Metabolic Acidosis


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


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How to be a junior doctor part 2


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.


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How to be a junior doctor part 1.mp3


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 Follow us on Twitter @FOAMdation Find part 2 coming after this!

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Diabetic Ketoacidosis in Adults


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.

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Polypharmacy/Inappropriate Medications in the Elderly, how to review medications


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. 


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Chest Pain, STEMI, NSTEMI and beyond


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. 

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Acute pain, managing epidural and the alternative!


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.





Antibiotics plus gentamicin/vancomycin prescribing


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.




Referrals: a primer and troubleshoot


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


Assessment of the unwell patient.mp3


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.


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