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Chapter Summaries

Trauma and Orthopaedics


The first day on-call as the Trauma and Orthopaedic SHO can be daunting, as it is a practical speciality both in and out with the operating theatre. The level of senior supervision can vary between hospitals, but you should always feel supported no matter what the circumstances are. The differences between district general and trauma centres will also dictate how much or how little independence you will be given. Other than the Orthopaedic registrar or consultant, experienced ED staff will often be willing to assist. 

The main role of the Orthopaedic SHO is to provide an initial assessment of patients in ED and decide between operative or non-operative management, with relevant follow-up arrangements. If operative management is deemed likely, the SHO role will involve medical optimisation for theatre, planning operation logistics, and completing relevant paperwork such as consent forms. However, you should only consent to patients if you have sound knowledge of the proposed procedure and its associated risks. Additionally, major trauma and significant injuries should be managed by a team, and as the Orthopaedic SHO, you should not be left alone to manage such injuries. It is entirely justifiable in asking ED to ensure a patient is sufficiently resuscitated prior to accepting their referral.

The fracture clinic is usually a Monday to Friday outpatient service, which can be utilised as a safety-net for patients who are either for a trial of conservative management or being followed-up post-operatively. Do not hesitate to bring a patient back as regularly as you feel is needed to ensure a safe recovery. If you feel out of your depth, then you probably are. Most senior staff will not mind being contacted whilst on-call, particularly for complex cases, emergencies or polytraumas.

This chapter is not a textbook on Orthopaedic conditions. It is, however, a summarised and practical source of common Trauma and Orthopaedic conditions, and an overview of basic orthopaedic procedural skills.

  • Mr Sean Milner




Surgical SHOs are commonly required to cover Urology on calls often combined with cross cover for another surgical speciality such as General Surgery. The commonest emergency presentations that you will be asked to see are renal colic, urinary retention, haematuria and testicular pain. In addition to these common emergencies, several other acute Urology presentations are covered. 

This chapter will provide you with a stepwise approach on how to assess and manage these patients when you are on call. We have also provided you with a series of red flags to help guide you with identifying the unwell patient who you might need to escalate to your friendly Urology registrar. In most units, the Urology registrar is off-site out of hours, but don’t forget we are only a phone call away!

Remember, more lubricant is almost always a good idea.

  • Mr. Salim S. Malik


Ear, Nose and Throat Emergencies 


Despite accounting for nearly 20% of all GP encounters, most doctors generally know remarkably little ‘working’ ENT. Resultantly, a small amount of knowledge can set you apart over the phone or in A&E. It is also a speciality with numerous easy procedures that can be performed independently at the SHO level which can turn patients around quickly, not only improving patient experience but also providing a sense of autonomy and job satisfaction. 

Outlined in this chapter is a non-exhaustive selection of common ENT ‘emergency/acute conditions’ likely to be encountered by SHOs on-call for ENT. It goes without saying, anything for which you are unclear or concerned should be discussed with your friendly on-call ENT Registrar. Do not forget, they are used to SHOs unfamiliar with ENT covering their on-calls and no doubt whatever your question, they would have had a worse one from a GP.

N.B. Antibiotics should be prescribed as per local hospital guidelines where possible.

Red Flag symptoms or signs should be discussed with the registrar immediately.

  • Mr. Tobias James, ENT ST2


General Surgery

General surgery is the most common specialty that surgical trainees will be asked to cover whilst on-call, and is also the one that receives the greatest volume of referrals from the Emergency Department. Fast paced with often extremely unwell patients, General Surgery is one of the most exciting and rewarding specialties to work in. The breadth of practice is vast - with some patients requiring immediate ITU support, others with bowel obstruction or perforation mandating an urgent laparotomy to those who just need a bit of advice and a taxi home. 

For these reasons it is important that SHO’s gain a good grasp of the specialty in order to safely and efficiently manage an on-call shift and ensure that patients receive expeditious treatment where needed. It is of great importance to draw on your communication skills to escalate to seniors as well as to delegate tasks to junior members of the team. Your days will no doubt be busy, but can be immensely satisfying. 

Remember to eat lunch.

Anil Krishan