How would you manage this patient?
A 47 year old woman who was diagnosed with supraventricular tachycardia five years ago is admitted to the emergency department with palpitations. Simple vagal manoeuvres at home, or carotid sinus massage or vagal manoeuvres in hospital with ECG monitoring have proven effective before but this time the palpitation is not resolving. You look at her notes: she has hypertension controlled by enalapril and bendroflumethiazide and she also has severe brittle asthma, which she controls with oral steroids. Which management options would be an appropriate next step for this patient?
Check your answer in our highly rated Hospital Presentations module on Palpitations. You'll learn as you work through patient cases that are typical of the kind of scenarios you might face in your daily work. The module has been getting rave reviews from other junior doctors:
"Superb overview with excellent case based scenarios."
"Thought provoking and extremely useful."
Build your confidence in starting anticoagulation safely
A 40 year old man is diagnosed as having a deep vein thrombosis. You start him on low molecular weight heparin and then warfarin. On day four his INR is 2.3. What should you do?
Check your answer in our newly updated module on Starting patients on anticoagulation. Anticoagulants have many benefits but they can also cause harm and adverse events are common in the hospital setting. Initiating anticoagulation is particularly risky and doing it safely is complex. After completing the module, you will be familiar with the indications and contraindications for different anticoagulation options, clear about starting doses and ongoing monitoring, aware of the pitfalls and informed on how to reverse the effects of anticoagulant drugs.
Would you be confident to manage a diabetic emergency?
What does the latest guidance say about choice of insulin regimen in a patient with diabetic ketoacidosis? When should you consider a diagnosis of the hyperosmolar hyperglycaemic state - and how should it be managed? What’s the best initial insulin regimen for a patient presenting as an emergency with a new diagnosis of type 1 diabetes? And how aggressively should stress-induced hyperglycaemia be treated in an acutely ill patient?
Check your answersin our new Ask the consultant module on Diabetes, in which clinical problems and dilemmas submitted by junior doctors are answered by Dr Anne Dornhorst, consultant physician in diabetes. Other issues covered include indications for a stat dose of insulin in patients with type 2 diabetes, how to adjust glucose-lowering medication in patients with impaired renal function and how to adjust diabetes treatment when starting a patient on steroid therapy.
Our other recent Ask the consultant modules cover:
Learn as you work through typical patient scenarios
Our popular Hospital Presentations series is the ideal way to test out your knowledge and skills as you work through typical challenges that are faced by junior doctors in everyday hospital practice. The modules are packed with evidence-based best practice and practical tips on all aspects of care from initial assessment through investigations and diagnosis to initial management.
You've been bleeped: a fall on the ward
As a junior doctor, it’s a common experience to be asked to review an inpatient who has fallen. Most falls are the result of a simple trip but it's vital to rule out the possibility of a more serious cause as well as to assess the patient for any injury sustained in the fall. This You've been bleeped module for newly qualified doctors gives practical tips on initial assessment, advice on when to seek help from a senior and an update on the management of suspected hip fracture.
Join our audience panel
If you’d like to help BMJ Learning ensure we deliver the content that you need as a medical trainee, join our audience panel to provide feedback and ideas. Email clinical editor Jo Haynes.
Animated practical skills modules to support you in your first years on the ward
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