To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This chapter provides guidance on how to effectively use the book as a case-based approach to learning emergency medicine, particularly in preparation for the certifying exam. It emphasizes the importance of active learning and offers strategies for working with a partner or alone to engage with the cases. The section on certifying exam preparation highlights the value of practicing cases with a partner, such as an emergency physician, and provides examiner instructions for guiding candidates through the cases. The chapter also encourages readers to supplement their learning by referencing standard emergency medicine texts and engaging in further discussions with colleagues and mentors. A sample case script is provided to demonstrate how the book can be utilized in a practical exam setting.
Efficient triage in general practice is critical to optimize appointment allocation and minimize patient delays. Delays in receiving clinical information, such as photographs or symptom questionnaires, lead to unnecessary consultations and inefficiencies. This study evaluated the feasibility and impact of a structured pre-triage protocol requesting photos and questionnaires for common conditions (skin, eye, tonsillitis, and urinary tract infections).
Methods:
A pre-post intervention quality improvement project was conducted in a UK general practice. Triage administrators were instructed to proactively request photographs for skin and eye complaints and symptom questionnaires for tonsillitis and UTIs at initial patient contact. Outcomes included process metrics (number of pre-triage requests, proportion of cases managed directly by the triage GP) and subjective measures of ease, speed, satisfaction, and confidence.
Results:
The protocol increased photo requests for skin (mean increase 4.0/session, Cohen’s d = 7.77) and eye (2.2/session, d = 4.09) conditions, while questionnaire requests remained unchanged. The proportion of skin cases managed directly by the triage GP increased significantly (from 0.2 to 2.2 cases/session, d = 1.65), and eye case management also improved. Questionnaire-based pathways showed minimal change in efficiency or direct management. Subjective feedback indicated a slight reduction in triage speed, but ease and satisfaction were maintained, while diagnostic confidence increased, particularly for photo-supported conditions.
Conclusion:
A structured pre-triage protocol is feasible, acceptable, and potentially effective in enhancing triage efficiency, particularly for visually assessable conditions like skin and eye presentations. By enabling earlier access to essential information, such protocols may reduce unnecessary consultations, improve workflow, and support clinician confidence.
This scenario explores the management of nonfreezing cold immersion injury (NFCI) in a Disaster Medical Assistance Team (DMAT) field hospital setting. The scenario involves a 38-year-old firefighter/EMT who, after prolonged exposure to cold floodwaters, presents with severe pain and swelling in his lower extremities. The case highlights the clinical presentation, diagnostic challenges, and treatment strategies for NFCI, emphasizing the importance of timely intervention and appropriate care in austere environments. Key teaching points include the recognition and management of mild hypothermia, differential diagnosis of cold and wet exposure, and effective communication and teamwork in a field hospital context. The case also discusses the logistical considerations for patient transfer and the critical actions required to stabilize and manage NFCI in a resource-limited setting. This study serves as a valuable educational tool for medical professionals working in disaster response and emergency medicine.
The aim of this study is to determine the demographic, clinical characteristics, and outcomes of the patients who applied to the emergency department (ED) of Akdeniz University Faculty of Medicine Hospital (Antalya, Türkiye) after the Kahramanmaraş-Pazarcık earthquake dated February 6, 2023, as earthquake victims were included in the study. The results of the study could be a guide in terms of emergency health services and the healthy management of disasters.
Methods:
The study included patients over the age of 18 who presented as earthquake victims to the ED of Akdeniz University Medical Faculty Hospital from February 6, 2023 through March 8, 2023. The demographic data of the patients, including age, gender, earthquake zone, time and manner of arrival to the ED, time under debris, length-of-stay (LOS) in the service and intensive care unit (ICU), infection rates, culture results, and mortality, were retrospectively analyzed using the hospital automation system.
Results:
A total of 1,833 earthquake victims presented to the ED. Of these patients, 1,294 were adults and 539 were children. Services and the ICU admitted a total of 137 adult patients. In the first week, 414 (31.99%) of the patients presented to the ED, while 82 (59.85%) of the hospitalized patients were admitted.
Hatay ranked first with 573 (44.28%) patients in the distribution of patients presented to the ED according to earthquake regions. In the distribution of hospitalized patients by earthquake regions, the patients requiring the most hospitalization were from the province of Hatay, with 68 (49.63%) patients.
