Off We Go!

Essential English for Ambulance Workers and Paramedics

Szerkesztette:

Bakos Ferencn
Kossuth Zsuzsa Egszsggyi Szakkzpiskola Szakiskola s Gimnzium Budapest 1999

1 A Morning in Casualty
Part One
Rrrrrrring NURSING AUXILIARY (MARY): Hello, Casualty Department. AMBULANCE DRIVER (TOM): We have a patient with severe chest pains. Well arrive in five minutes. MARY: The patients name? TOM: John Smith. Date of birth; 3rd July 1946. Hes conscious but has some trouble breathing. Weve given him oxygen in the ambulance. MARY: Thank you, well be ready to meet you Ambulance call cardiac patient in five minutes! REGISTERED GENERAL NURSE (JOAN): Tell the others quickly and Ill get the doctor.

Part Two
Five minutes later TOM: Here we are, weve got his wife with us as well. JOAN: (To the wife) If youd like to go with this nurse here, shell look after you and you can come in to your husband in just a few minutes. TOM: There we are sir, well just move you over from this stretcher to the couch. JOAN: Thanks. Good morning. My name is Sister Joan and Im the Staff Nurse here. Id like to ask you some questions. Well help you to take your clothes off at the same time. PATIENT (JOHN SMITH): OK nurse, but Im in the most terrible pain. Cant you give me something for it? JOAN: Yes, of course. As soon as possible. Where is the pain exactly? PATIENT: It goes across my chest and down my left arm as well. I can also feel a pressure in my chest all the time. JOAN: When did it start? PATIENT: Yesterday afternoon. I was working in the garden but I had to go indoors and sit down when this pain started. It was a bit better during the evening, but I couldnt sleep during the night because of it and I had to have three pillows to support me. Then this morning my wife phoned for an ambulance because it suddenly got much worse. I broke out in a cold sweat and my wife said I looked very pale

Check the meaning of these words:

ambulance ... patient chest.. pain .. arrive. conscious. unconscious trouble... breathing.. oxygen... stretcher couch. cardiac infarction.. wife husband give move. help.. feel go.. start . take off put on.. left right. arm.. pressure.. work. sit down sleep.. have ..

support.. cold sweat. afternoon.. Part Three phone for.. suddenly evening. look pillow. night.. break out in.. morning Now Mrs Smith is in the sisters office with a nursing auxiliary. While the doctor is examining John, his wife is giving the nurse his personal particulars. The nurse has to fill in a form so she asks a lot of questions. Here is the admission card. Try to fill it in according to the dialogue below: ST. PETERS HOSPITAL, LONDON Admission Card SURNAME (IN BLOCK LETTERS) ADDRESS & TELEPHONE NUMBER CIVIL STATE Married/single/divorced/widowed/separated/ Other: RELIGION

Hosp. Reg. No. Ward/Department FIRST NAME(S) DATE OF BIRTH OCCUPATION

NAME & ADDRESS OF NEXT OF KIN

NAME & ADDRESS OF GP

TELEPHONE NO. (If not on the phone, give a number where messages may be sent. Add Messages only.)

SURGEON OR PHYSICIAN IN CHARGE OF CASE

DATE OF ADMISSION SIGNATURE

Sister: Well, Mrs Smith. Dont worry. Everything will be all right now. Your husband is in the best hands. Would you sit down, please? Mrs Smith: Thank you, Sister. Youre really very kind. But Im still anxious. Sister: The doctor will examine him thoroughly and well see what he says. Now we have to fill in this admission card. Your surname is Smith, isnt it? Mrs Smith: Thats right. Sister: And whats your husbands Christian name? Mrs Smith: John Andrew. Sister: Where do you live? Mrs Smith: 37 Waterloo Road, London. Sister: Are you on the phone? Mrs Smith: Yes, our number is 3547354. Sister: Thank you. And when was your husband born? Mrs Smith: 3rd July 1946. Sister: He is married, isnt he? Mrs Smith: Yes, of course. But he has a son and a daughter from his previous marriage.

Sister: I see. It says Name and address of next of kin here. Shall I put your name here or one of his childrens? Who is his nearest relation? Mrs Smith: Its me, of course. We live at the same address. Sister: Thanks. Now, who is your family doctor? Mrs Smith: Dr Newman. Sister: Do you know his address or telephone number? Mrs Smith: Im sorry, I dont. But its on my husbands patients card. Sister: Do you actually have his patients card with you? Mrs Smith: Unfortunately, I dont. I was so frightened that I really forgot about it. Sister: Never mind. Your husband will probably remember his GPs address. The doctor in charge of his case is Dr Henderson. Hes a very good physician. Now Ill take you to your husband. Come with me.

Part Four
Dr Henderson is asking Mr Smith about his past medical history. DR HENDERSON: Good morning. My name is Dr Henderson. Well give you an injection immediately to ease the pain and youll soon be feeling better. Have you taken his blood pressure? I see youve started to prepare Mr Smith for an ECG. Have you ever had one before? JOHN SMITH: No, never. Does it hurt, nurse? JOAN: Not at all, were just going to place these electrodes on your skin and then the machine will register your heartbeat. Im afraid well have to shave your chest a bit, though. JOHN SMITH: Thats all right. DR HENDERSON: Have you ever had any trouble with your heart before? JOHN: Never. DR HENDERSON: Do you take any medicines? JOHN: No, not regularly. DR: Have you ever been admitted into hospital before? JOHN: No, this is the first time. DR: Id like to admit you to our Cardiac Unit for some more tests. NURSE MARY: Shall I fetch his wife in now? JOAN: Yes. Thank you. Im inserting this intravenous catheter into the back of your hand, so we dont have to prick you every time we need to take a test or give you some drugs. Ah, here is your wife now. JOHN: Hello dear! Theyre going to take me up to the Cardiac Unit. Theyve given me a painkiller and Im feeling much better already. JOAN: Well go up straightaway, then (To Mary) Is everything here? The oxygen, the defibrillator and the emergency bag? MARY: Yes, Ive checked it all. JOAN: All right. Off we go.

Check your vocabulary!

injection immediately.. ease blood pressure. prepare. before never. hurt .. place.. electrode.. skin. register. heart. beat Im afraid shave medicine... regularly.. be admitted... into. admit. some.. more.. test
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fetch. insert. intravenous.. catheter

back... hand.. prick.. every time.

need to.. drug pain killer. straightaway...

defibrillator.. emergency bag. check. off we go

Exercise 1
Dates of birth are the opposite way round in Great Britain. Remember to check this if you have an English patient! In Great Britain 06-10-26 would be 6th October 1926. Practise the following dates: 01/12/60, 12/11/75, 02/05/83, 03/10/67, 31/01/13

Exercise 2
Work in pairs. Fill in this form by asking your partner. SURNAME: SURNAME AT BIRTH: MARITAL STATUS: S M D W Sep PLACE OF BIRTH: NATIONALITY: ADDRESS - PERMANENT: TEMPORARY: Phone number: EMPLOYER: NATIONAL INSURANCE (NI) NUMBER: ADDRESS: PHONE NUMBER: WARD: FIRST NAME(S): MOTHERS SURNAME AT BIRTH: SEX: M F DATE OF BIRTH: RELIGION: NEXT OF KIN: ADDRESS:

TELEPHONE NUMBER: OCCUPATION: FAMILY DOCTOR: SURGEON OR PHYSICIAN:

Exercise 3
There are many different words which mean to be well or to be ill. Use your dictionary and discuss the differences in the following words. Put each word into a sentence. all rightill...healthyunhealthy better...poorlywell.unwell... be fit.be sick...good.bad.. worse...feel sick.

Exercise 4
Look up the meaning of these words which are all substances of the body. blood...bone.cartilage..fat... lymph.muscle.nerve..skin. tendon.tissuecell

Exercise 5 Learn the parts of the body. /See Appendix, Picture 1/ For grammar references and other useful sets (ordinal and cardinal numbers, names of the days and months, the English alphabet) see also Appendix.

Exercise 6 Listen and fill in the following dialogue between a cardiac patient and a doctor.
Dr: ? P: I seem to be getting very short of breath nowadays, so I thought it best to come in to see you. I also feel a tightness in my chest. Dr ? P: It seems to have been getting worse over the last few weeks. Dr .or is it just when walk up the stairs? P: Well, its a hard work going up the stairs. The pain feels like a knife. Dr: ..? P: Yes, it moves to my neck, my left arm, my back and my shoulder. Dr: ...? P: Well, I dont feel sick but I often break out in a sweat. Dr: .? P: Yes, sometimes it beats really slowly, then from time to time it skips a beat then continues to beat very rapidly. Dr: Can you tap out with a finger what the rhythm feels like to you good. Have you had any swelling in your ankles? P: Yes, both of my feet have been somewhat swollen. Dr: .? P: Oh, my feet feel much better and they arent as swollen in the morning.

Translate and learn these useful questions!

Have you ever had any medical and heart problems? What seems to be the problem with your heart? What kind of pain do you get during exercise? .. Do you often get short of breath? . Do you ever feel sweaty when this happens? ... Where does the pain move? ... And have you had any swelling in your feet or ankles? . Do your feet hurt all the time? .. Can you lie flat in bed? .. How many pillows do you use? .

Aches and pains

There are many different words to describe pain and injury. Here are a few of them. Translate and discuss them in small groups.
Nouns: a bite a cut . a rash a scab a swelling . Adjectives: agonising . slight sprained stiff ... throbbing . constant Verbs: to ache . to irritate .. to sting . to throb a bruise ... a graze .... a spot .. a scar .. a sting . sharp .. sore . stabbing .. strained ... dull . intermittent . to hurt to itch .... to swell .. to scratch ...

Exercise 7/a
Describe these different types of injury and how you think they can feel. Imagine yourself in a patients situation. Pretend you have come into Casualty and have to describe how you feel to a nurse. Work in pairs. Here is some help: I have (Ive got) a pain in my chest. My chest hurts. My chest aches. He has (hes got) a pain in his stomach. His stomach hurts. His stomach aches. You have (youve got) a pain in your elbow. Your elbow hurts. Your elbow aches. She has (shes got) a pain in her leg. Her leg hurts. Her leg aches.

Exercise 7/b Practise the parts of the body using the picture in the Appendix.

Polite requests
Patients in hospital are usually anxious and fearful. It is important that hospital staff put them at their ease, by being polite and pleasant. The following examples teach you polite forms in English. Be careful about the way your voice rises and falls when you say these sentences. Command Request Come in. Come in, please! Will you come in/, please/? Would you come in/, please? Would you mind standing up/, please/?

Exercise 8 Change these commands to polite requests and translate them.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Come in. ... Sit down. .. Stand up. .. Turn round. .. Turn over. Bend down. .. Lie down. . Sit up. Look up. Say Ah. .. Raise your arm. . Move your head. Open your mouth. .. Put out your tongue. ... Lift your leg. .. Bend your knees. Touch your toes. . Lower your foot. Arch your back. . Wriggle your fingers. . Roll your sleeve up. ... Take your shirt off. Put your trousers on. ...... Roll your sleeve down. ... Turn your head to the left. .. Hold your head up. . Take a deep breath. Hold your breath in. ... Keep your mouth open. .. Keep your eyes shut. .. Strip to your waist. .

32 33 34 35

Take off everything except your underwear. . Get into the ambulance. . Get out of the car. .. Mind your head. .

Exercise 9 Put in the correct word from these

off 1 2 3 4 5 6 7 8 9 10 to back in down by up through round near Ask the patient to come . and sit . Ask the patient to stand .. and turn .. . Will you lie . on the couch, please? Would you roll your sleeve? Ask Mr Smith to take his coat. Bend .. and touch your toes, please. Take your trousers, please. Ask the patient to turn his head the left. Will you put . your clothes, please? Come next week, please.

Exercise 10 Complete the following sentences with the correct possessive pronoun.
1 2 3 4 5 6 7 Tell Mrs Smith to raise right arm. Would you straighten .. left leg, please? The baby has a pain in .. stomach. John has a cut on .. thigh. Ask me to lower .. arm. You have a rash on .. shoulders. Hes got a scar on ... left forearm.

Exercise 11 Translate into your language.

1 2 3 4 5 6 7 8 9 10 11 Please will you go into the cubicle? Sit down, please. Would you like to lie down?... Do you feel nervous?.. Do you usually feel all right after a blood test?.. Im going to take a blood sample. . Give me your finger, please. .. Have you had blood tests before?... Will you pull up your sleeve, please?. Im going to put a tourniquet round your arm. .. Do you feel dizzy/faint?..

Exercise 12 Learn the parts of the female body. /Appendix Picture 2/

Kate Simpson

/Reading/

Kate Simpson works in a surgical ward in a London hospital. Kate does shift work, so she does not got to work at the same time every day. When she is on an early shift, she goes on duty at 6 a.m. and comes off duty at 2 p.m. Late shifts start at 2 p.m. and finish at 10 p.m. Kate does not like late shifts. Kate always goes to work by bus when she is on an early shift. The bus stops outside the outpatients department. When she is on a late shift, Kate generally walks from her home to the hospital. When she comes off duty at 10 p.m., she is usually rather tired, and takes the bus home. Sometimes she goes to the taxi-rank outside the main entrance of the hospital and goes home by taxi. Kate is not a qualified nurse. She is a student nurse, so she does not work in the ward every day. On certain days, she has to attend lectures on general nursing, anatomy and physiology, hygiene and various other subjects. She wants to pass the State Final examinations and become a State Registered Nurse. As a State Registered Nurse she becomes a staff nurse and can, in time, become a sister or even a nursing officer. (You can read more about the promotion ladder of nurses in the Appendix.)

Exercise 1 Answer the following questions

1 2 3 4 5 6 7 8 9 10 11 Where does Kate Simpson work? At what time does she go on duty when she is on an early shift? When does she come off duty when she is on an early shift? At what time do late shifts start? When do late shifts finish? When does Kate go to work by bus? Where does the bus stop? When does Kate walk from her home to the hospital? When does she take the bus home? What lectures does Kate attend? What can she become when she has passed the State Final examinations?

Exercise 2 /Grammar/ Look at these sentences.

Jane works in a medical ward. I go to work at 6 oclock. We always take the bus home. You do shift work. Jane doesnt work in a medical ward. I dont go to work at 6 oclock. We dont always take the bus home. Do you do shift work?

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He usually does a late shift. The bus stops near the hospital.

Does he usually do a late shift? Does it stop near the hospital?

