F2 Teaching Day (Aug)

F2 Teaching Day (Aug)

This week we held the first F2 teaching day for our newest rotation of junior doctors at Leicester Royal Infirmary’s ED. We had a smörgåsbord of topics from mental health, through to minor injuries and managing head injuries.

Here's a summary of some of the key learning points from the day…



Mental Health


Primary Assessment

Physical health needs:

  • Observe the patient, look for any injuries or evidence of self-harm

  • Assess their cognition


  • Is the environment safe for you?

  • Is the environment safe for the patient?

Personal possessions:

  • Does the patient have any potential weapons on them?

  • Remove anything that could be used to harm themselves


  • Any thoughts to harm self or others

  • Any desire to leave

Assessment of Risk

Suicidal thoughts:

  • What were they thinking at time of episode?

  • Did they want to die?

Lethality of episode:

  • Would it have resulted in death?

  • Made efforts not to be found

Intent now:

  • Any current thoughts to self-harm

  • Do they have any regrets?

Protective or Adverse factors:

  • Aspects can be protective and/or adverse…

    • Jobs, relationships, friends and family

    • Criminal charges

Risk factors and past/current mental health problems.



A person is presumed to have capacity and can refuse treatment…

  • Person must understand the information given to them

  • Retain the information

  • Weigh up the information to come to a decision

  • Communicate that decision

If refusing, explore why they are refusing and consequences of refusing.





Intentional and Non-Intentional overdoses are managed in the same way at the start.

Find out…

  • What was taken?

    • Consider activated charcoal if within 60 minutes

  • How much was taken?

  • When was it taken?

  • Was anything else taken with it? (e.g. alcohol or other drugs)

Check on Toxbase.org for investigations…

  • Bloods (FBC, U&E, LFT, CK, Clotting, VBG)

  • ECG (rate, rhythm, QTc)

Once treated get Mental Health assessment (if indicated)




Head Injury

Why? How? When? Are they on anticoagulation? Consider and know the CT Head NICE Guidance (see below).

When examining head injuries in patients always check…

  • Eyes and CNs

  • Ears – haemotympanum?

  • Have a good feel at the lumps and bumps → if boggy, large or unsure get a senior to have a feel.

  • Any evidence of seizure? Wet themselves or bitten their tongue?



Palliative Care

“Compassion. Compassion. Compassion!”


Lightning Learning: Henoch-Schönlein Purpura (HSP)

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