophilia
      • The thrombophilia screen

 

  • Immunology
    • Understanding Four types of hypersensitivity
    • Anaphylaxis
    • Urticaria
    • Angioedema

 

  • Infectious Diseases – Sepsis General
    • Sepsis & scoring
    • Blood Cultures

 

  • Infectious Diseases – Specific Circumstances.
    • Returned Travellers
      • Fever
      • Diarrhoea
    • HIV / AIDS

 

  • Infectious Diseases 3 - Issues
    • BABS
    • Sexual Assault
    • Infection Control

 

  • Maxillofacial / ENT
    • Dental injuries
    • Epistaxis
    • Otitis media
    • Otitis externa
    • Mastoiditis
    • Perichondritis
    • Chondritis
    • Epiglottitis
    • Retropharyngeal Abscess
    • Post Tonsillectomy Bleed
    • Neck masses F.I.

 

  • Metabolic Derangements
    • Potassium
    • Sodium
      • Hyponatraemia workup
    • Calcium
    • Magnesium
    • Endocrine Electrolyte Pattern Recognition

 

  • Neurology – Focused Assessment
    • Dix-Hallpike-Epley
    • ASIA Chart
    • UMN vs LMN.
    • Peripheral Nerves
    • Spinal Tracts
    • Cranial Nerves
    • Cerebellar signs

 

  • Neurology
    • Stroke
      • NIHSS Scoring
      • Stroke Mimics
      • TIA Risk Stratification
      • NIHSS scoring
      • Focused Posterior Stroke Examination
      • HINTS ruleout
      • Thrombolysis
    • Delirium / Acute Brain Failure
      • Scoring Systems (4AT / CAM ICU)
      • Treating Delirium
      • Differentiating delirium, dementia and psychosis
    • Altered Conscious State Workup
      • Template approach and differentials.
    • Guillain Barre
    • Myasthenia Gravis
    • Multiple Sclerosis

 

  • Neurosurgery
    • Subarachnoid Haemorrhage
    • Subdural haemorrhage
    • Epidural Haemorrhage
    • Brain Herniation
    • Spinal Epidural Abscesses
    • Cauda Equina
    • Radiculopathy
      • Cervical radiculopathy
      • Lumbar radiculopathy

 

  • O&G Obstetrics
    • Normal Pregnancy
    • Delivery
      • APGAR
      • Shoulder Dystocia
    • Post partum haemorrhage
    • Drugs in Pregnancy
    • Early bleeding in pregnancy
    • Late Pregnancy Bleeding
    • Hypertension in Pregnancy
      • HTN
      • Preeclampsia
      • HELLP
      • Eclampsia

 

  • O&G Gynaecology
    • Epididymoorchitis
    • Genital Ulcers
    • Pelvic Inflammatory Disease
    • Bacterial Vaginosis
    • Trichomoniasis
    • Ovarian Torsion
    • Emergency Contraception

 

  • Opthalmology
    • Red Eye Differentials
    • Painless Visual Loss
    • Painful Visual Loss
      • Optic Neuritis
      • Glaucoma
    • Bilateral Visual Loss
    • Traumatic Eye Injury
      • Retrobulbar haemorrhage
      • Ruptured Globe
      • Burns
      • Hyphaema
    • Infections
      • Pre-septal / Periorbital Cellulitis
      • Orbital Cellulitis (Endopthalmitis)
    • Ocular Cranial Nerve Palsies
    • Horner’s Syndrome
    • Fundoscopy Pattern Recognition
    • The standard eye exam.

 

  • Psychiatry
    • Mental state exam
    • Managing agitated patient
    • Suicide Risk Assessment
    • Psychosis Differentials
    • Alcohol Abuse
    • Anorexia
    • …and finally, actual psychiatric disorders
      • Depression
      • Schizophrenia
      • Personality Disorders

 

  • Radiology General
    • Safety – in layman’s terms.
    • Consultant Terminology
    • Xray references
    • MRI basics

 

  • Renal
    • UTI
    • ARF
    • Glomerulonephritis

 

  • Respiratory
    • Pneumonia
      • Scoring systems
    • COPD
    • Asthma
    • Pneumothorax
    • Pneumomediastinum
    • Lung lesions
      • Cavitating
      • Rounded
    • Haemoptysis
    • Pleural Effusions
      • Light’s Criteria
    • ARDS
    • Inhaled Foreign Body

 

  • Resus
    • Airway
      • Difficult airway predictors
      • Special airways
      • Front of neck access
      • Airway foreign body
      • Blocked tracheostomy tube pathway
    • Breathing
      • Protective ventilation
      • Restrictive ventilation
      • NIV
    • Circulation
      • ALS Arrest Algorithm

 

  • Rheumatology
    • Arthrocentesis
    • Septic arthritis
    • Crystal arthropathy (gout/pseudogout)
    • Adult Vasculitis (L/M/S)
      • GCA
      • PAN
      • Wegeners.
    • Low Back Pain

 

  • Toxicology 1 – General Approach, Toxidromes, and Antidotes
    • RRSIDEAD
    • Toxidromes
      • Opioid
      • Cholinergic
      • Anticholinergic
      • Sympathomimetic
      • Serotonergic
      • Sedative-Hypnotic
      • Methaemaglobinaemia
      • Tardive Dyskinesia
      • Neuroleptic Malignant Syndrome
      • Malignant Hyperthermia
    • One Pill Killers
    • Important Drug Thresholds
    • Spot Dx ECGs
    • Enhanced Elimination
    • Antidotes.