Put the following sentences into the negative

1 2 3 4 5 6 7 8 She works in the x-ray department. .. He usually studies hard. We have to stay until 9 oclock. I want to attend lectures. ... She often walks past the operating theatre. ... She does shift work. I finish at 12 oclock. .. It stops outside the main gate. .

Make questions from these sentences

1 2 3 4 5 6 7 8 Jane works in a surgical ward. . She does shift work. They go on duty at 3 p.m. The late shift finishes at 10 p.m. .. We walk past the out-patients department. . The nurse generally walks to work. . You have to attend lectures. . He usually finishes at 12 oclock.

Exercise 3 Ask the patient

Ask the patient about his eyes. Ask the patient about his head. Do your eyes hurt? Does your head hurt?

Ask the patient about his 1 back . 6 foot .. 2 ears . 7 right arm .. 3 left thigh. 8 heels . 4 stomach .. 9 toes .. 5 fingers 10 chest

Exercise 4 Answer the questions

Do your ears ache? No. No, they dont. Does your stomach ache? Yes. Yes, it does. 1 Do your elbows hurt? Yes. .. 2 Does your chest hurt? No.

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3 4 5 6 7 8

Does your back ache? No. Do your ears hurt? Yes. Does your leg ache? Yes. Does it hurt here? No. . Does it hurt there? Yes. Do your shoulders ache? No.

REVISION
(1 A Morning in Casualty)
Exercise 1
Match the lines in column A and B to get correct sentences. A B 1 2 3 4 5 6 7 8 9 Well help you Hes conscious but Have you ever been Do you take Have you ever had Well give you an injection immediately Theyre going to take you Well just move you over We have a patient a) with severe chest pains. b) admitted into hospital before? c) from this stretcher to the couch. d) to take your clothes off. e) to ease the pain. f) he has some trouble breathing. g) up to the Cardiac Unit. h) any medicines? i) into the back of your hand. j) any trouble with your heart before?

10 Im inserting this intravenous catheter

Exercise 2
Match the sentences in column A and B to make short dialogues. A 1 Shall I fetch his wife in now? 2 Do you take any medicines? 3 Have you ever been admitted into hospital before? 4 Im inserting this intravenous catheter into the back of your hand. 5 Have you ever had any trouble with your heart before? 6 Have you taken his blood pressure? 7 Im in the most terrible pain. Cant you give me something for it? 8 Wheres the pain exactly? B a) Yes, of course. As soon as possible. b) It goes across my chest and down my left arm as well. c) Yesterday afternoon. d) Thank you. Youre really very kind. e) Unfortunately, I dont. f) Yes, and Ive started to prepare him for an ECG. g) Never. h) No, not regularly. i) No, this is the first time. j) Yes, thank you.

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9 When did it start? 10 Would you sit down please? 11 Do you actually have your patients card with you?

k) Will it hurt?

Exercise 3
Work in pairs. One of you is the ambulance man, the other is the patient. Act out the following situation. Choose from the cues below or find out your own case. (To make the exercise more difficult the situation and the cues are given in Hungarian!) Student A: n a ments. Mutatkozzon be. Krdezze meg a betegtl, mi a problmja. Student B: n a beteg. Ksznjn a mentsnek. Panaszolja el, mi trtnt. Cues: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 nnek bekklt a karja. nt megcspte egy darzs. Fel van dagadva a bokja. A kislnya elvgta az ujjt s nagyon vrzik. Megrndult a bokja s nem tud rllni. Lktet fejfjsa van mr napok ta. Ksszrsszer fjdalmat rez a mellkasban tegnap este ta. Aludni is csak lve tudott. Viszket a hasa s prsens van rajta. Fj a torka napok ta s nem tud beszlni, mert nincs hangja. Kisfia lehorzsolta a trdt a jtsztren. les fjdalmat rez a derekban. Megmerevedett a nyaka, nem tudja elfordtani egyik irnyba sem. Tompa fjdalmat rez a mellkasban, olyan mintha sly lenne rajta. les fjdalmat rez a hasban. Vakblgyulladsra gyanakszik. Megharapta egy kutya. A seb csak egy karcols, de lehet, hogy tetanuszt kell kapnia, mert valamikor gyerekkorban kapott utoljra.

Exercise 4
Krje meg a beteget udvariasan a kvetkezkre: 1 2 3 4 5 6 7 8 9 10 11 12 13 Jjjn be s ljn le. lljon fel s forduljon meg. Vegyen egy nagy levegt s tartsa benn a llegzett! Fekdjn le a vizsglasztalra, majd ljn fel s nyissa ki a szjt, mondja: ! Fekdjn le s emelje fel a karjt, majd engedje le. ljn fel s mozgassa a fejt, fordtsa balra. Fekdjn le, emelje fel a lbt, majd engedje lejjebb. Vegye le a nadrgjt, fekdjn le s hajltsa a trdt. ljn fel, nyissa ki a szjt, nyjtsa ki a nyelvt s hagyja nyitva a szjt. ljn le, nyjtsa ki a karjt, hajtsa fel a ruhja ujjt, hogy megmrhesse a vrnyomst. Jjjn be, vetkzzn le derkig. Forduljon meg s vegyen egy nagy levegt. lljon fel s hajoljon elre. rintse meg a lbujjait. ljn le, emelje fel a karjt, mozgassa az ujjait.

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14 lljon fel s hajltsa a htt. 15 Szlljon be a kocsiba, ljn le. 16 Szlljon ki a kocsibl! Vigyzzon a fejre!

Exercise 5
Now you are on duty in the Admissions Department. A new patient has just arrived and you have to ask him about his personal particulars. Fill in the following open dialogue: A: .. B: Stephen. A: .. B: White. A: :. B: 21. A: .. B: No, Im single. A: .. B: 28th February 1978. A: .. B: You mean, in Brighton? A: .. B: I see. Here, in Hungary. At 62 Telepes t, Budapest, Zugl. A: B: My mother. A: .. B: No, she lives in Brighton. I only have a girlfriend here. A: B: No, never. A: .. B. No, unfortunately I havent got a patients card. Im only for two weeks here with my girlfriend. Shes Hungarian. A: ..

Doctor, I have come with my legs. How could you come without them? The doctor examining a rash on a patient was baffled and finally asked him: Have you had this rash before? Yes. Ah, well then, youve got it again. Patient: I have difficulty in breathing. Medico: When is it worse? Patient: It is worse when I stand up.

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So the history read The patient complains of dyspnoea on erection.

2 On the Wards
The nurse has just arrived on the Coronary Care Unit with Mr Smith, the patient who has had a heart attack. She introduces him to the Health Care Assistant. RGN (JOAN): Hello, here we have Mr Smith. I rang you from Casualty to say we were on our way. HCA (BARBARA): Good morning. My name is Barbara. Im a Health Care Assistant. I shall help you while youre on this ward. Were going to move you from this trolley into a bed. No, just stay still, well help you. You mustnt exert yourself. JOHN SMITH: Whats going to happen to me now? I must admit I feel rather anxious about all this. BARBARA: Dont worry. Well look after you. Just relax. JOHN: Ill try to. Everything has happened so quickly. Yesterday I was digging in the garden, and now, here I am in the Intensive Care. BARBARA: Did they give you an injection in Casualty to kill the pain? JOHN: Yes, they did. I felt much better afterwards. BARBARA: Im going to help you to take off the rest of your clothes and to put on this gown. JOHN: Oh, I can do that myself. BARBARA: No. We want you to stay as quiet as possible while youre on our ward. Im going to connect you to this machine now. Its called an oscilloscope. It checks your heart rate all the time. JOHN: But what if something happens when youre not in here with me? BARBARA: Thats no problem. We can read your heart rate on a monitor in our office and there is a nurse sitting there at all times. NURSING AUXILIARY (STEVE): I want to check your blood pressure now. Ill just put this cuff round your arm and pump it up. Well also take a blood test every four hours. The doctor will come in later and check up on everything and talk to you. JOHN: How long will I be here? BARBARA: Its difficult to say. The doctor will decide that, but probably about two days. Then youll be transferred to a Medical Ward. JOHN: One more thing! Do you have a TV? Theres a good match on tonight. BARBARA: No, Im sorry. We dont allow our patients to watch television, in case they get too excited. JOHN: Perhaps my wife will watch it for me, then she can tell me all about it tomorrow. Where is she now? BARBARA: Shes talking to the Ward Sister. Ill go and see if shes ready to come in to you. JOHN: Thank you. Id like to talk to her if I may. Vocabulary ward introduce trolley. into.. bed stay still must.. mustnt. exert.. admit. anxious about.. look after.. relax.. gown.
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quiet.. connect to. heart rate cuff

pump it up... blood test. decide transfer.

excited.. ready.

Wards and Departments

Casualty and Emergency Department (or Accident and Emergency Department)... ... Admissions Department ... Surgical Ward (or Department) Medical Ward (or Department)..... Cardiac Unit . Coronary Care Unit .. Intensive Care Unit .. Orthopaedic Ward Observation Ward Geriatric Ward . Paediatric Ward (or Childrens Department) ... Gynaecological Ward ... Maternity Unit .. Nursery . Antenatal Clinic ... Post-Natal Clinic .. ENT Ward .... Long-stay Ward Terminal Care Unit .. X-ray Department Anaesthetic Room Operating Theatre Out-Patients Clinic . Dispensary Laboratory Pharmacy .. Occupational Therapy Department .. Psychiatric Unit Infectious Diseases Unit ... Physiotherapy Department ...

Exercise 1
Find the meaning of these words in your dictionary and make sentences with them. Do you know any more similar words? anxious concerned excited .. fearful frightened .. nervous .. restless ...
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tense ... uneasy upset ... worried ..

Exercise 2 Fill in the gaps with the name of the appropriate ward or department.
Where could you find 1 a dermatologist? 2 a radiologist? 3 a surgeon? 4 a paediatrician? 5 a physician? 6 an obstetrician? 7 a haematologist? 8 a psychiatrist? 9 an anaesthetist? In a ward. In an .. department. In an .. theatre. In a . ward. In a . ward. In a . unit. In a . In a . unit. In an . room.

Exercise 3 Answer these questions.

In what hospital ward or department would you expect to find 1 2 3 4 5 6 7 8 9 10 11 12 a patient who has had his appendix removed? a patient with broken leg?... a patient who is being admitted? a radiographer? a woman who will have a baby in two months time? a pharmacist?... a patient who has had his tonsils out?. a patient with a skin disease?.. someone who has just had an accident an elderly patient?... a patient with cerebral haemorrhage?. someone who is having an operation?...

Speaking Work in pairs. Act out the dialogues.

Dialogue 1 A: You are bringing a patient to the hospital. Tell him which ward he will be taken. The patient is anxious. Comfort him. B: You are a patient who feels very excited. Talk about how you feel to the ambulance worker/paramedic with you. Dialogue 2 A: You are an ambulance worker/paramedic and you have a patient with (a disease). Tell the nurse everything you know about the patient.

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B: You are the nurse. Introduce yourself and tell the patient which ward you are going to admit him.

Exercise 4 Learn the internal organs. /Appendix, Picture 4/

Kate on the Wards

/Reading/

Do you remember Kate Simpson? She and her friend Joan Chapman are both nurses. They work at Saint Peters Hospital, a large teaching hospital in London. Joan did her training at St Peters and last year she passed her State Finals and qualified. She is an S.R.N. She is now working as a staff nurse in a mens medical ward. Kate is a student nurse and is still training. Last month she worked in one of the hospitals surgical wards. She learned to set trolleys for sterile procedures such as surgical dressings, intravenous infusions and catheterization. She carried out certain procedures herself and assisted doctors with others. She often had to go to the central sterile supply department to fetch sterile dressing packs. Sometimes she took patients to the x-ray department or to the occupational therapy unit. This month Kate is working in the same ward as Joan. She is learning to nurse patients suffering from diseases such as cardiac infarction, cerebral haemorrhage, cerebral thrombosis and pneumonia. At the moment, she is helping a staff nurse to give injections. The staff nurse is explaining to her the doses, action and side effects of the drugs they are administering. The other nurses in the ward are carrying out various nursing duties. Some are doing bedbaths, one is helping a patient to get out of bed, and another is taking t.p.rs. A doctor is doing a ward round and a physiotherapist is helping a pneumonia-patient to do deep-breathing exercises.

Exercise 1 Answer these questions

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 What sort of hospital is St. Peters? Where did Joan do her training? When did Joan pass her State Finals? Which ward is Joan working in now? Where did Kate work last month? Which sterile procedures did she learn to set trolleys for? Where did she go to fetch sterile dressing packs? Where did she sometimes take patients? Where is Kate working this month? Which patients is Kate learning to nurse? What is she doing at the moment? What is the staff nurse explaining to her? What are the other nurses in the ward doing? What is the doctor doing? What is one nurse taking? What is the physiotherapist doing?

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Everyday English
Making a phone call
A: B: A: B: A: B: A: B: A: B: A: B: A: Hello. Hello. 3452671. This is . speaking. Can I speak to ? Im sorry but hes not free just now. Can I leave a message? Yes, of course. Please tell him to call me back. Im at my office till 6 oclock. Just a moment, please, Ill write it down. Would you give me your name and work number? Of course. Im Mr Morrison from the Union of Medical Workers. My number is , extension . Could you spell your name for me? Certainly. M-O-R-R-I-S-O-N. Thank you. Good-bye. Good-bye.

Telephone enquiries
You would like to know the telephone number of Dave Allen who lives at 28 Wallis Avenue in Halifax. Operator: Directory Enquiries. Which town please? Caller: .. O: What name? C: O: Whats the initial? C: O: And whats the address? C: O: The number is 47399. C: Thank you.

Getting the wrong number

A: B: A: B Hello. Can I speak to Jennifer, please? Jennifer who? Jennifer James. Im sorry. You must have the wrong number because theres nobody of that name living/working here. A: Oh, sorry. Must have the wrong number.
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B: Thats all right.

Emergency calls
Emergency calls are free in Britain. You only have to lift the receiver and listen for the dial tone. When you hear continuous purring dial 999 and ask the operator for FIRE, POLICE or AMBULANCE. Remember that an emergency call should always be very short and right to the point. Look at the following example. /In the USA you have to dial 911 for emergency calls. What are the numbers for these services in your country?/ Operator: Emergency. Which service, please? Caller: Ambulance, please. O: Ambulance service. C: Could you come to 34 Walmer Drive, Kingsway? Theres been an accident and my friend is suffering from loss of blood. O: Were on our way.

