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Flashcards in CPRS Case 3: Aortic dissection Deck (15)
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1

***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

2

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

3

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

4

Pathology of thrombosis

See CPRS lecture 41

5

Risk factors for atherosclerosis

See CPRS lecture 41

6

Basic abnormalities of serum lipids

See CPRS lecture

7

Effect of atherosclerosis on flow through blood vessel

See CPRS lecture 41

8

Complications of atherosclerotic plaque

See CPRS lecture 41

9

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
- SOB
- chest, back, abdominal pain
- dysphagia
- hoarseness, difficulty speaking
3. Cardiac tamponade (pericardial effusion)
4. Mediastinal tumour

10

Interpret results of CT scan

See Radiology practical

11

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

12

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

1. ECG
2. CT scan

13

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

14

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

15

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