During hospital observations, the medical staff took 132 culture samples based on the positive clinic of the patient. The microorganisms detected in the culture studies were different from the flora of the hospital. The mortality at seven days was two (1.45%), and at the end of 30 days, the mortality was six (4.37%).
Conclusions:
The ED evaluated all affected cases, with most patients being brought by their relatives using their own means, and had low mortality rates despite presenting with fewer injuries. New environmental conditions that developed after the earthquake caused unexpected results, especially in terms of community-acquired agents.
One of the issues that has increasingly become relevant to medical practice is the ability to communicate well with patients. Better communication results in better care for the patient, as well as greater satisfaction for the physician. For this reason, the aim of this study was to assess the efficacy of a communication skills training program for medical residents (MR).
Method
Eighty-six MR underwent a 6-month training program in three phases: a 12-h theory and practice workshop, a period of real practice, and a 4-h workshop in which the most challenging scenarios were role played with an actress. In each phase (T0, T1, and T2), participants’ beliefs about their competence in caring for patients’ psychosocial aspects and their self-confidence in communication skills were assessed.
Results
No differences were found between T0 and T1 in participants’ beliefs of self-competence in psychosocial care. However, this competence significantly improved after completion of the entire program. Only 7 of the 12 areas explored in communication skills significantly improved between T0 and T1. However, after T2 completion, significant improvements were observed in all 12 areas.
Significance of results
The research results highlight the usefulness and importance of training young doctors to foster their psychosocial approach to patient care and improve their confidence in their own communication skills. The results also show the appropriateness of the structure of the training: the key features of the programme were the follow-up of the participants in three phases over 6 months, and a focus on the needs of the residents and the resolution of difficult clinical cases, with the support of an actress. Therefore, the training presented in this study may become a guide for other trainings in other contexts with similar objectives.
Coronavirus disease 2019 (COVID-19) began to spread across Wuhan, China, by the end of 2019, and patients were unable to be hospitalized because medical resources were limited.
Methods:
A questionnaire survey was conducted among 108 participants with mild COVID-19 who have isolated at home under the guidance of doctors. The results of the questionnaire and outpatient data were integrated to evaluate participants’ compliance with various epidemic prevention measures.
Results:
During isolation, most participants were able to follow epidemic prevention measures under the guidance of doctors. After 14 d from the start of isolation, 45.37% of the participants recovered. Approximately half of the participants were relieved of symptoms, and most of them were transferred to mobile cabin hospitals to continue isolation. Three participants with worsening symptoms were transferred to the designated hospitals. There were no deaths of the participants, but there were 7 family members that were infected.
Conclusions:
During a period of home isolation under the guidance of a doctor, individuals can comply with epidemic prevention measures and symptoms can be improved. Scientific home isolation may be an effective way to relieve the strain of medical and social resources during the epidemic of COVID-19.
This chapter summarizes standards and recommendations relevant to the care of the pregnant or recently pregnant critically ill woman for maternity and critical care. The acute care competencies required focus primarily on the clinical and technical aspects of care and the delivery of effective patient management. They assume the possession and application at every level of complementary generic competencies such as recordkeeping, team working, interpersonal skills, and clinical decision making. Maternity services should define which of their staff take on each one of the acute care responder roles and ensure that they have suitable training and assessment of the competencies they require. Lead professionals in maternity services have a responsibility to ensure that staff are deemed competent in the early recognition of acutely ill and deteriorating patients and are able to perform the initial resuscitation and management.
Lower urinary tract dysfunction (LUTD) can result from a wide range of neurological conditions. This chapter provides the clinician with an approach to neurogenic bladder dysfunction based on the history, physical examination and investigations, in order to optimize patient management and follow-up. Classification helps with understanding the functional disturbances occurring in neurogenic LUTD. Understanding the underlying dysfunction is paramount before starting treatment. History-taking should address potential dysfunction in both the storage and voiding phases of micturition. Several symptom scales have been validated for the evaluation of urinary disorders, but none are specific for neurogenic LUTD. Physical examination should include neurological, urological, gynecological, abdominal and rectal examination. History, bladder diary and clinical examination may not always be sufficient for understanding the nature of LUTD. Urodynamic tests involve functional and dynamic assessment of the lower urinary tract and are used to assess detrusor and bladder outlet function.
Recommend this
Email your librarian or administrator to recommend adding this to your organisation's collection.