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I am sure every DoctorsHangout colleague has have acquired special clinical skills during their clinical life. I would like to request all the esteemed DoctorsHangout members to share their practical/ clinical, self acquired & confident secret tips from all the medical specialties like surgery, obstetrics, gynecology, general medicine, oncology, odontology, anesthesiology etc.

It would pave a concrete way to the development of medicine as well as review the medicine with personal sound experiences.

Please do share the clinical secrets!

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AED is mentioned in ACLS. 

I have been contemplating about AED  for post CABG patient. Basically,  it serves the same purpose and principle with the defibrillator. Commonly, AED is a paraphernalia for emergency medical team (EMT) to respond to any  eventuality that can or might happen in the community. It is handy and has lower voltage compared to defibrillator. If you use AED to patients post CABG with or without pacemaker I think  is acceptable, just don't place it where the pacemaker has been planted or the AED will pick up a different reading. You can actually do manual compression to post CABG patient. If you think of the weakened sternum, I believe the sternal wire used is strong enough to hold it in place. In emergency situation where an individual is found to be breathless and pulseless and with fracture of the sternum, we still give compression. This is done primarily with the purpose of giving oxygen to the brain to prevent brain damage from lack of circulating oxygen.

yeah.. i agree with Dr.Subrahmanyam Karuturi... listening to the patient is quite important. as Sir William Osler said... "listen to the patient... he is telling you the diagnosis".  apart from making a diagnosis.. personally i feel that, when a patient is admitted in the ward, most of the time.. he stays away from his family and feels lonely and depressed. many a thought run in his mind and he will be vexed up with those thoughts.. in other words.. he will be under severe mental stress which aggravates the mental burden posed by the disease.so,  if a doctor has enough time.. it is better if he cares to spend few minutes with the patient.. listen to his grievances, listen to what he feels show some empathy towards him.. try to understand his grief and just pay him an ear. use some expressive words like - "oh.. is it?"  "then what are you going to do about that?"  "how did u manage then??"  "it's all part of life sir.."        and the patient feels that his grievances are cared for. sharing feelings always reduces burden of the mind and this can help in faster healing of the patient. moreover it develops rapport between patient and doctor. when i attend my clinical postings.. i follow whatever i have said above, and at times.. patients tell me their family secrets and break into tears.. i do console them tell some soothing words.. next time when i attend the postings.. they great me and talk to me like a family member..  i am not a consultant, i'm just a student, but listening patiently gains me respect

Very well said. I hope everybody can spare a little of their precious time to listen. Listening is actually one of the communication techniques I teach my students during my lecture on Maladaptive Behavior/ Psychiatric Nursing concepts.

You would have already healed 50% of his/her suffering Dr K.S.R.Bhargava :o)

That is true Dr. Sudhakar. Listening is a way to alleviate emotional sufferings/ anxiety of a patient along with touch.

Very well said Dr K.S.R.Bhargava.

Young patients of psychogenic respiratory distress are very often misdiagnosed as cases of Bronchial Asthma.

at dispensary level I do agree with you, even I have seen misdiagnosed cases of diabetes mellitus taking OHA since last 3 years.

That is unbelievable! Misdiagnosis is a mortal sin in the field of medicine I suppose.

Yes. Hyperventilation has to be differentiated from Br.asthma. Proper auscultation can definitely tell you.

I have encountered so many cases of hyperventilation and bronchial asthma. And with just one look I can differentiate the 2. In hyperventilation,  fingers are rigid or stiffened and patient is breathing rapidly and shallow. If you see these, ask what happened prior. Emotions can have important influence, or stressful situations can result to hyperventilation with uncontrolled and exaggerated respiratory movements. In Bronchial asthma,  flaring of nares is common.  If you see this, even without auscultation, you can say the patient is hungry for air. Proceed with asking if the patient has history of asthma while you are preparing for necessary interventions.

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