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***Role of how procedures can be performed in patients unable to give consent

Treatment for dealing with emergency situation can be given without obtaining prior consent

Unconscious patients
- competent patient unable to give consent
—> views of family members should be considered
—> provided that such views are
1. Compatible with patient’s best interests
2. Compatible with patient’s right of self-determination

Emergency situation:
- Doctor may proceed without actual / legally authorised consent is in a situation of emergency or necessity to save patient’s life
- Only course of action is to act in best interest of patient
- Decision as to what is in patient’s best interest from doctor’s view is strictly a medical one, and is expected to be professionally formed
- Discussion with family may assist if time permit but
- Family view’s are not determinative
- Decision making process should be documented in patient’s records


Explanation by doctor to patient in treatment decision

- patient should be given enough time to make the decision
- pateints’ refusal must be respected and documented
- doctors’ duty to ensure patient truly understand the explanation by being careful and patient
- explanation should be given in clear, simple and consistent language
- explanation should cover not only significant risk but also risks of serious consequence even the probability is low
- should not withhold information necessary for making a proper decision for any reason unless the information will cause serious harm to the patient (serious effect on patient’s mental health)
- upsetting or causing him to refuse treatment is not proper justification for withholding information
- must record reason in medical record if withhold information/ regularly review his decision to see whether the information could be given at a later stage


Main structure in plain x-ray of chest

Male vs female: amount of breast tissue

Main visible structures:
- trachea
- heart
- ribs
- scapulae
- lungs

Invisible/obscured structures:
- sternum
- esophagus
- pleura
- fissures
- aorta


Pathology of thrombosis

See CPRS lecture 41


Risk factors for atherosclerosis

See CPRS lecture 41


Basic abnormalities of serum lipids

See CPRS lecture


Effect of atherosclerosis on flow through blood vessel

See CPRS lecture 41


Complications of atherosclerotic plaque

See CPRS lecture 41


Interpret results of Chest X ray

Widened mediastinum:
1. Aortic dissection: Separation of media and intima
- Type A: ascending aorta (chest pain)
- Type B: other parts of aorta (back pain)
- sharp and stabbing pain
2. Aortic aneurysm
- chest, back, abdominal pain
- dysphagia
- hoarseness, difficulty speaking
3. Cardiac tamponade (pericardial effusion)
4. Mediastinal tumour


Interpret results of CT scan

See Radiology practical


Interpret ECG results

See CPRS lecture + Dr JoJo Hai Clinical skills ppt

PR interval: time intervals from onset of atrial depolarisation to onset of ventricular depolarisation
QT interval: duration of ventricular depolarisation and repolarisation
RR interval: duration of ventricular cardiac cycle
PP interval: duration of atrial cycle

1. Determine regularity:
- P-P interval —> regular atrial rhythm
- R-R interval —> regular ventricular rhythm

2. Calculate HR:
1x大格/ 5x小格 = 0.2 seconds
Count no. of R waves in 6 second strip (30大格) —> multiply by 10

3. Identify the rhythm


2 investigation performed for a patient with suspected vascular obstruction of chest

1. ECG
2. CT scan


4 major non-communicable diseases and their common characteristics

CCRD (mortality arranged in order)
1. Cardiovascular disease
2. Cancers
3. Chronic respiratory disease
4. Diabetes

Common characteristics:
- non-contagious
- complex etiology
- multiple risk factors
- long latency
- prolonged course of illness
- functional impairment / disability
- all age group
- low / middle income countries
- largely preventable
- attributed to common risk factors e.g. alcohol, smoking, diet, inactivity


Why NCD is highly prevalent in Hong Kong and worldwide

1. Modifiable behavioural risk factors
- Tobacco use
- Physical inactivity
- Alcohol use
- Unhealthy diet

2. Metabolic/physiological risk factors
- Raised BP
- Overweight / obesity
- Hyperglycemia
- Hyperlipidemia


What constitute a risk factor for disease

Risk factor: any attribute, characteristics or exposure of an individual that increases the likelihood of developing a disease / injury