Exercise 5 How would you make an emergency call in the following situations?
1. A friend of yours has had a very bad accident with the electric carving knife while you were having lunch with the family. You dialled 999 immediately. Your friend lives at 53 Regent Street, London W1. 2. You come across somebody who has just been mugged. You were walking through Greenwood Park to North Street. You run to the public phone box and dial 999. 3. You are walking home in the afternoon when you see a car accident. There are three people injured. One of them is stuck in the car and unconscious. The accident happened at the crossroads near your place of work.

Exercise 6 These are the most common cliches that you will come across when making private telephone calls. Translate them into your language.
1 2 3 4 5 6 7 8 9 Hello. Is that Mary? Its Tom here. Hello. Is Mary there? . Hello. This is . speaking. Can/Could I speak to please? Could you give her a message please? .. Speaking. Yes, she is. Just hold on a second. . Can you wait for a moment, please? Oh, shes just here. .. Ill get her for you. (Mary, telephone!/Mary, its for you.) ... Im sorry, shes not in. Can I take a message?

20

10 Shes not here at the moment. Would you like to ring back in about an hour or so? 11 Im sorry, I didnt quite hear that. Could you say that again?/Could you repeat that, please?

REVISION
(2 On the Wards)
Exercise 1
Match the lines in column A and B to get correct sentences. A 1 2 3 4 5 6 7 8 9 10 11 12 B a) b) c) d) e) f) g) h)

I want to check in case they get too excited. Ill just put this cuff check up on everything and talk to you. Im going to connect you your blood pressure now. We can read your heart rate on a monitor in our office. The doctor will come in later and from this trolley into a bed. We dont allow our patients to watch TV, round your arm and pump it up. We want you to stay as quiet as possible to this machine now. Were going to move you the rest of your clothes and put on this gown. I shall help you i) to kill the pain? No, just stay still, j) while you are on this ward. Im going to help you to take off Did they give you an injection in Casualty k) well help you. l) while youre on our ward.

Exercise 2
Match the sentences in column A and B to make short dialogues. A 1 Do you have a TV? 2 But what if something happens when youre not in here with me? 3 Did they give you an injection in Casualty to kill the pain? 4 I must admit I feel rather anxious. 5 Good morning. My names Kate. Ill help you while youre on this ward. 6 Just relax. 7 Im going to help you to take off the rest of your clothes and to put on this gown. 8 How long will I be here? B a) b) c) d) e) f) g) h)

Whats going to happen to me? Dont worry. Well look after you. Ill try to. No, Im sorry. We dont allow our patients to watch TV. Its difficult to say. The doctor will decide that. Oh, I can do that myself. Yes, they did. I felt much better afterwards. Thats no problem. We can read your heart rate on a monitor in our office.

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Exercise 3
Work with your partner. Act out the cued dialogue. A A: Greet the patient. B: A: Ask where it hurts. B: A: Comfort the patient. Say where you are going to take him. /Which ward?/ B: A: Tell the patient that youve arrived at the .. ward. B: A: Say that he will be in the best hand. The nurses will look after him. B: B A: B: Greet the ambulance man. A: B: Tell him what your trouble is and that you are anxious. A: B: Say that its very comforting to be in the hospital. A: B: Ask what is going to happen to you. A: B: Thank the ambulance man for his kindness.

Exercise 4
Now work in pairs again. One of you is the ambulance man and the other is a nurse. Youve just arrived at the hospital with a patient. Inform the nurse and she should tell you to which ward she is going to admit the patient. AMBULANCE MAN Cues: You have a patient with 1 broken leg 2 cerebral haemorrhage 3 severe chest pain 4 stomach ache 5 broken arm 6 tonsillitis 7 skin disease 8 appendicitis 9 multiple pregnancy 10 lung cancer NURSE Youre going to admit the patient to the ..ward

Doctor: Good morning, Mrs Black. Ive just received the results of your pregnancy test. Ive got good news for you. Patient: Doctor I am Miss Black! Doctor: In that case, Miss Black, I have bad news for you! MEDICAL COLLEGEA fountain of knowledge where all go to drink.

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Exercise 5
Fill in this dialogue between a nurse and a patient. HELEN: Good morning. My name is .. Im a Health Care Assistant. . . BILL : Whats going to happen to me now? I must admit I feel rather anxious about all this. HELEN: BILL: Ill try to. Everything has happened so quickly. Yesterday I was digging in the garden, and now, here I am in the Intensive Care. HELEN: ? BILL: Yes, they did. I felt much better afterwards. HELEN: . BILL: Oh, I can do that myself. HELEN: No. .. . BILL: But what if something happens when youre not in here with me? HELEN: BILL: How long will I be here? HELEN:.. .

Exercise 6
Act out the following situations: 1 Kzlje a beteggel, hogy meg szeretn mrni a vrnyomst. Krje meg, hogy hajtsa fel a ruhja ujjt s nyjtsa ki a karjt. Kzben mondja a betegnek, hogy mit fog csinlni: felhelyezi a mandzsettt, felpumplja. Nyugtassa meg a beteget, hogy a vrnyomsa rendben van, nincs oka aggodalomra. Most mr lehajthatja a ruhja ujjt. n baleset sznhelyre rkezett. Hvja fel a mentket s kzlje, hol trtnt a baleset, mi trtnt s hny sebeslt van, milyen slyos a sebeslsk, eszmletknl vannak-e stb.. Adja meg a nevt s a cmt, telefonszmt. n a telefonos. Hrom bejelents rkezik rgtn egyms utn. Egy frl leesett kisfi az egyik, a msik egy utcn eszmletlenl fekv elhanyagolt klsej frfi, a harmadik egy ers gyomorfjsra panaszkod kismama. Dntse el, milyen sorrendben kldi ki egyetlen benn lv kocsijukat.

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Exercise 7
a) Translate and learn the following expressions about making an international phone call or having problems in getting through to a number. 1 2 3 4 5 Id like to make an international phone call. Id like to make a phone call to Budapest. . Ive been trying to phone 3425618 but I keep being cut off. . Ive been trying to phone 254321 and I cant get the number. . Ive been phoning 5789933 but I keep getting a crossed line. (A crossed line is when you hear other people talking on the line.) .

b) When making telephone calls you can easily get flustered and want to change into your mother tongue. Translate and learn the following items as well. Hagyd csak! Majd n felveszem. Valsznleg engem keresnek. 2 Nem tudtalak tegnap hvni. Egsz este sket volt a telefonom. Felhvtam a hibabejelentt. Azt mondtk, holnap kijnnek s megnzik a kszlket. 3 Egsz nap kptelen voltam utolrni telefonon. . 4 Egsz este prbltalak hvni, de gy ltszik, az iker lt a telefonon. . 5 Nem akartam, hogy felbredjenek a gyerekek. Inkbb kihztam a telefont. . 6 llandan foglaltat jelez. Biztosan rosszul tette vissza a telefonkagylt. . 7 Cseng, cseng, de nem veszi fl senki. . 8 Elszr nem ismertem meg a hangodat a telefonban. . 9 Elnzst. Nem hallottam jl. Megismteln? . 10 Kapcsoln nekem a 220-as mellket? Mr Greennel szeretnk beszlni. . 1

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3 My right leg is killing me!

921 921 accident on the E75 just south of Kecskemt. Motorcycle involved AMBULANCE DRIVER (PETER): Right then, dont worry now. Well get you comfortable as quickly as possible. MOTORCYCLIST (JIM): Thank you. My right leg is killing me! PETER: Youve got a lot of luggage on your bike. Are you on holiday? JIM: Yes, I thought I would travel through Hungary for a couple of weeks, but I wont be seeing much of it now, will I? PETER: No, but perhaps youll get to know us Hungarians a bit better than you would have done! Now, can you tell me exactly where it hurts? JIM: Yes, my right leg is in agony just above the ankle. PETER: Im going to examine your arms, hands and legs. I want you to tell me if anything hurts. JIM: No, nothing else hurts, it just feels normal. PETER: Im going to take your pulse at your wrist now Your pulse is fine, it feels strong, its probably faster than usual, but thats because youre worried and tense. JIM: I feel better now that youve come. Its comforting to talk to you. Im so glad that you can speak such good English! PETER: Thanks! Your leg is probably broken, but there doesnt seem to be anything else wrong with you. Of course they will check everything when we arrive at the hospital Were going to put a vacuum splint around your leg to lock it into position until we arrive at Casualty. JIM: Can you give me an injection to stop the pain? PETER: No, Im sorry, were not allowed to, but we can give you Medimix, a gas which is a mixture of oxygen and nitrous oxide. That will help you a bit. JIM: Oh, Ill wait until we get to Casualty, then perhaps they can give me an injection. PETER: Weve got the vacuum splint round your leg now and pumped out the air. Does it feel all right? JIM: Yes, it feels better now that its firm. PETER: Well lift you onto the stretcher now and get you into the ambulance. JIM: What about my bike and luggage? PETER: You neednt worry about that at all. The police are on their way. Theyll make sure that your motor-bike gets taken away, and that your luggage is locked up until you can collect it. Theyll question you about the accident later at the hospital. JIM: You think of everything here, dont you?

Vocabulary
south motorcycle.. comfortable. quickly.. luggage. on holiday travel. through. perhaps. get to know.. take pulse. wrist.. probably... comforting Im glad vacuum splint.. lock until.. be allowed to.. pump out the air. firm lift onto. stretcher... get sy into the ambulance. neednt.. make sure. collect..

25

I skidded with my motorbike

SEN (PAMELA): Hello, Im an Enrolled Nurse here. What have you done? JIM: I skidded with my motorbike. I was riding along when suddenly a big brown animal with horns ran across the road in front of me. PAMELA: That sounds like a deer! This country has some of them. But they rarely come out of the woods. Sometimes they cause accidents, as you can see. JIM: Well, its certainly put an end to my holiday. PAMELA: Thats a shame. Now lets see about getting your leg better. A doctor from the Surgical Department will be here to examine you first in case you have any internal injuries. Then an orthopaedic surgeon will have a look at your leg.

************* ORTHOPAEDIC SURGEON (MR STONE) Ive just spoken to the surgeon and he says he cant find any internal injuries. Have you been given an injection to ease the pain? JIM: Yes, I have. Its starting to feel a bit better now. MR STONE: Do you feel any pain in your back or neck? JIM: No, its only my leg which hurts. MR STONE: Did you try to stand up before the ambulance arrived? JIM: No, I was lying at the side of the road when they came. I couldnt put any weight on my leg at all. MR STONE: Im going to send you straight up to the X-ray Department so that we can see the exact extent and position of the fracture. Well leave the vacuum splint on until you come back. It will support your leg and prevent further injury. NURSE: Ill take you for your X-ray and wait with you while you have it. We must keep your leg high to reduce the swelling. ************* MR STONE: I have the X-ray report here. You have a simple fracture just above your right ankle. Well have to put your leg in plaster up to your knee. Youll then be admitted to the Orthopaedic Ward. Im afraid youll have to think of the ward as your holiday hotel from now on!

Check your vocabulary!

skid sounds like... deer... cause. certainly... shame in case.. internal. injuries. to ease.. lie.. put weight on sg. straight. exact. extent fracture leave on support. prevent. further.. high.. reduce.. swelling simple fracture put in plaster... break. dislocated.
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Exercise 1 Find examples for the natural and polite way of asking people to do something in the text. Practise these sentences in pairs.

Exercise 2 Explain the following words and expressions. Write sentences or a short story using the words below.
Example: put weight on I cant put weight on my leg now. Its broken. put on weight - I put a lot of weight on when I was on holiday because I ate so much! put in plaster - .. put a plaster on - strain -.. sprain - . break - .. a compound (or open) fracture a simple (or closed) fracture bruise dislocated . cracked . swollen .

Exercise 3 Learn the names of the bones.( See The Skeleton in the Appendix!)

Exercise 4 Fill in the blanks with the suitable words.

Jim is a m. from England. He was r. along when suddenly a d ran across the r. in front of him. He s with his m. and broke his l. just above the a. . The a. arrived soon and the a. m examined his a.., h and l . He was c.. and he felt n. but his r l.. was killing him. He wasnt given an i. to stop the p until they arrived at the h . A doctor from the S.. D. examined him first in c he had any i i. Then he was taken to the X- Dto see the exact e. and p.. of the f.. He had a s. f . His leg was p in p up to his k.. . Then he was a to the O. W.. . He spent his holiday in h

27

Everyday English
Countries and Nationalities Here are the names of some nationalities. Find the nationality for each country in the chart below. Then practise the conversation with your partner.
Nationalities: Bulgarian, Russian, Croat, Ukrain, Spanish, Czech, Saudi Arabian, Japanese, Canadian, Italian, Danish, Slovakian, Serb, Sudanese, Argentinean, Indonesian, Welsh, Finnish, Swiss, Algerian, Turkish, Indian, Greek, Swedish, British, Pakistani, Thai, Hungarian, Belgian, Malaysian, Irish, Mexican, Scottish, Australian, Norwegian, French, Cuban, Dutch, Austrian, Iraqi, German, Chinese, Colombian, English, Transylvanian, Nigerian, Romanian, Brazilian, Egyptian, Portuguese, South African, Peruvian Country England Canada China Romania Transylvania Japan Denmark Slovakia Serbia Croatia Czech Republic Wales Ireland Scotland Germany The Netherlands Greece Italy Austria Hungary Belgium Sweden Britain Switzerland France Finland A: B: A: B: A: B: Nationality Country Norway Bulgaria Spain Turkey CIS/Russia The Ukraine Mexico Brazil Argentina Indonesia Portugal Algeria Egypt South Africa Saudi Arabia Peru Sudan Pakistan India Malaysia Cuba Iraq Thailand Nigeria Columbia Australia Nationality

Where are you from? Im from . /country/ So you are /nationality/, I suppose. Yes, but my father is . and my mother is .. . I see. You have a dual nationality. Thats right.

28

A good holiday after all!

Jim the motor-cyclist has now had his leg put in plaster and has been admitted to the Orthopaedic Ward. Hes busy writing to a friend at home in England.

