Lana Sarah Napoleon

• Management and treatment of complex patients in a busy emergency department.
• Manage the floor and patient flow within the unit.
• Assist SHO's and students where needed
• Regular departmental teaching as per roster

• Manage and treat acutely ill patients in a busy emergency department.

• Locum shifts in Trauma units and emergency centres in both state and private facilities.

Developed skills and experience working in primary healthcare. Excellent exposure in outpatients department and busy 24 hour trauma unit.

Common exposure, responsibilities and skills included:

• Primary and secondary survey on patients (adults and paediatrics)
• Airway management including endotracheal intubation of both adults and paediatrics
• Appropriate inter and intra-facility referrals
• Prescription and adminitration of vaccines and PrEP
• Thoracentesis, paracentesis and chest tube thoracostomies
• Electrocardiogram (ECG) and interpretation
• X-ray interpretation (adults and paediatrics)
• Cardiac pacing, pericardiocentesis
• Administering thrombolytic therapy in patient with myocardial infarction (MI) and monitoring during lysis
• Arterial puncture/catheterization, peripheral intravenous (IV), Intraosseous placement
• Fracture/dislocation reductions, splinting and applicatioin of skin traction
• Suturing and management of open injuries
• Reviewing wounds, evaluating wound healing and dressings
• Bladder catheterisation
• Lumbar punctures (Adults and paediatrics)
• ENT foreign body removal
• Conscious sedation, ver blocks (finger, penile)
• Fluid resuscitation in adults and paediatrics
• Breaking bad news

Other health facilities involved: Red Cross War Memorial Childrens Hospital, Vanguard CHC, Wesfleur Hospital, Mowbray Maternity Hospital, Valkenberg Psychiatric Hosiptal

Common exposure, responsibility and skills included:

Family Medicine/Primary Care (6 months)

• Primary and secondary survey in both adults and paediatrics
• Basic and advnaced life support
• Assisting with minor surgical slate e.g. Tonsillectomies, I&D's
• Monitoring of highcare patients
• Ventilator use
• Appropriate intra and inter-facility referrals
• ABG and VBG interpretation
• Diagnosis and managementt of fractures (open and closed) and dislocations
• Intercostal drain insertion and monitoring
• Suturing
• Lumbar puncture and interpretation (paeds and adults)
• Ring blocks
• Conscious sedation
• Pap smears
• Urine dipsticks interpretation
• Pleural and ascitic taps
• Family planning and counseling - insertion of implanon, IUCD
• Management of sexually transmitted infections

Psychiatry (2 months)

• Diagnosis and management of mental health conditions in both the acute and chronic phases
• In-patient and out-patient management of psychiatric patients
• Conducting family meetings
• Psychopharmacology
• Management of psychiatric emergencies and appropriate referrals 
• Mental State Examination

Management and approach to:

• The aggressive/acutely anxious/psychotic patient
• Depression
• Suicide and suicide risk assessment 
• Substance use and abuse 
• Pre and post HIV counseling
• Ethical issues in psychiatry e.g. autonomy/informed consent/confidentiality

Orthopaedics (2 months)

• Radiology of common orthopaedic conditions
• Closed reduction of common fractures/dislocations
• POP application and follow-up
• Splinting and application of traction
• Management of open fractures
• Diagnosis and management of compartment syndrome
• Local and regional anaesthesia e.g. Bier's block
• Osteroporosis work-up in appropriate patients

Anaesthetics (2 months)

• Pre-operative evaluation of patients
• Consent
• Preparation of anaesthetic medications and equipment
• Adminitration of general/spinal and regional anaesthesia
• Monitoring of patients during anaesthesia/maintaining physiological homeostasis
• Airway management and adjuncts e.g. endotracheal intubation, LMA insertion and use
• Ventilation and fluid management
• Anaesthetic drug pharmacology
• Management of common anaesthetic emergencies e.g. high spinal, failed spinal, laryngospasm, the difficult intubation
• Arterial line insertion
• Rapid sequence induction and anaesthesia in the trauma patient
• Post-operative management

Obstetrics and gynaecology (3 months)

• Cardiotocogram (CTG) and interpretation
• Vaginal examinations, speculum and rectal examinations
• Caesarian sections
• Normal vaginal deliveries
• Management of ectopic pregnancies
• Emergency management of eclampsia and fetal distress
• Examination of the neonate, APGAR scoring and airway management
• Open tubal sterilisations
• Cervical biopsy
• Endometrial sampling
• Pap smears
• Contraception methods, counseling and administration
• Clinical staging and management of pelvic inflammatory disease and carcinoma of the cervix
• Termination of pregnancy counseling

Paediatrics (3 months including 1 month neonatology)

• Diagnosis and management of common paediatric emergencies
• Use of Road to Health Booklet
• Anthropometry
• Management of malnutrition
• Venepuncture/ IV line insertion, interosseous insertion, scalp vein insertion
• Diagnosis and management of dehydration
• Urine collection: urine bag, in-out catheter
• Neonatal and paediatric resuscitation
• Induced sputum collection
• Administration of MDI with spacer
• Mantoux testing and interpretation
• Plan and prescribe prevention of mother to child transmission treatment
• Removal of foreign body from ear/nose

Internal Medicine/General Medicine (3 months)

• Primary and secondary survey
• ABG and VBG interpretation
• ECG and x-ray interpretation
• Management of Covid-19 infected patients including managing respiratory emergencies
• Request and interpretation of abnormal biochemistry
• Management of hyper and hypokalemia including Potassium shifts
• Management of Hypertensive urgency/emergency
• Antibiotic Stewardship
• Stabilization of unstable patients
• Basic and advanced life support
• Appropriate referrals to palliative care
• Breaking bad news
• Understanding the importance of the multidisciplinary team in patient management

General surgery/trauma surgery:

• Primary and Secondary assessment of the trauma patient
• Basic and advanced life support
• Diagnosis and management of septic wounds
• Diagnosis ane management of acute limb ischaemia and the approach to the threatened limb
• Fluid resuscitaion
• Peri-opreative management of trauma patients
• Transfusion of blood and blood products
• Initiating massive transfusion protocol
• Nasogastric tube insertion