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***Triage system

1. Critical (0 mins): dying/life-threatening condition, attended immediately
2. Emergency (15 mins)
3. Urgent (30 mins)
4. Semi-urgent
5. Non-urgent
—> Assessed by experienced and specially trained triage nurse


***Procedures if patient disagree with treatment

1. Explain why procedures is advised in Open and Explicative way so patient fully understand the reasoning

2. Identify Core Concerns of patient, address Root Cause behind hesitation

3. Involve Family so patient can receive Support and Encouragement they are looking for

4. If not legally bind (quarantine needed), doctor ought to respect autonomy, provided that the patient is competent

5. ***Discharge Against Medical Advice (DAMA) have to be invoked / similar documentation


***6 primary vital signs (BRTPOU)

1. BP (postural: fall >20mmHg systolic, >10mmHg diastolic from supine to erect)
2. Respiratory rate (12-20)
3. Body temperature (35.8-37.2)
4. Pulse (60-100)
5. Oxygen saturation (97-99%)
6. Urine in/output

- pain
- distress
- standing-supine blood pressure


***5 Questions asked by nurse for initial assessment

1. Basic particulars of patient
2. Nature of medical condition
3. Medical history
4. Allergy
5. 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
1. Reach limits of tolerance
2. Reach limits of anxiety
3. Problem of living presented as symptoms
4. Prevention
5. Administrative reasons

Patient expectations:
1. Waiting time
2. Cost of medical service
3. Impact on their lives

Importance of effective communication skills:
1. Patient understand what is wrong
2. Better patient compliance
3. Better doctor-patient relationship
4. More time-efficient
5. Reduce chances of error in communication


How population can approach health care services in HK

1. 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

2. Specialist Out-patient Clinics (SOPCs)
- booking:
—> need referral from GOPC / medical practitioner
—> HKID, referral letter, proof of address

3. HA Chinese Medicine Centres for Training and Research (CMCTRs)
—> Chinese medicine service
—> collaboration between government, NGOs, universities

4. Fees: A&E: $100, inpatient ($50 admission, $100/day) (all fees are for eligible patient)


Impact of accidents on health and health related issues

- disability
- pain

- PTSD (post traumatic stress disorder)
- Anxiety
- Phobia
- Depression


Sources of population health data

1. Official statistics by
- The Census and Statistics Department
- Various policy bureaus and government department

2. 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)
- 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


Traffic accidents trends in HK

Traffic accident trends:
- No significant change in total number
- Drop in fatality rate and casualty rate
- increase in slight accidents

- inappropriate driving behaviour
- driving under influence
- pedestrian violation of traffic rules

Causes of traffic accident trends
- improved A and E service
- better car safety designs
- seatbelts on minibus and taxi

Risk decreasing, due to
- development of traffic facilities, pedestrian roads
- increase in public awareness on traffic safety
- government promotion
- people > 60 more often involved, because walk on streets, less capable of assessing traffic safety


Preventative measures to minimise impact of traffic accidents

1. Driving behaviour
- public education on road safety
- mandatory driving course for repeat offenders

2. Legislation and enforcement
- more speed cameras
- mandatory driving course for repeat offenders

3. Traffic engineering
- review speed limits
- review traffic facilities at black spots
- more traffic facilities and pedestrian roads

4. Vehicle control
- install black box on commercial vehicles

5. Public education
- pedestrian
- drivers


Purpose of triage system

1. Reduce unnecessary delay of treatment
2. Increase effectiveness by allocating patients to appropriate treatment according to their conditions
3. Initiate immediate diagnostic test, intervention, nursing treatment
4. Ensure early recognition and assessment of patients’ condition
5. Gather important patient information
6. Brief first-aid advice