Monday Dear Kate, Guess where Ive been for the last 5 days. In hospital! Ive broken my leg. I have to stay longer than normal as I have no home to go to here. Can you tell them at work that I must go on sick leave. Im keeping a diary of everything that happens here Ill send it to you. See you soon (I hope) Love Jim

Miss Kate Wharton 10, Denton Road, Stanground, Peterborough ENGLAND

Jims Diary
Day 3 6.30 a.m. I was woken up. A thermometer was left at the side of my bed and I was asked to take my temperature. 7.00 The day staff came on duty and got a report from the night nurse. Night staff went off duty. A Staff Nurse came round and talked to each patient. I was asked to get up and wash. 7.15 The Nursing Auxiliaries came and made the beds. They made sure I was up and hadnt gone back to sleep again. 7.30 The doctors did a ward round. A Staff Nurse brought round medicines. 8.0 Breakfast. (A roll, some butter and a cup of white coffee or tea. The coffee is usually cold and disgusting so I had tea with lemon. It was delicious!) 9.0 I was sent to have an X-ray. The radiologist is a really pretty and kind woman. Imagine, she has a great sense of humour! Two more patients in my room were sent to theatre. 10.00 I came back to the ward. The nurses were busy dusting and cleaning. 10.15 The Physiotherapist came to help me exercise my leg. 12.00 Lunch. (A kind of soup, too hot but tasty, some vegetable sauce and a sunnyside-up egg. The sauce was sour, the egg was cold, otherwise it was lovely! Im starting to get used to Hungarian food. 2 p.m. Medicines, again. Yak! 2.15 Afternoon coffee. Black and strong but I have it with lots of sugar. I must admit its much better than our coffee.

29

2.30 4.0 5.0

The nurses ward round. Then quiet activity until 4 oclock. This is the time I write postcards to my friend and this interesting diary to YOU! I was asked to take my temperature again. Luckily its under 37. Evening meal. Coffee or hot chocolate and sandwich or sausages. Its a little bit early for me but later a Nursing Auxiliary gets me something from the buffet. Hes a very kind young boy and he speaks English very well, so we often talk to each other. Although he has some mistakes, he willingly speaks to me and tries to help me. The beds were tidied up and some of the patients were given sleeping tablets. I went to watch TV. The night staff came on duty. I tried to speak English with the night nurse. I was sent to watch TV again!

7.30 9.0 9.30 9.45

Remember! In Great Britain the twelve-hour clock is still used most of the time. To avoid misunderstanding, a.m. (ante meridiem) is used with a morning time (up to noon) and p.m. (post meridiem) is used for and afternoon or evening time. Practise clock times: 8.00.. 8.15. 8.30. 8.45. 8.05. 8.55. 8.40. 8.48. 8.57. 8.20. 8.09.. 11.00. 11.15. 11.30. 11.45. 11.10. 11.50. 11.35. 11.38. 11.25. 11.19. 11.49.

Ask each other questions using the following time expressions: yesterday the day before yesterday three days ago last week/month/year. the month before last. tomorrow in two days time. in a fortnight .. the week after next. in a couple of months time. the day after tomorrow next week/month/year.

30

REVISION
(3 My right leg is killing me!)

Exercise 1
Match the lines in column A and B to get correct sentences. A 1 Were going to put a vacuum splint 2 Of course they will check everything 3 Its comforting 4 Im going to take your pulse 5 Weve got the vacuum splint round your leg now 6 I want you to tell me 7 Your leg is probably broken, 8 Now, can you tell me exactly 9 Well lift you onto the stretcher now 10 Yes, my right leg is in agony 11 Well get you comfortable 12 Im going to examine your B a) to talk to you. b) when we arrive at the hospital. c) around your leg to lock it into position. d) and get you into the ambulance. e) and pumped out the air. f) but there doesnt seem to be anything else wrong with you. g) at your wrist now. h) as quickly as possible. i) if anything hurts. j) where it hurts? k) arms, hands and legs. l) just below the knee.

Exercise 2
Match the sentences in column A and B to make short dialogues. A B 1 Can you give me an injection to stop the pain? a) Thank you. My right leg is killing me. 2 Well get you comfortable as quickly as possible. I want you to tell me if anything hurts. Weve got the vacuum splint round your leg now. Does it feel all right? Your pulse feels a bit faster than usual, but thats because youre worried and tense. Now, can you tell me exactly where it hurts? What about my bike and luggage? b) No, nothing else hurts, it just feels normal. c) You neednt worry about that all. d) I feel better now that youve come.

3 4

e) Yes, my right leg is in agony just above the ankle. f) Yes, it feels better now that its firm. g) No, Im sorry, were not allowed to.
31

6 7

Exercise 3
Fill in the dialogue. SEN (PAMELA): . JIM: I skidded with my motorbike. I was riding along when suddenly a big brown animal with horns ran across the road in front of me. PAMELA: JIM: Well, its certainly put an end to my holiday. PAMELA:

************* ORTHOPAEDIC SURGEON (MR STONE) . .. JIM: Yes, I have. Its starting to feel a bit better now. MR STONE: .. JIM: No, its only my leg which hurts. MR STONE: JIM: No, I was lying at the side of the road when they came. I couldnt put any weight on my leg at all. MR STONE: ... .. NURSE: Ill take you for your X-ray and wait with you while you have it. We must keep your leg high to reduce the swelling. ************* MR STONE: I have the X-ray report here. .

Exercise 4
Role play the following situation. n baleset helysznre rkezett. Van egy eszmletnl lv lbsrlt betege. Lssa el a beteget, kzben megnyugtatskpp mindig mondja a betegnek, hogy mit fog vele csinlni. (pl. kitiszttje a sebet, rgzti a lbat,, felhelyezi a snt, hordgyra helyezi a beteget, beteszi a mentkocsiba stb.)

32

Brian was knocked down

/Revision of Units 1-3/

While Brian Hill was going to school this morning, a car knocked him down. His left leg was broken just below the knee. Some people who saw the accident laid him in a comfortable position on the pavement and phoned for an ambulance. Brian was badly shocked and in great pain. While the people were waiting for the ambulance, the driver of the car that knocked Brian down covered him with his jacket and tried to comfort him. When the ambulance arrived, Brian was lifted onto a stretcher, put into the ambulance and driven to a hospital that was not far away. When he arrived at the casualty department, he was admitted. The nurse who admitted him gave him an injection of morphine to combat the shock and the pain. The doctor who examined him comforted him and told him everything would be all right. While the doctor was examining him, the nurse who had admitted him took his pulse and blood pressure. No anti-tetanus injection was necessary as Brian had been immunised against tetanus six month earlier. As Brians wound was lacerated and contused, he was given an antibiotic to prevent the onset of infection. He was taken to the x-ray department. While the x-ray examination was being carried out, Brians parents arrived at the hospital. The doctor who examined Brian told them that Brian had sustained a compound fracture of the tibia and fibula. He explained that an operation was necessary and asked Mr Hill to sign a consent for operation form. Mr Hill signed the consent form while Mrs Hill was giving Brians personal particulars and previous medical history to the nurse. Before Brians parents left the hospital, they were told when they could visit him and were given a list of things that he would need. While Brian was waiting to go to theatre, a quarter-hourly record of his pulse and blood pressure was kept and he was given a suitable premedication.

Check your vocabulary!

knock down below see saw. lay laid . comfortable. pavement.. badly shocked. wait for. cover. jacket comfort. drive.. combat.. tell told.. will be would be.. immunise against wound... lacerated.. contused... antibiotic.. prevent.. onset.. infection carry out.. parents. sustain.. compound fracture tibia.. fibula explain. necessary. sign consent form personal particulars. . previous medical history.. ... visit list.. record... suitable. premedication

33

Exercise 1 Answer these questions

1 What was Brian doing when he was knocked down? 2 What did the people who saw the accident do? 3 What did the driver of the car that knocked him down do? 4 What happened when the ambulance arrived? 5 Who gave him an injection of morphine? 6 Why was he given morphine? 7 Why wasnt he given anti tetanus injection? 8 What sort of wound had Brian sustained? 9 Which bones had been broken? 10 What was Mr Hill asked to sign? 11 What was Mrs Hill asked to give? 12 What record was kept while he was waiting to go to theatre?

Exercise 2 Read the text carefully. Then fill in the blanks with suitable words
Brian was k.. d. by a car. Some people who saw the a called for help. Brian was badly s. and in great p . Someone covered him with a j . When the a. arrived, Brian was lifted onto a s. . He was taken to the c. d.. of the local hospital. He was given an i.. to combat the s.. and the p. Brians wound was l. and c . He had sustained a c. f. of the t.. and f.. . Mrs Hill gave Brians personal p.. and previous m h.. . While Brian was waiting to go to theatre, he was given a suitable p.. .

Exercise 3 Read the first part of the text again. Imagine that you are a witness of this accident. Who are the other people? Role play the situation!
Possible roles: Brian(victim) and you (witness) the driver and Brian the driver and you

Do the same after reading the other parts.

34

In the Theatre
In the theatre, Brian will be given an anaesthetic and his wound will be explored. The x-rays which were taken by the radiographer will show the surgeon the exact site and extent of the fracture. Dead or dirty tissue will be excised and any small splinters of bone will be removed. The surgeon will perform the operation using a no touch technique to reduce the chances of infection. When the surgeon is satisfied that the wound is as clean as possible, he will dust it off with an antibiotic powder. He will then suture it and cover it with a sterile gauze dressing. Any areas that are raw will be dressed with sterile Vaseline petroleum jelly gauze. The surgeon will now be able to treat the fracture as closed. He will reduce the bones into their anatomical position, and then the leg will be put in plaster of Paris. Brian will then be taken back to an orthopaedic ward.

When a post-operative patient like Brian arrives in the ward, he is carefully lifted from the stretcher and laid in a specially prepared bed. The foot of the bed is often raised on wooden blocks. The patient is placed on his back with his head turned to one side. As he is generally still unconscious, an artificial airway is in position and a nurse stays with him to ensure that his airway is kept clear. She also checks his pulse rate and volume, his colour and the rate and depth of his respirations.

Exercise 1 Answer the following questions

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 What will Brian be given in theatre? What will be done to his wound? What will the x-rays show the surgeon? What will happen to any dead or dirty tissue? What will happen to any small splinters of bone? Why will the surgeon use a no touch technique? What will the surgeon do to the wound when he is satisfied it is as clean as possible? What will he do to the wound when he has sutured it? What will any raw areas be dressed with? What will he do to the fractured bones? What will he do to Brians leg? Where will Brian be taken after the operation? What happens to a post-operative patient when he arrives in the ward? How is he placed in bed? What does he have in his mouth? Why does a nurse remain with him? What does the nurse check?

Exercise 2 Read the text carefully and complete the following sentences
35

In the theatre, Brian will be given an a . The x-rays will show the s.. the exact s. and e.. of the fracture. Dead or dirty t.. will be excised and any s. of bone will be removed. The surgeon will perform the o using a no touch t . When the surgeon is satisfied that Brians w is as clean as possible, he will dust it off with an a.. powder. It will then be sutured and covered with a sterile g.. d. . The surgeon will now be able to treat the f. as closed. He will reduce the bones into their a.. position, and the leg will be put in p.. of P. . Brian will then be taken back to an o.. w.. . When a p- patient arrives in the ward, he is carefully lifted from the s. and laid in a specially prepared bed. As he is generally still u.., an a. airway is in position and a nurse stays with him to ensure that his a.. is kept clear. She also checks his pulse rate and v.., his c.. and the rate and d. of his r.. .

36

Brian on the Ward

Soon after Brian had returned to the ward, he began to regain consciousness. The nurse who was looking after him removed the airway from his mouth and gave him a pillow for his head. For the next few hours he slept soundly. From time to time the toes of his injured leg were examined to see if they were warm and pink, and hi pulse and blood pressure were taken halfhourly. At 6 p.m. Brian woke up and complained of severe pain in his leg. The surgeon who had performed the operation had prescribed Pethidine if Brian complained of pain, and he was given an intramuscular injection of 50 mgs of Pethidine at 6.20 p.m. As his blood pressure was within normal limits, the bed-blocks were taken away and a bed-cradle was put in his bed to take the weight of the bedclothes off his legs. A nurse offered him a bottle, but he said he could not manage to pass water. A houseman visited Brian during the evening to check that he was all right and that he would be able to sleep. He prescribed a second injection of Pethidine, which was to be given at midnight if Brian complained of further pain. Two nurses came and helped Brian to wash his hands and face and to change from the white theatre gown into his own pyjama jacket. Brian, who had been allowed frequent sips of water because he had not complained of nausea, was now given a cup of tea and told the nurses that he was beginning to feel fine.

Exercise 1 Answer the following questions

1 2 3 4 5 6 7 8 9 10 What happened soon after Brian returned to the ward? What did the nurse who was looking after him do? What did Brian do when he woke up at 6 p.m.? What was Brian given at 6.20 p.m.? Who had prescribed the Pethidine? Why was a bed-cradle put in Brians bed? Why did a houseman visit Brian during the evening? What did the two nurses help Brian to do? Had Brian complained of feeling sick? What did he tell the nurses?

Exercise 2 What are these instruments used for? Make sentences in the passive voice.
sphygmomanometer: artificial airway: gag: . tongue forceps: .. crutch: .

37

Exercise 3 Put the following sentences into the passive

1 2 3 4 5 6 7 8 A nurse removed the artificial airway from his mouth. A nurse examined the toes of his injured leg. A nurse took his pulse and blood pressure half-hourly. A nurse gave him a pillow for his head. A nurse gave him an intramuscular injection of Pethidine. A nurse asked Mr and Mrs Hill to come back the next day. A nurse gave Brian a cup of tea. A nurse offered him a urinal. .

Exercise 4 Vocabulary work. Find synonyms for the missing words in the texts
1 2 3 4 5 6 7 8 9 10 11 12 13 The surgeon examined Brians wound. The surgeon Brians wound. He cut away the dead tissue. He .. the dead tissue. He took away the small splinters of bone. He . the small splinters of bone. He carried out the operation. He the operation. He used a technique to make the risk of infection smaller. He use a technique to .. the risk of infection. He sewed up the wound. He . the wound. He replaced the bones in their normal position. He the bones .. their . .. . A doctor orders the use of a drug. A doctor a drug. The patient is coming round. The patient is . The patient complained of feeling sick. The patient complained of He is complaining of very bad pain. He is complaining of . pain. The nurse offered him a urinal. The nurse offered him a . The artificial airway was taken away from his mouth. The artificial airway was .. from his mouth.

Exercise 5 What tenses are used in the following sentences? Why?

1 2 The doctor told them that Brian had sustained a fracture. The nurse took Brians pulse and blood pressure after she had admitted him. 3 Soon after Brian had returned to the ward, he began to regain consciousness.