 

  • Toxicology 2 – Important Toxins

 

  • Toxicology 3 – Miscellaneous Toxins

 

  • Toxinology, Plants and Animals.
    • Snake bite
      • Tiger
      • Brown
      • Black
      • Death Adder
      • Taipan
      • Sea snake
    • Spiders
      • Whitetail
      • Redback
      • Funnelweb
    • Marine
      • Box jellyfish
      • Bluebottle
      • Stonefish
      • Irukandji
      • Blue ringed octopus
      • Ciguatera
      • Scromboid
    • Mushroom Poisoning
    • Plants
      • List / table.

 

  • Venous Thromboembolism
    • DVT
    • Pulmonary Embolism

 

  • Trauma 
    • Trauma risk assessment / Trauma Call activation
    • Special situations
    • Damage control resuscitation
    • Chest Trauma
      • Rib fractures.
      • Haemothorax
      • Pneumothorax scoring
    • Abdo Trauma
      • Splenic Injury
      • Liver Injury grades
      • Abdominal compartment syndrome
      • Renal trauma grades
    • Pelvic trauma
      • Bladder injury
      • Urethral injury
    • Trauma Haemorrhage
      • Massive Transfusion Protocol.
    • Trauma Arrest
      • Thoracotomy.

 

 

  • Trauma – Head Neck Spine (link v13.10.21)
    • Head
      • Head Anatomy
        • Skull Anatomy
        • Signs of BOS#
        • Le-Fort Fractures
      • Intracranial Injury
        • Grading intracranial injury
        • Four types of intracranial bleeding
        • Managing a deteriorating patient with head trauma
        • Preventing Secondary Brain Injury
      • Concussion
        • Symptoms and signs of concussion.
        • Advice regarding return to sport
        • Monitoring concussion in ED Short Stay
      • Imaging Pediatric Patients
        • Differences between the PECARN, CATCH and CHALICE rules
        • Rephrasing CDM rules in the negative.
        • The PREDICT guidelines

 

    • Neck
      • Neck Anatomy
        • Zones of the neck
        • Triangles of the neck
        • Penetrating trauma
      • Approach to Neck Injuries
        • Who to scan? NEXUS and Canadian Cspine rules
        • Attempted Hanging
        • Blunt Cerebrovascular Injury

 

    • Spine
      • Spine Anatomy
        • Anatomy primer
        • Basic Assessment – Dermatome / Myotome landmarks
        • Spinal tracts
        • ASIA Chart
      • Spine trauma patterns
        • Neurogenic shock
        • Spinal Shock
        • Cord Syndromes
      • Anatomy Primer
        • Xray Interpretation
      • C1 Neck Fractures (yes, it’s own subsection)
        • Type 1: Isolated undisplaced stable anterior arch, or displaced Plough fracture.
        • Type 2: Posterior arch from hyperextension.
        • Type 3: Lateral mass (axial load + rotation)
        • Type 4: Burst Ring Jefferson fracture.
      • Neck Flexion Injuries
        • Anterior wedge fracture
        • Anterior Teardrop fracture
        • Clay shoveller’s spinous process fracture
        • Subluxation
        • Facet joint disruption (bilateral)
        • Atlanto-occipital dislocation
        • Odontoid(dens) fracture
      • Other Neck Injuries
        • Unilateral facet joint dislocation (rotation)
        • Rotary dislocation C1-C2
        • Extension Teardrop Fracture
        • Hangman fracture
        • Burst fracture of vertebra
      • Thoracolumbar Fractures
        • Anatomy Primer
        • Mechanisms
        • Three column model
      • Thoracolumbar MAJOR/Unstable Fractures
        • wedge compression fracture
        • burst fracture
        • chance fracture
        • flexion distraction injuries
        • translational injuries
      • Thoracolumbar Stable Fractures
        • Transverse Process Fractures
        • Spinous Process Fractures
        • Pars Interarticularis Fractures
      • Specific Issues
        • Management of Neurogenic Shock

 

  • Urology
    • Renal Colic
    • Urinary Retention
    • Acute Scrotum
    • Paraphimosis
    • Priaprism

 

  • Paediatric Resus Cubicle
    • WETFAG
    • Newborn Life Support
    • APLS
    • Neonatal resuscitation
    • Paediatric drug dosing
    • Paediatric fluid calculations
    • Procedural sedation
    • Seizure termination
    • Paediatric Trauma Considerations

 

 

  • Paediatric Dermatology
    • Measles
    • Scarlet Fever
    • Rubella
    • Erythema Infectiosum / Slapped cheek
    • Roseola Infantum
    • Coxsackie A16 (Hand, foot and mouth disease)
    • Scalded Skin Syndrome
    • Impetigo

 

  • Paediatric Orthopaedics
    • Salter Harris Classification
    • Buckle and torus fractures
    • Elbow ossification centers.
    • Limping child
      • Perthes
      • SCFE
      • Transient sinuvitis.
    • Child Abuse fracture patterns

 

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