IASM Case 1: Fracture Flashcards
***Triage system
- Critical (0 mins): dying/life-threatening condition, attended immediately
- Emergency (15 mins)
- Urgent (30 mins)
- Semi-urgent
- Non-urgent
—> Assessed by experienced and specially trained triage nurse
***Procedures if patient disagree with treatment
- Explain why procedures is advised in Open and Explicative way so patient fully understand the reasoning
- Identify Core Concerns of patient, address Root Cause behind hesitation
- Involve Family so patient can receive Support and Encouragement they are looking for
- If not legally bind (quarantine needed), doctor ought to respect autonomy, provided that the patient is competent
- ***Discharge Against Medical Advice (DAMA) have to be invoked / similar documentation
***6 primary vital signs (TURBO-P)
- BP (postural: fall >20mmHg systolic, >10mmHg diastolic from supine to erect)
- Respiratory rate (12-20)
- Body temperature (35.8-37.2)
- Pulse (60-100)
- Oxygen saturation (97-99%)
- Urine in/output
Others:
- pain
- distress
- standing-supine blood pressure
***5 Questions asked by nurse for initial assessment
- Basic particulars of patient
- Nature of medical condition
- Medical history
- Allergy
- Social history
Health, disease, illness, sickness, acut and chronic disease
Health: State of complete physical, mental, and social well-being, and not merely the absence of disease / infirmity
Disease: Abnormality out the range of pre-set boundary
Illness: Subjective feeling of being unwell
Sickness: Socially-legitimised state of being unwell
Acute: Disease with rapid onset and short course
Chronic: Diseases of slow progression and long course (cut-off: 3 months)
Principles of X-ray
- Electromagnetic waves through body, exposing the film to reflect internal structure
- Dense tissue appear white because of absorption of radiation —> radioopaque
- Less dense tissue allow radiation to pass through —> radioluscent
- Barium sulphate / dye to make some structure stand out
- several angles
- should include at least 2 views (PA view + lateral view)
- CT / MRI better delineate fractures identified on X-ray / suspected fractures when X-ray does not show
- MRI also be done to diagnose complex strains (e.g. ligament rupture) / soft tissue injuries (cartilage injuries)
Theromoregulation principle
See lecture
Soft tissue welling mechanism
See lecture
Importance of vital signs
- Measure body’s basic function
- check health status to make appropriate first aid treatment
- decision about triage category
- monitor vital function to prevent deterioration
- assess prognosis
Basic principle of first aid
Aim: Preserve life, Prevent further harm, Promote recovery
RICE: Rest, Ice, Compression, Elevate
DRABCDE: Danger, Response, Airway, Breathing, Circulation, Disability, Expose
Assessing consciousness: AVPU (awake, verbal, painful, unresponsive)
Patients’ concern and expectations in driving medical consultation
Why visit doctors
- Reach limits of tolerance
- Reach limits of anxiety
- Problem of living presented as symptoms
- Prevention
- Administrative reasons
Patient expectations:
- Waiting time
- Cost of medical service
- Impact on their lives
Importance of effective communication skills:
- Patient understand what is wrong
- Better patient compliance
- Better doctor-patient relationship
- More time-efficient
- Reduce chances of error in communication
How population can approach health care services in HK
- General Out-patient Clinics (GOPCs)
- Booking:
—> Chronic: appointment made after each consultation
—> Episodic: can reserve slots within next 24 hours through phone
- Services:
—> nursing services: dressing, injection
—> health risk assessment and follow-up care
—> targeted treatment service (wound care)
—> smoking cessation - Specialist Out-patient Clinics (SOPCs)
- booking:
—> need referral from GOPC / medical practitioner
—> HKID, referral letter, proof of address - HA Chinese Medicine Centres for Training and Research (CMCTRs)
—> Chinese medicine service
—> collaboration between government, NGOs, universities - Fees: A&E: $100, inpatient ($50 admission, $100/day) (all fees are for eligible patient)
Impact of accidents on health and health related issues
Physical
- disability
- pain
Psychological
- PTSD (post traumatic stress disorder)
- Anxiety
- Phobia
- Depression
Sources of population health data
- Official statistics by
- The Census and Statistics Department
- Various policy bureaus and government department - Population health data
- DH (behavioural risk factors, communicable disease statistics)
- HA
- Food and Environmental hygiene department (Environmental, food safety etc.)
- Agricultural, Fisheries and Conservation Department (Animal disease)
- WHO
- NGOs (HK Cancer fund)
Impact of disease burden on health care service delivery
Major challenges:
- Increasing need (aging population, increasing disease occurrence (esp. lifestyle-related))
- Increasing costs (advance in technology, high expectation, medical inflation)
Impact on social delivery
- High occupancy rate
- Long waiting time
- Decreased quality of service