38

Exercise 6 Compare the use of past simple and past perfect tense. /See Grammar Reference in the Appendix/ Then complete the following sentences.
The nurse who had admitted Brian (ask) what (happen) ... to him. 2 He (tell) .. her that he (be knocked) down. 3 Jane (work) .. at the hospital for six months before she (meet) .. Kate. 4 When the nurse (set) . the trolley, she (take) . it into the ward. 5 After the surgeon (examine) .. the patient, he (tell) him there was nothing to worry about. 6 After disposable instruments (be used) . they (be thrown) away. 7 Marys headache (not get) . better until she (take) . several Aspirins. 8 The radiographer (tell) ... the patient not to move until she (take) . the x-ray. 9 When she (take) .. the x-rays, the radiographer (take) the patient back to the ward. 10 The surgeon who (perform) .. the operation (visit) .. John next morning. 1

Exercise 7 Ask the patient

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 when the accident happened. When did the accident happen? if he has had pneumonia before. Have you had pneumonia before? who her general practitioner is. if he has been immunised against tetanus. if he has been in hospital before. .. if his leg hurts. .. when he woke up this morning. if she slept well last night. . if he is feeling better. if there is anything you can get for him. .. if he would like to sit in the day room. where the pain is. . if he has had the same pain before. .. when the pain started. .. if he has taken his medicine.

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4 Ive got a terrible pain

Part One
RECEPTIONIST (ANNA): Good afternoon. Can I help you? PATIENT (JESSICA): Ive got a terrible pain in the stomach. ANNA: How long have you had it? JESSICA: Its been very bad for about three hours. ANNA: Ill ask a doctor in the Surgical Department to see you first. You may have to see a gynaecologist as well. Its sometimes difficult to know which doctor you should see first when you have abdominal pain. The nurse will ask you for some more details in a few minutes. Do you have your patients card with you? JESSICA: No, Im sorry. Ive been here in your country only for a few days. I havent had enough time yet to register with a doctor. ANNA: And didnt you take out medical insurance before travelling to Hungary? JESSICA: No, I was told that I can take it out when I arrive in the country. ANNA: You are British, arent you? JESSICA: Yes. Im staying with my friends for a month or two. ANNA: Can I ask your name, please? JESSICA: Of course. Jessica Taylor. ANNA: Well, Im terribly sorry Miss Taylor, but then you must pay for the treatment. JESSICA: I know. And how much shall I have to pay? ANNA: It depends on the treatment. Ill write out a bill for you which you have to pay as soon as possible. Will that be all right? JESSICA: Yes, of course. Im afraid Ill have to phone my father to ask for money, but I think Ill get it in a couple of days. ANNA: Thats OK. Now, would you tell me your date of birth? JESSICA: 15th June 1978. ANNA: Are you on the phone? JESSICA: Yes, my number is 4356732. ANNA: Now if youd like to sit down in the waiting-room, a nurse will fetch you soon. JESSICA: Thank you.

Check your vocabulary

stomach tummy.. How long?.. gynaecologist. abdomen.. abdominal details patients card... medical insurance pay (for). treatment How much? depend on... bill write out a bill... waiting room.

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Part Two
NURSING AUXILIARY (ANDREA): (Calls out name) Jessica Taylor. JESSICA: Yes, thats me. ANDREA: Hello, my name is Andrea. Im a Nursing Auxiliary. Are you in a lot of pain? JESSICA: Yes, I am. It seems to be getting worse all the time. ANDREA: The doctor will see you as soon as possible. But first we must check your temperature. Heres a thermometer. Then we must have a urine sample from you. Can you take this paper mug, please? The toilets over there and if you leave it in there Ill fetch it later. Afterwards you can come with me into the treatment room and get undressed. (Later) JESSICA: How much shall I take off? ANDREA: You can leave your blouse on. If you just take your skirt and tights off, it should be enough. Now if youd like to lie down on the couch, Ill ask the nurse to come in and talk to you. JESSICA: Thank you. RGN (KATI): Hello, my name is Kati. Im the nurse on surgical duty today. I shall ask you some questions, then Ill go and tell the doctor and ask him to come and examine you. Can you tell me where it hurts? JESSICA: Yes, the pain is worst around my navel, but it seems to go down towards the right side as well. KATI: How long have you had the pain? JESSICA: About four hours like this, but twice in the last ten days Ive felt a slight pain which disappeared after a couple of hours. KATI: Is it worse when you go up and down the stairs? JESSICA: Yes, it is. I went upstairs to fetch something before I came here, and I could hardly lift my right leg at all. KATI: Have you eaten normally? JESSICA: No, I havent felt like eating at all today. KATI: Have you been sick? JESSICA: No, I havent, but I felt a bit sick this morning when I woke up. KATI: Have you felt feverish? JESSICA: Not really, but the other nurse said my temperature was 38,1C. KATI: Ill fetch the doctor now and hell examine you. Will you be all right lying here on your own for a few minutes? Theres a bell here. If there are any problems, just ring and someone will come in to you. JESSICA: Thank you.

Vocabulary
thermometer temperature. urine sample get undressed.. blouse skirt... tights. examine hurt navel. belly button tummy hole disappear stairs hardly.. feel like -ing be sick.. vomit. throw up... feel sick. feverish. bell ring

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Part Three
DR GREEN: Hello, my names Dr Green. How are you feeling? JESSICA: Not too good. The pain is very bad around my stomach. DR GREEN: Im going to examine you now. Please just lie still and try to relax. If I press here, around your navel, does it hurt? JESSICA: Yes, it does. DR GREEN: Does it hurt more on the right side, or on the left side? JESSICA: On the right. DR GREEN: Im going to bend your right leg up towards your stomach. Tell me if it hurts. JESSICA: Ouch!! Yes, it does. DR GREEN: Its possible that you have an inflamed appendix. Well have to admit you straight away for an operation. You mustnt eat or drink anything from now on. Well take you to the Observation Ward and take some tests before we operate, and also set up a glucose drip. Ill ring the anaesthetist and ask him to come and talk to you. JESSICA: How long will I have to stay in hospital? DR GREEN: Only about two or three days on the ward. Then youll come back as an outpatient to have your stitches out in the Surgical Department. JESSICA: Can I make a phone call to tell my father where I am? KATI: Yes, of course. You can find a public phone in the hall near the entrance or ask the receptionist to call the number. Do you have a phone card? JESSICA: Yes, of course. I never leave my home without one. KATI: If only you had to use it for telling some more pleasant news!

Check your vocabulary

around lie still.. try relax press bend. towards possible inflamed.. appendix.

appendicitis straight away. from now on Observation Ward operate glucose drip anaesthetist stay.. out-patient. in-patient stitch

Translate the following sentences

This patient is going to theatre today. . Im going to the theatre tonight. .

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Exercise 1 Use a dictionary and discuss the differences between the following words. Write a sentence for each word.
wound . gash . cut. sore injury.

Exercise 2 b) What tense is used in the following questions? Why? Translate them.
1 How long have you had the pain? 2 Have you eaten normally? b) Have you been sick? b) Have you felt feverish?

b) Complete the following sentences with the correct form of the present perfect tense of the verbs in brackets
1 2 3 4 5 6 The doctor . just (speak) .. to the nurse. She (not, ask) . for the patients notes yet. Jennifers bus . already (go).. . Early ambulation (make) . it essential to provide a lot of space. Bruce (be) . in this ward for the last two weeks. These patients . never (have) .. operations before.

Exercise 3 a) Compare the following sentences:

1 2 3 4 5 6 I have seen him before. I saw him last Sunday. . We havent finished the course yet. .. We finished the course last week. Have you seen her? .. Did you see her last night?

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(The present perfect is used when no definite time is mentioned. The past simple is used when a definite time is mentioned.)

b) Complete the following sentences with the correct tense

1 2 3 4 5 6 7 8 Doctors (use) disinfectants for nearly one century. Scientist (discover) .. many new antibiotics since the last war. Jane (take) . the patient to the x-ray department yesterday. Nurse Smith (work) at St. Thomas since she (qualify) .. in 1978. Nurse Johnson (just, take) a patient to theatre. Sir Alexander Fleming (discover) . penicillin in 1928. Lord Lister (use) .. carbolic acid to prevent infection at the end of the last century. Since the 1930s, the search for better antibiotics (continue) .

Exercise 4 b) Look at these sentences. Translate them.

1 2 3 4 5 Pulse rate is not normally slower than 50 per minute. ... The patients temperature is as high as it was yesterday. Temperature is lowest in the morning and highest in the evening. . The patients temperature was the highest we have ever recorded. . The most convenient point to take a persons pulse is on the anterior surface of the wrist: it is less convenient to take the apex beat. ..

With long adjectives and the ones with recognisable suffix (-ed, -ing) we usually use more/less and most/least. (See Sentence 5) We usually use more/less and most/least for short adverbs (adjective+ly)as well as for long ones. (See Sentences 6 to 8) 6 7 8 Pulse rate is most easily felt at the wrist. .. She recovered more quickly than they had expected. .. His temperature decreased less rapidly than they had hoped.

b) Fill in the missing words

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1 2 3 4 5 6 7 8 9 10 11 12 13

Normal urine is (light) . urine passed when fluid intake is decreased. The patient is feeling (good) . she was yesterday. Pulse rate is usually (high) after exercise. You will get home (quick) by taxi on foot. He received (expensive) .. treatment in our hospital. The pain is (bad) .. it was yesterday. Autoclaving sterilizes (efficient) .. than boiling. This is (bad) . attack of asthma Ive ever had. It was (large) cyst the surgeon had ever removed! Good, his heart is beating (strong) .. it was an hour ago. Mr Smith was (sick) a dog this morning. Shes (uncooperative) . patient in the ward. Im glad to say she comes for check-ups (regular) ... she used to.

Exercise 5 b) Translate the following sentences

1 2 3 4 5 6 7 8 9 10 11 12 You are British, arent you? You have seen the treatment room, havent you? She is a gynaecologist, isnt she? . Kate will come, wont she? . John likes ice-cream, doesnt he? They often visit him, dont they? . You arent Hungarian, are you? She isnt a gynaecologist, is she? . You havent seen the treatment room, have you? . Jack doesnt like coffee, does he? . Mary wont come, will she? .. They dont visit him often, do they? .

b) Supply the missing question tags

1

2 3 4 5 6 7 8 9 10 11

The syringe is sterile, .? He has had his injection, .? Hes not a consultant, ..? They are radiographers, ..? Youre not going, ..? They did it, ..? This is the dispensary, .? This isnt the preparation room, ? They werent staff nurses, .? John was admitted yesterday, ..? She went home last week, ..?

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12 You will help me, .? 13 It wont hurt, ? 14 It doesnt hurt, .? 15 There are enough beds, ..? 16 She can walk, ..? 17 It wasnt difficult to find, ..? 18 You found them, ..? 19 He will get better, ..? 20 This equipment isnt sterile, ? 21 You have given her a bedpan, ? 22 She is on duty, .? 23 Nurse Brown admitted him, .? 24 You will come tomorrow, ?

I feel very sleepy

Jessica has just woken from her operation for appendicitis and is lying on the Surgical ward. NURSE (ANDREA): How are you feeling? Your operations over now and everything is fine. JESSICA: I feel very sleepy. ANDREA: Yes, its quite normal after having had an anaesthetic. JESSICA: Can I have something to drink? ANDREA: All right then, if you dont feel sick you can have a sip of water. Ill come back and have another chat with you when youre more awake. (Later) ANDREA: Do you feel better now? Youve had a long sleep. JESSICA: Yes, much better. How long do I have to stay in bed? ANDREA: You can get up soon. We like our patients to be up and about as quickly as possible after an operation. JESSICA: When can I have something to eat? ANDREA: In the morning. You must stay on liquids today, then if you feel all right you can eat normally tomorrow. JESSICA: Do you know when Ill be discharged? ANDREA: Probably on the third day after your operation. We must make sure your bowels are working properly again, but as soon as youve been to the toilet theres no reason why you shouldnt go home. JESSICA: I suppose Ill have to come back to have my stitches out at the out-patients clinic. ANDREA: As long as there are no complications, you can come back in 10-12 days to have them out. Ill fetch you another drink now if youd like one. JESSICA: Yes, that would be nice Im still feeling rather thirsty.

Vocabulary
liquids be discharged bowels intestines

46

5 That looks like a nasty cut!

Part One
RECEPTIONIST (MARY): Can I help you? MOTHER: Yes, my little girl has fallen off her bicycle and cut her forehead badly. MARY: Is it bleeding a lot? MOTHER: Quite a lot. It seems to be rather deep. MARY: Well fit her as soon as possible. Have you got her card? MOTHER: Yes, here you are. MARY: Thanks. Now if youd like to sit in the waiting-room for a few minutes, well call you in. MOTHER: Thank you.

Part Two
RGN (EVE): Were ready for you now. That looks like a nasty cut. What have you done? CHILD (JULIE): I fell off my bike and banged my head. EVE: Does it hurt very much? JULIE. Yes, dont touch it! EVE: Well have to clean it up for you, but well be as gentle as we can, so dont worry. JULIE: I shall scream if you hurt me! EVE: Well have to be careful then, wont we! Now hop up here on the couch and your Mummy can sit beside you. There, now first of all, Im going to wash this cut for you. Weve got a special lotion here, and I promise you, it wont sting. JULIE: What is it? Let me look! EVE: Its called saline solution, its a mixture of salt and water. It will get your cut nice and clean without hurting Now, Ill just put a clean piece of gauze on, and then Ill go and fetch the doctor.

Check your vocabulary

receptionist girl.. boy.. daughter son.. fell off. bicycle forehead. bleed seems rather deep.. fit call in ready. looks like.. nasty.. cut.. bang.. touch. clean (up) gentle scream.. be careful. hop up on. beside wash (out) lotion. promise. sting.. solution. salt. water. gauze.

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Part Three
DR BROWN: Hello there, my name is Doctor Brown. What have you done? JULIE: Ive fallen off my bike. DR BROWN: Let me see how it looks Im afraid well have to sew that for you, its quite a deep cut youve got. JULIE. I dont want to, itll hurt. I want to go home. DR BROWN: I must sew it for you or youll have a very nasty scar on your forehead. If I sew it, youll hardly see it after a few weeks. JULIE: Will it hurt? DR BROWN: First Im going to give you an injection which will make your skin go to sleep and then you wont feel anything. Is everything ready, nurse? EVE: Yes, its all laid out here. DR BROWN: Now look heres a needle and a syringe. Youll just feel a little prick. JULIE: Ouch! EVE: Just hold your Mummys hand and it wont be so bad. DR BROWN: Now you wont feel anything when I sew it for you. Heres the needle and thread Im going to use. There we are, its over now. It wasnt too bad, was it? JULIE: I didnt feel anything. EVE: Im going to put a piece of tape over it for you, to keep the cut clean. DR BROWN: Did your little girl faint after she fell off her bicycle? MOTHER: No, she didnt. DR BROWN: Has she been sick at all? MOTHER: No, she seemed to be quite all right apart from the cut. DR BROWN: Good. I wanted to be sure that there was no risk of concussion. You can take her home now. Keep the tape on for five days, then take her to the District Nurse or to the School Nurse to have the stitches out. EVE: If the wound starts to hurt, or if it becomes swollen or if she gets a temperature, ring us up and well have another look at her Here you are, heres a little sticker for you because youve been such a brave girl. JULIE: Thank you, I like it here. It wasnt nearly as bad as I thought!

Check your vocabulary

sew... deep. cut scar. hardly. go to sleep. needle. syringe prick hold. thread. tape. faint. apart from.. concussion.. stitch to have the stitches out . wound. swollen sticker.. brave

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Exercise 1
This child was able to go home after treatment. You have brought in an other child who has fallen and hit his head so badly that he has fainted. He must be admitted for observation for a couple of days. Comfort his mother and tell her what will happen to her child. Write and act out a dialogue between an ambulance man/nurse and the mother of this child.

Exercise 2 a) Vocabulary work. Find the meaning of these words.

cotton wool swab dressing towel. folded gauze. gallipot.. a pair of scissors. plain dressing forceps dissecting forceps dressing trolley bandage tray disposable equipment. non-disposable equipment. jar/cylinder a pair of forceps instrument handling forceps/Cheatles forceps.... bottle antiseptics.. disinfectants... used instruments... paper container. soiled dressings adhesive strapping.. safety-pin bandage clip.. bandage scissors... suture scissors... clip-removing forceps.. ribbon gauze.. wound probe.. curved sinus forceps. receiver (kidney dish).. mask bedpan urinal/bottle.. artery forceps scalpel/surgical knife.. blade syringe ... needle .

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b) Which instruments from the above list are used for

1 2 3 4 5 6 7 8 taking out stitches? .. cutting bandages? giving injections? removing clips? ... exploring a wound? . stopping bleeding? .. handling sterile dressings? .. handling sterile instruments? ..

c) Finish the sentences

1 2 3 4 5 6 7 8 A wound probe and sinus forceps are used for Cheatles forceps are used for .. Artery forceps are used for .. A syringe and needle are used for Bandage scissors are used for .. Dissecting forceps are used for Suture scissors are used for .. Clip-removing forceps are used for ..

d) Rewrite the above sentences as you can see in the following example.
Instead of saying, A thermometer is used for taking temperatures, you can say, You use a thermometer to take temperatures. 1 2 3 4 5 6 7 8

Exercise 3 Find the difference between these words. Explain them in Hungarian.
liquid (e.g. She was told to drink a lot of liquids because she had a bad cough. .. fluid (e.g. She had fluid on her knee which had to be drained.) .. lotion (e.g. The nurse cleaned the skin with lotion.)

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..

Exercise 4 a) Look round in the ambulance. Name the instruments you can find there. What are they used for? . .. .. b) Look into the first-aid kit. List the content of it.
. . .

KP MENTAUT BELSEJE ELSSEGLY-LDA.

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6 The intensive care doctor

Before reading this text discuss with your partner the kind of problems sometimes facing the doctor who has to connect a ventilator to a patient. What do you imagine those problems to be? After your discussion, scan the first half of the chapter to compare your ideas with those of the author. Another word for a ventilator is a l...... s.......... m............... . Most hospitals today have an intensive care unit. The doctors and nurses in this unit look after patients who are extremely sick. Many of these patients have had serious road accidents. Some are victims of violence. A few have severe infectious or other illnesses. Others are recovering from major operations such as open heart surgery. Patients on the intensive care unit have difficulty performing the most basic functions of life: breathing, maintaining the circulation of the blood, and eating. No single drug can restore all these functions, and no machine can permanently replace them. But modern drugs and machines can help temporarily while the patient's body is healing. A patient who cannot breathe for himself must use a ventilator. The doctor puts a plastic tube in the patient's throat to keep the airway open, and connects this to the ventilator. The ventilator has a pump which blows air or oxygen into the patient's lungs ("inspiration"), and a valve which lets exhaled air escape ("expiration"). The doctor must watch the oxygen concentration and the pressure of the pump. If the pressure is too high, the patient's lungs might puncture. The ventilator is, in fact, a very simple machine, but it can save the lives of patients who cannot breathe for themselves. Perhaps this is why some people call it a life support machine. The ventilator, or life support machine, is very useful for patients who have injuries or diseases in the chest which will get better. Examples of this are a patient who has broken several of his ribs in a road accident (who needs a ventilator until the broken ribs have healed), a patient with a very severe attack of asthma (who needs a ventilator until the asthma is better), and a patient who has had major surgery to the heart or lungs (who needs a ventilator until he has recovered from the operation). When the patient is better, the doctor disconnects the ventilator and the patient will begin to breathe again. Doctors do not usually connect a patient to a ventilator if they know that he will never recover enough to breathe without the ventilator. For example, a patient who has a severe head injury in a road accident may have permanent damage to the part of his brain which controls his breathing (the respiratory centre). He probably has severe damage to other parts of the brain as well. If the doctor knows this from the beginning, he will probably not use a ventilator and the patient will die quickly. But sometimes the doctor only discovers the brain damage after he has connected the patient to the ventilator. Should the doctor then switch off the ventilator? Some people say this is murder. But if the doctor does not switch off the ventilator, the patient may live for many years in discomfort and torment. And if there are not enough ventilators in the hospital, another patient might die. High-technology medicine can save lives, but it can also produce difficult ethical problems. In healthy people, the heart pumps blood into the arteries under pressure. In very sick patients, the heart is sometimes too weak to pump the blood at a high enough pressure. The patient develops severe low blood pressure; we say he is in shock. (The word "shock" often means "fright," as in "I had a fright." But when doctors use the word "shock," they mean something different. You can read more about shock in the Appendix.) When the blood pressure is too low, the kidneys do not work. The patient
52

cannot produce urine. Waste products and fluids build up inside the body and start to poison the patient. Low blood pressure in the brain causes confusion, and then unconsciousness and brain damage. Severe shock can damage any organ in the body. An important task of the intensive care doctor is to improve the blood pressure of patients who are in shock. The treatment of shock depends on what has caused it. If a shocked patient has lost blood - for example in an accident or during surgery - a blood transfusion will help to raise his blood pressure. Some drugs can make shock worse. The doctor should make sure a shocked patient is not taking any unnecessary drugs. Other causes of shock include severe infection and heart attack. A patient with an infection needs antibiotics, and a patient who is in shock after a heart attack sometimes responds to drugs which stimulate the heart. Healthy people can go without food for several weeks. But if a sick patient is unconscious for more than a few days, he should be fed. If his stomach and intestines are healthy, he can receive his food via a nasogastric tube. This is a thin plastic tube which goes through his nose and into his stomach. The nurses can give fluids down the tube several times a day. This is the best way to feed an unconscious patient, because he digests normal food in his own intestines. However, if the stomach or intestines are not working (for example, if the patient has had an operation on his stomach), the doctors must give the food directly into the patient's bloodstream. This is called intravenous feeding. Intravenous feeding must be digested artificially before it is given to the patient. It is therefore simply a mixture of glucose, amino acids, and tiny particles of fat. Intravenous food is expensive, and bacteria can easily infect the patient through the food mixture. As soon as possible, the patient should change from intravenous feeding to nasogastric feeding. Patients on the intensive care unit are often unconscious and drowsy. They cannot tell the doctors that they are uncomfortable and they cannot cry out in pain. But they still feel pain and distress. The doctors must look for subtle signs of pain, such as an increase in the pulse rate or sweat on the skin. Patients who have had surgery, and patients with serious injuries, often need very strong painkillers such as morphine. If the patient is unconscious, the nurses usually give these drugs by injection. A side effect of morphine is suppression of breathing. If the patient is having difficulty breathing, an injection of morphine may cause a respiratory arrest - that is, the patient stops breathing. The patient may need a ventilator to help him breathe for a few days so that he can receive the painkillers safely. A very important aspect of intensive care is the work of the nurses. Most of the patients are too sick to wash themselves, use a toilet or even turn over in bed. They are at risk of skin infections and pressure sores. The nursing care of a very sick patient includes regular turning to prevent pressure sores, as well as careful washing and massaging the skin. The physiotherapist can also help by stretching and exercising the patient's muscles. If the muscles are not stretched regularly, they become stiff and contracted. Patients sometimes spend many months in an intensive care unit after a major accident. Some of their friends or relatives might have died in the same accident. These patients are likely to become depressed and demoralised. The nurses should anticipate this and try to prevent it. A little care and compassion can go a long way. Patients who have survived life-threatening accidents sometimes say that the enthusiasm and devotion of the nurses gave them the whole life. This "human aspect" of intensive care is just as important as the doctors' skills and the complicated drugs and machines.

53

Exercise 1 Summary writing

Read carefully the two paragraphs in the chapter dealing with shock and how to treat it. Then, with your partner, match part of the sentence in column A with the appropriate part in column B. Finally, rearrange the sentences to form a logical paragraph and write the paragraph out. Column A As regards the treatment of shock, it depends In this case the kidneys do not work, Any organ in the body can be damaged Column B because of low blood pressure.

who are in shock. the patient has developed very low blood pressure. so the doctor should eliminate to any unnecessary ones. what has caused it.

The intensive care doctor has to deal with patients However, some drugs can make shock worse, To be in shock means

so waste products and fluids begin to poison the patient. and drugs to stimulate the heart sometimes work following a heart attack. a blood transfusion will raise blood pressure.

On the other hand, antibiotics are needed for an infection If blood has been lost in an accident or during surgery,

Exercise 2

Reading and speaking

Read the text about shock in the Appendix. Make notes for yourself, then retell the main points to the class. Make sure they can do the following exercise after your talk. Circle the signs and symptoms that identify SHOCK. slow, thready pulse rapid, weak pulse rapid respirations constricted pupils dull eyes changes in level of consciousness slow, regular respirations restlessness red face dry, warm skin pale face cold, clammy skin thirst

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Exercise 3

Speaking

The following case histories come from Accident and Emergency Departments. These are the only departments of a hospital which see patients without a letter of referral from the GP. Read them carefully and practise with your partner. 1. WOMAN, AGED 35 Doctor: Patient: Doctor: Patient: Doctor: Patient: Doctor: Patient: Doctor: Patient: Doctor: What's happened? I've just been in a road accident. Were you the driver or the passenger? The driver. Were you thrown out of the car or did you get the steering wheel in your chest? I wasn't thrown out but I got the steering wheel in my chest and I hit my head on the windscreen. Were you knocked out? I don't remember anything after the accident. Have you got headache or pain anywhere other than your chest? My head aches; that's all. We'll send you for some X-rays and stitch any wounds later.

After examining X-rays. Doctor: You've fractured your skull. We'll have to admit you for observation. Do you want the clerk to notify any of your family? Patient: Oh yes. Will you ring my husband at work? This is his number.

2. WOMAN, AGED 32 Doctor: Patient: Doctor: Patient: Doctor: Patient: Doctor: Patient: What happened? I was in a fight and got my head hurt. When was this? Just a while ago. How long ago? Half an hour ago. Down the road. Somebody hit me. Tell me exactly what happened. I was walking down the road with my friend and we came to my sister's house and it was clear that my sister was having some trouble with her husband. He told me to clear off and I told him to leave my sister alone. What happened then? He threw some milk bottles at me but they missed. Then he hit me with a long iron pole. Were you knocked out? No. Are you sure you remember everything that happened? Yes. I want you to go for an X-ray and then come back to me. You'll need some stitches in that wound.

Doctor: Patient: Doctor: Patient: Doctor: Patient: Doctor:

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Exercise 4 VERTIGO

Learn these expressions, questions and the dialogue

Medical words: vertigo, uncoordinated, rotation, lateral pulsion, tinnitus Colloquial words: dizziness, dizzy spells, wobbly, spinning around, falling to one side, ringing in the ear Useful questions Do you ever become dizzy? Have you ever fainted? Before you faint, are you aware that you are about to faint? Do you actually lose consciousness or are you aware of your surroundings and people talking? Do you actually fall to the ground? When you feel faint, are you able to steady yourself against the wall or an object? Do you sometimes feel faint when you get up from a chair or out of a hot bath? Do you often experience dizzy spells? Do you ever feel that the room is spinning around or that you are falling to one side? Do you feel wobbly on your feet? When you are dizzy, do you notice any ringing in your ear? Dialogue D: P: D: P: D: P: D: P: D: P: D: P: D: P: D: P: Do you ever suffer from dizziness? Yes, quite often. When does this happen? When I get up too quickly. Do you feel as if you are falling in a certain direction? No, not really. Does the dizziness feel like spinning or is it just a kind of unsteadiness? It feels more like spinning. How would you describe it? Is it as if the room is going around or do you feel as if it is you that is going around? It feels as if I am going around. Do you have any other problems such as ringing in the ears perhaps? Yes, sometimes. Have you seen a consultant about this? Yes, she prescribed some medication for it, but it did not help at all. Do you have any associated symptoms like blurred vision? Not that I have noticed.

Exercise 5 Listening
Listen to the dialogue and write the case history of this woman.

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Exercise 6 Reading
Read this passage, paying special attention to these topics: The causes of fainting The symptoms of fainting How you can help someone who has fainted Fainting Fainting is caused by an insufficient supply of blood to the brain. Some people will faint if they are hungry, tired or forced to stand for a long time. Blood loss and pain after an accident often results in fainting. Before he faints, the victim experiences dizziness, and his skin is pale and sweaty. The pulse becomes weak and the breathing shallow. Then he loses consciousness. If he does not realise that he is going to faint he will fall, and may injure himself. The victim is helped by pushing his head forward between his knees, so that more blood flows to the head. He should not try to stand up as soon as he recovers consciousness, because the fainting may be caused by some serious injury. Now answer these questions: 1 2 3 4 What causes fainting? What symptoms does fainting cause? How can you help someone who has fainted? Should the victim get up as soon as he has recovered consciousness? State why or why not.

Say whether these statements are true or false. Correct the false statements. a) If you push someone's head forward between his knees, more blood will flow to his head. b) Fainting is never a sign of anything very serious. c) If a person is going to faint, he will look pale and feel dizzy. d) Fainting may occur as a result of hunger, pain or tiredness. e) An excessive supply of blood to the brain leads to fainting.

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Exercise 7

Listening and writing

Read the next three dialogues and try to complete them. Then listen to them for correcting. 1. MAN, AGED 52 Man with boil on the neck. Doctor: How long have you had this ...........? Patient: ........ five days. After examining the boil: Doctor: This needs an incision to let out the ........ . For this we'd like to give you an ...................... so there won't be any pain. When did you have food and ..........last? Patient: Yesterday. Doctor: Are you sure you had nothing ...................? Patient: Only a ....... of tea for ................... . Doctor: ...................... was that? Patient: Three ............. ago. Doctor: Well, you'll have to wait an ........... then as we can't give you an anaesthetic until four hours after you've eaten or ............ . Are you quite healthy otherwise? Patient: ......... . Doctor: Right. We'll attend to you in an hour's ............ .

2. MAN, AGED 28 Doctor: Patient: Doctor: Patient: Doctor: Patient: Doctor: Where's your injury? Here, my ankle. ............ did it happen? I tripped over on the pavement and .............. it. It's swollen and .............. . ............ did it happen? This morning. I'd like you to have an ............. and after you've had it, come back to me.

After examining the X-ray Doctor: Well, there's nothing broken. It's just a ............ . Nurse will put on a supporting .................... . Do exercises and have contrasting ............. . Put your .......... in hot and cold water alternately three or four ............ a day. The pain and ........ should go but if it doesn't settle down (1), come and ........ us again. (1) settle down: get better

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3. MAN, AGED 78 Doctor: Patient: Doctor: Patient: Doctor: Patient: Doctor: Patient: Doctor: Patient: Where is your ............? ...... ankle and ...... leg. What .................? I was standing on a chair and I slipped off. When did this ...............? Four weeks ........ . I've been trying to ............ myself. ........ this happen at home? Yes. ........ you under a doctor? Yes.

After examining the patient. Doctor: I want you to keep this up at home above the .......... of your seat. You can ... to the toilet but then keep your ........ up again. Have you someone to look after you? No. I'm all ............. . Well, we'll get you a home .......... . I feel better walking than ................ . Yes but this won't heal up if you don't get rid of some of this .................... of your ankle. When you've had your leg ............., don't go until you've seen the social ................... .

Patient: Doctor: Patient: Doctor:

Exercise 8

Speaking

Read the passage about fracture, dislocation and sprain in the Appendix. Spot the main differences between them and retell in the class. Outline the first care plan of them. Make a skeleton of your talk like this: Musculoskeletal emergencies are usually of three types: ........................ ........................ ........................ FRACTURES: ..................................................................................... Types of fractures: ................................, ............................................, ................................, ............................................, ................................, ............................................ Signs and symptoms of fractures: 1. ...................... 2. .......................... 3. .............................................. 4. .......................... 5. .............................................. 6. .......................... DISLOCATIONS: ................................................................................ Signs and symptoms of dislocations: 1. ....................... 2. ...................... 3. .................................................. 4. ................................................. 5. .................................................. 6. ................................................. SPRAINS: ............................................................................................ Signs and symptoms of sprains: 1. .......... 2. ................ 3. ..................... FRACTURES, DISLOCATIONS AND SPRAINS: FIRST CARE PLAN

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Exercise 9

Reading

The doctor and the law

Pre-reading In what ways does a doctor become involved with the law? With your partner, make a list of common examples mentioned in the chapter. While you are reading the chapter, make brief notes on the author's examples. All doctors occasionally become involved with the law. An obvious example is when a patient dies. The doctor writes a death certificate to confirm that the patient is indeed dead, and to state of which disease he died. The death certificate is a legal document. It is a criminal offence to write a death certificate without seeing the dead body. If the body is to be cremated, the doctor must also sign a certificate which says that the patient died of natural causes. (Burning the body will destroy the evidence of a suspicious death.) If the doctor suspects that the patient was poisoned by his relatives, for example, he must not sign the cremation certificate. A coroner is a doctor who is also a lawyer. He investigates any death where the cause is not obvious. For example, if a student is found dead in his bed by his friends one morning, the coroner must perform a post mortem examination to find out why the young man died. He might have taken an overdose of drugs, either accidentally or in order to commit suicide. However, the post mortem examination might show that he died from a brain haemorrhage. If a young baby dies after falling out of his cot, the coroner must perform a post mortem examination to confirm that the injuries are "consistent with the story." If the baby was murdered, the coroner might find evidence of previous violence, such as healed fractures or old bruises. Doctors and social workers are discovering more and more cases of violence towards children ("non-accidental injury"). The parents often love their children but they may be mentally disturbed themselves. The husband beats his wife, and the wife then becomes violent towards the children. The parents may bring the child to the doctor for a different problem (such as a minor infection). When the doctor examines the child, he sees bruises or burns on the child's skin. The doctor has a legal and a moral duty to help the child, but he must first confirm his suspicions. Not all bruises are caused by deliberate violence. The parents are innocent until proved guilty. The doctor must not accuse them of injuring the child. Often, the best action is to send the child into a hospital for a "general check-up," where a specialist can examine him and perform Xrays. If the doctor suspects non-accidental injury, he must give medical evidence to the courts. The doctor is then called an expert witness. Sometimes, it appears that parents are injuring their child when they are not. If a child has haemophilia (a disease where he bruises and bleeds easily), brittle bones (which are more likely to break), or a skin disease which looks like severe burns, the child's school teacher may suspect nonaccidental injury. The child's doctor, as an expert witness in court, could explain the medical reasons for the apparent "injuries." Occasionally, social workers have taken children away from their parents unnecessarily because they did not know about an unusual medical condition. Of course, this has led to dramatic stories in the newspapers. However, these medical conditions are very rare, and non-accidental injury is common. If the doctor confirms the diagnosis of non-accidental injury, the courts may decide that

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the parents are not fit to look after the child. The legal methods for protecting children from non-accidental injury are different in different countries. In Britain, the child often goes to live with foster parents. Doctors sometimes appear in court as expert witnesses in compensation claims. One person claims that another person has caused him injury, and seeks compensation for his pain and suffering. This often occurs after road accidents. For example, the doctor might confirm that the patient was healthy until the accident and then developed neck pain and depression. Another role for the doctor after road accidents is to measure the amount of alcohol in the driver's urine or blood. This test is simple and does not usually need an expert witness in court. But occasionally, a person may be involved in a road accident and then drink a large amount of alcohol. If the doctor takes four or five blood tests over several hours, he usually can calculate whether the accused person drank the alcohol before or after the time of the accident. Employees sometimes make compensation claims against their employers. An employer has a legal duty to provide a safe working environment. Work-related injuries range from back strain caused by lifting loads which are too heavy to severe lung disease from working in coal mines. Compensation claims by employees can involve large amounts of money, especially if an employee is permanently disabled and the court confirms that the employer was to blame. Some employees might be tempted to exaggerate their disability. The doctor must be aware of this temptation. In some cases, he can measure the disability objectively. For example, he can assess lung damage very accurately with a spirometer. In other cases, such as back pain, it is impossible to measure how much pain and disability the patient really has. The doctor must use his clinical judgement. In the past, another legal duty of the doctor was the testing of a woman's virginity before marriage. Virginity testing is still common in some countries, particularly where Islam is the dominant religion. However, changing views about sexual standards and women's rights have made the test obsolete in most countries. Doctors are now seldom asked whether a woman has had sexual intercourse. But they are often asked to find out whom she has had intercourse with. This may happen, for example, when a woman claims that a man has raped her, or when she says that a particular man is the father of her child. In most modern countries, fathers have a legal duty to pay money for their children's upkeep. If a man doubts that he is the father, he might ask a doctor to help him to prove this. Absolute proof of paternity is not yet possible, but scientists can now estimate the probability that a man is (or is not) the father of a child. They use a genetic technique called DNA fingerprinting. The doctor takes blood samples from the child, the mother, and the man who might be the father. He first analyses the mothers chromosomes using restriction enzymes which split the chromosomes into small fragments. These fragments form a specific pattern when they are placed in an electric field. He then analyses the child's chromosomes in the same way. The child has inherited two copies of each chromosome - one from his mother and one from his father. The chromosomes inherited from the mother will split into fragments with the same pattern as the mother's chromosomes. The remaining chromosomes must have been inherited from the father. If the accused man's chromosomes have a completely different pattern from these remaining chromosomes, he is not the child's father. DNA fingerprinting is becoming an important tool in forensic medicine. Like all powerful tools, it must be used carefully. For example, DNA fingerprinting of a man accused of rape and of the semen obtained from the "victim" might prove that he had sex with the woman, but does not prove that he raped her. The doctors and lawyers must

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use conventional medical and legal methods to find whether the woman consented to sex. DNA fingerprinting is very accurate on fresh specimens, but it becomes inaccurate if the specimens are more than twenty-four hours old, or if they are contaminated. The identification of a criminal from a fragment of dirty skin found at the scene of a crime which was committed two weeks ago is not yet possible. Most doctors do not like appearing in court. A court hearing often takes several days or weeks, and the doctor cannot attend to his other patients during this time. It may involve an unpleasant confrontation between two people, which the doctor does not wish to see. The doctor's legal duty to provide evidence is sometimes in conflict with his professional duty to care for the patient. But whether doctors like it or not, today's society is increasingly "litigation-conscious," and doctors will undoubtedly spend even more of their time in the role of expert witness in the future.

Exercise 10

Listening and writing

Listen to the following dialogue, then complete the Letter to GP from Consultant. Letter to GP from Consultant Chest Hospital Newbridge 20 March 1995

Dr Robert Walker 4 St Bedes Road Newbridge

Dear Dr Walker Samuel Lister (M) 2 7 1943, 32 Park Terrace Newbridge Yes, I agree with you that the patient's trouble is ................... .......................... with airway obstruction. His peak expiratory flow rate is not as .......... as I thought it would be, 245, but of course it is grossly ................... . The chest X-ray film shows minimal ............. change which, in my opinion, is not sufficient to qualify him as a case of ........ ........................... . There is, of course, no objection to his putting in a ............... . Mr Lister can expect slow ................................ in his breathing as long as he continues ...................... . It may help him to clear his chest in the morning if he has a .................... ......................... . I have explained to him the correct dose is .......... .............., repeated if necessary, and then no more for at least ........... ............... . Please let us know if you would like him to be seen again in the future. Yours sincerely John Hamilton Consultant Physician

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7 Taking of History
1 Past Medical History
Exercise 1
Tick the questions concerning the patient's personal past medical history during the first visit to the doctor's surgery. a) b) c) d) e) f) g) h) Have you ever been in hospital? Did you have any childhood diseases? Do you ever see double? Are your parents still alive? Have you ever had an operation? Are you currently taking any medicine? Do you have any problems with your teeth? What kind of treatment did you receive?

Exercise 2
Read or listen to this dialogue. D: I'd like to ask you about your past medical history. Can you tell me whether you have had any childhood diseases, for example, chicken pox, measles, mumps or German measles? P: When I was small, I had measles, chicken pox and whooping cough, but I don't think I ever had German measles. D: Have you ever been in hospital for anything, or have you ever had an operation? P: Well, I had my tonsils out when I was a child. D: Have you had any major health problems since then? P: Yes, I have diabetes. D: When were you first told that you had diabetes? What were your symptoms? P: After I was fourteen I was always thirsty, tired and depressed. D: Are you receiving any treatment for your diabetes? P: I've been having insulin ever since. D: Are you up-to-date with all your immunisations? P: Yes. D: Good. Let me have a look at the letter from your GP.

Exercise 3
Fill in the gaps with the words and phrases listed. symptoms, permanent health problem, hospitalised, up-to-date, childhood diseases a) b) c) d) e) Have you ever had any ........................ like measles or chicken pox? Have you ever been ................................for more than a week? Do you have a ..................................... such as diabetes or high blood pressure? Are you .................................. with your immunisations? What were the first ........................... of your overactive thyroid?
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Exercise 4
Read the following phrases and formulate questions to your patient. a) b) c) d) e) f) childhood diseases ..................................................................................................... major health problems .............................................................................................. admission to hospital ................................................................................................ surgery ..................................................................................................................... treatment .................................................................................................................. immunisation ............................................................................................................

2 Family History
Exercise 1
This is a pre-listening task. Read the following questions and choose the one from each pair which you consider more polite. a) A Is there anybody who is crazy in your family? B Is anybody suffering from mental disease in your family? b) A At what age did your father die? B How old was your dad when he popped off? c) A Are there any medical problems with your kids? B Is there anything wrong with your childrens health?

d) A And your aunt who has diabetes, is she still so fat? B And your aunt with diabetes, is she still so fat?

Exercise 2
Now read or listen to this dialogue. D: As far as you know, are there any illnesses that run in your family? P: Not that I know of, Doctor. D: Nothing like diabetes, high blood pressure, or heart disease, strokes, cancers, mental illness or anything like that? P: Oh, I see! My father died of a heart attack, and I have two aunts who have diabetes. D: How old was your father when he died? P: He was 68. D: What did he die of? P: He had a heart attack. D: Was he ill for a long time with his heart before he died? P: Oh no; it was very sudden. D: And your aunts? Do you know what kind of diabetes they have? Do they have to take insulin or tablets, or are they just on a diet? P: They just take some pills, I think. D: You are married, I see. Have you any children? P: Yes, a boy and a girl. D: Are they healthy? P: Yes, they are.
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Exercise 3
Look at these questions and choose the correct response the patient would give. 1 Do you have a family? family? 3 How did your father die? 1 a) Yes, three times to Greece. b) I'm married with two children. c) No, we have an apartment. 3 a) He was 55 years old. b) He visited the hospital. c) He died of old age. 2 Are there any illnesses that run in the 4 How is your aunt's health? 2 a) Yes, diabetes and heart problems. b) Yes, chicken pox and measles. c) Yes, pneumonia and a bad cough. 4 a) She is 60 years old. b) She has broken her leg. c) She has trouble with her heart.

3 Patients Social History

Exercise 1
The following questions are necessary to find out a patient's social history. Find the answers to the questions. a) Are you employed? b) 1 Yes, a couple of bottles of beer a day. 2 I smoke three packs of cigarette and Is it an office job or are you sometimes a pipe. on your feet all day? 3 Yes, I have a quite stressful job. 4 I live in a damp basement apartment. It is How much do you smoke a day? usually quite cold. 5 I usually had to sit at my desk all day. Do you ever drink alcohol? 6 I live in a house in the countryside. 7 I'm a sales clerk so I have to stand on my feet What are your living conditions all day. like? 8 I just lost my job last week. 9 Some wine with my friends at weekends. 10 I don't smoke because it bothers my eyes.

c) d) e)

Exercise 2
Read or listen to the following dialogue.
D: Do you have a job at the moment? P: No, Ive just been made redundant. D: Oh, Im sorry; what was your job? P: I was a civil servant in Customs and Excise. D: I see. Was it an office job or were you on your feet all day? P: No, I was desk-bound, Im afraid. D: Was it managerial - did you have a lot of responsibility? P: Yes. I was in charge of a large department. D: I see, quite stressful. Now, tell me, do you smoke? P: Yes, unfortunately, quite a bit.

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D: P: D: P: D: P: D: P: D: P:

Oh, really, how much? Oh, about forty a day. How long have you been smoking? Since I was about fourteen. Have you ever tried to give up smoking? Yes, Ive tried to give it up several times, but without success. What about drinking? Do you drink? Yes, sometimes with my friends. How much alcohol do you drink a day? Lets see... a couple of pints in the pub at lunch time, a whisky in the evening and about half a bottle of wine with our meal. D: Thats quite a bit. How old were you when you started drinking? P: Oh, when I was about 17 or 18, I suppose. D: What sort of house do you live in? P: We live in a small flat; its our own but we are still paying the mortgage on it, of course.

Exercise 3
Here are some statements from patients. Choose the question the doctor may have asked to elicit the patient's responses. 1 2 3 4 I'm a maths teacher at a boys' school. Yes, this is my first term teaching and I am still quite nervous. I've been trying to give up smoking cigarettes since last December. Every morning when I get up I need a stimulant, you know, a drink to get me through the day.

1 a) How long have you been unemployed? 2 a) Where do you work? b) Do you have any children? b) Is your job stressful? c) Are you working right now? c) Are your work conditions safe? 3 a) Do you smoke a pipe or cigarettes? 4 a) Do you only drink at night or do you start in the morning? b) How long have you been smoking? b) Do you ever feel guilty about your drinking of alcohol? c) Have you ever tried to stop smoking? c) Have you ever tried cutting down your drinking?

4 History of Present Complaints

Exercise 1
You will see eight questions below but only five are relevant to find out a patients present complaints. Find the three odd ones out, then listen and repeat the questions. a) b) c) d) Whats the problem today? Can you tell me what your symptoms are? Was your mother also allergic to cats? Have you ever had these complaints before?

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e) f) g) h)

What seems to bring this condition on? Are you married or single? When did you start to feel poorly? Does anyone else in the family have the same problem at the moment?

Exercise 2
Now read or listen to this dialogue. D: P: D: P: D: P: D: P: D: P: D: P: What seems to be the problem at the moment? Well, Ive been feeling poorly. I see. Feeling poorly. What do you mean by that? Ive been getting very short of breath. Hm How long has this been going on? For about 18 months, I think. And were there any symptoms before then or did it start quite suddenly? I hadnt noticed anything before then. So you hadnt had any of these symptoms before? No, not that I can remember, doctor. I see. Was there anything that seemed to cause them? Well, nothing, really. Except maybe it gets really bad when I go up to London to see my sister. D: Lets take a look. Ill listen to your heart and lungs to begin with.

Exercise 3
Decide whether the following statements are true or false. a) b) c) d) e) The patient was short of breath, for the first time, a year and a half ago. He has had the same complaints on and off since he was a child. He knows the cause of his illness, and wants some tablets for it. His condition improves whenever he goes to see his sister in London. The doctor thinks that something might be wrong with the patients respiratory and circulatory systems.

Exercise 4
The following questions are useful when asking a patient about his present condition. Match the questions. Then listen and repeat them.

1 2 3 4 5

What can I do for you today? What do you mean by that? What are your symptoms? Did it start suddenly? What brings it on?

A B C D E

Can you describe the changes that have occurred? What do you think causes your condition? Did your condition change without any warning? Can you describe that in more detail? How can I help you, Mr Brown?

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Exercise 5
It is vital for ambulance men to understand exactly what kind of pain the patient experiences. There are a large number of words describing pain in English and this unit tries to introduce most of them. /You can find some more in the Appendix./ Below are questions which are asked concerning pain in particular areas. Study the different words and phrases used and indicate the one in each section which is inaccurate. HEAD Do you have a/an ............. headache? splitting throbbing band like dull aching burning sharp stabbing colicky migraine stress induced tension LOWER BACK Is the pain in your back ............? slow in onset long in duration dull diffused aching steady/constant severe progressing poorly localised crushing deep mild EXTREMITIES Do you have a/an ......... pain in your shoulder/ hand/foot? sharp tingling aching shooting dull burning severe pulsating throbbing Do you have ....... in your arms? weakness numbness tension KIDNEY AND URINARY TRACT Do you have a ........... pain/ache/discomfort? sharp dull severe burning stinging nagging splitting flank back abdominal dull steady low grade Do you have a vague discomfort?

CHEST Is the pain in your chest ............? burning constricting bursting choking squeezing gripping pressing crushing sticking jabbing sharp sensitive knife-like fleeting throbbing dull severe like a weight on it like a band across it

ABDOMEN Do you feel any/a ........... pain in your abdomen? sharp dull aching gnawing burning cramping colicky diffused localised recurrent constant lank intermittent Do you get/feel .........? bloated Do you have any ........? heartburn indigestion

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8 Respiration, the Cough and Sputum

Respiration Changes in the rate and type of respiration are one of the principal symptoms of disorders of the respiratory system. They are also symptoms of diseases affecting other parts of the body. Respiratory disturbances can be seen in cardiac disease, cerebral depression, uraemia and diabetic coma. When observing a patient, the rate and depth, and the ease or difficulty of breathing are noted. It is also important to observe whether breathing is noisy or quiet. The following are some of the terms commonly used to describe the different types of respiration: Apnoea a period during which breathing is absent Dyspnoea difficult breathing Orthopnoea the patient can breathe comfortably only when sitting or standing erect Hyperpnoea breathing of increased rate and depth Shallow breathing seen when chest movements are painful Stertorous breathing noisy, snoring breathing

The cough Coughing is a reflex action which occurs when the respiratory passages are irritated. Coughing expels irritants such as excess sputum and foreign bodies from the respiratory tract. A cough is known as non-productive when no sputum is expectorated, and when sputum is expectorated, the cough is known as productive.

Sputum The following terms are used to describe various types of sputum: Mucoid sputum is clear, tenacious mucus which is produced in the early stages of respiratory tract infection. Mucopurulent sputum is a mixture of mucus and pus which is produced in the later stages of respiratory tract infection. Purulent sputum consists mainly of pus, and is seen in cases of bronchiectasis and lung abscess. Rust-coloured sputum is tenacious and contains altered blood. It occurs in cases of lobar pneumonia. Haemoptysis is the term used to describe the coughing up of bright red, frothy blood from the lungs. It is seen in cases of pulmonary tuberculosis, carcinoma of the lung and bronchiectasis.

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Interview
A patient with chest trouble and a high temperature has come to the casualty and emergency department of a hospital. Here is a part of the interview between the patient and a doctor Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Good afternoon, Mrs Taylor. Im Doctor Martin. Now, youre having some trouble with your chest, arent you? Yes, doctor, I am. Ive got a terrible cough and a pain down here in my chest. How long have you had the cough? Oh, it started about a month ago a nasty tight cough then it seemed to go away. Then, about a week ago, it came back again. Are you bringing anything up when you cough? Yes. The last couple of days Ive been bringing up sticky, reddish-brown phlegm. Next time you bring something up, Id like you to spit it into this mug, please. O.K. Do you smoke much? No not really. Fifteen to twenty a day. Have you ever coughed up any blood? No, never. Have you had a temperature? Well, Ive been feeling feverish for two or three days. I took my temperature this morning just before I came hereand it was 103. Oh, I feel awful!

Check your vocabulary

respiration cough. sputum rate.. type.. principal. disorder.. disease. affect. respiratory... disturbance.. to be seen. cardiac. cerebral depression uraemia diabetic coma.. observe. depth. ease... difficulty... noisy.. quiet.. absent comfortably. erect.. increased.. movement. painful.. snoring. action occur. passages... irritated expel. irritant.. excess foreign body tract.. non-productive productive expectorate.. clear.. tenacious.. early stage... infection mixture. consist of. pus bronchiectasis .. lung abscess altered.. lobar pneumonia ... frothy pulmonary tuberculosis .. carcinoma of the lung ... chest trouble trouble with ones chest .. a tight cough.. a loose cough. nasty. to bring something up ... to cough up.. phlegm.. feverish.

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Exercise 1 Practise these sentences

Are you having chest trouble?/Are you having trouble with your chest? Have you had a cough? How long have you had the cough? Did anything special bring it on? What kind of cough is it?/Is it a tight cough?/Is it a loose cough? When do you get it? Does any position make it worse? Are you bringing anything up when you cough? Do you bring anything up?/Do you bring up any phlegm? How much do you bring up?/When do you bring it up? Id like you to spit it into this mug, please. What colour is it?/Have you noticed any blood? Is it frothy, watery, etc? Have you ever coughed up any blood?/Is there a lot of blood or just streaky with blood? Do you get a pain in your chest when you cough? Do you smoke much? Have you had a temperature? Im having chest trouble./Im having trouble with my chest. Ive got a terrible cough./Ive got a nasty, tight cough./Ive got a loose cough. Ive been bringing up sticky, reddish-brown phlegm. Ive been feeling feverish for two or three days. I took my temperature this morning. I feel awful!

Exercise 2 Vocabulary work. Complete the sentences according to the text .

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 We can say main or most important or p Another word for disease, condition, something wrong is d.. We can say cough up or e.. Instead of saying distance from top to bottom, we can say d.. We can say standing or sitting or pointing up or e Another word for too much is e We can say throw out or e Instead of saying an unwanted substance or object, we can say a f b. Instead of saying holding on, adhesive, sticky, we can say t. We can say made up of many small bubbles or f We can say a collection of pus somewhere in the body or an .. Instead of saying of the lungs, we can say p.. Sputum consisting of mucus and pus is known as sputum. Breathing of increased rate and depth is known as . A tight cough is one that produces no sputum: it is also known as a. cough. Absence of breathing is known as

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17 is the term used to describe the coughing up of blood from the lungs. 18 breathing is noisy, snoring breathing. 19 A productive cough is one which produces sputum: it is also known as cough. 20 .. sputum is clear, tenacious mucus.

Exercise 3 Learn these expressions, questions and complete the dialogues BREATHING
Medical words: respiration, expiration, inspiration. Colloquial words: breathing, breathing out, breathing in. Useful questions Have you had any difficulty with your breathing? Do you get short of breath? Do you get short of breath when you run for a bus or climb stairs? Do you get any pain on breathing? Take a deep breath, hold your breath and then breathe out slowly. Descriptive words Breathless; deep; jerky; laboured; noisy; out of breath; puffed; quick; quiet; rapid; regular/irregular; shallow; shortness of breath; troubled; weak; wheezing. Listen and fill in the dialogue. Practise it with your partner. /D - doctor, P - patient/ Dialogue 1 D: P: D: P: D: P: D: P: D: P: D: P: D: P: D: ........................................... difficulty breathing? Since last week, doctor. Is it very .........? Yes, I ...................... I can't get enough air. Which is more difficult, ..................... or ....................? It's harder to breathe in. Are you ...................... when you are resting or only when you are doing something? When I'm resting, but it's .............. when I try to do anything. Can you lie ....... in bed? Oh, no. ...................... pillows do you use? Three. Do you ever ..................... at night feeling short of breath? Yes, I do; it frightens me because I wake up feeling as if I .......................... . What ......................... when it happens? I mean, do you sit or stand up, does some movement help? P: If I ................, it helps a little. D: Let me listen to .................... I can hear a few crackles and it ............ a bit wheezy.

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COUGH
Descriptive words: Tone: barking; brassy; hacking; hawking (catarrhal and chronic sinusitis); husky; stridulous; wheezing (bronchitis). Character: dry/productive; explosive/suppressed; postural/not postural; spasmodic/persistent.

SPUTUM
Descriptive words Colour: black-grey; blood-stained; brown; dark red; flecked; green; pinkish; prune juice-like; raspberry-like; rusty-brown (pneumonia); streaked; yellow. Quality: clear; frothy; glassy; jelly-like; opaque; presence of cyst, bile, pellets, etc.; sticky; thick; thin; transparent. Odour: foetid; nauseating; putrid. Read the following dialogue. Can you write in the doctor's questions? Listen and check. Dialogue 2 D: P: D: P: D: P: D: P: D: P: D: P: D: P: D: P: D: P: .................................................? I have a cough but I also seem to wheeze a lot. ....................................................................................................? I've had it for some time, doctor. .........................................................? Yes, a lot. ................................................................................? I bring up quite a bit of phlegm. I'm afraid I have got asthma. ...........................................? What do you mean? ....................................................., what colour it is; is it white, yellow or greenish; and is it frothy or sticky? Yes, it's yellowish and feels kind of like jelly. ..................................................................? No, I don't think so. ...........................................................? Yes, just once I noticed some blood in it. ..............................................................................? Yes, I was on something to thin my blood.

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Exercise 4 Read the following case histories, then choose one and make the dialogue between the doctor and the patient.
Case history 1 The patient, who was aged 54, lived with his father and younger brother. Their mother had died at the age of 48 of bleeding from a gastric carcinoma. The patient was brought to the casualty department by his father, who said he was fed up because the son was refusing to help with the family scrap metal business, and had retired to his bed for the last 2 weeks. The only symptom that the patient would volunteer was lassitude. On direct questioning he admitted that he was short of breath after four or five stairs, that his feet were numb and tingling, and that he was unsteady when he walked, particularly in the dark. He did not smoke, and drank beer at the weekends only. His diet was good and varied, thanks to the family allotment. He was taking no drugs, and there were no symptoms whatever relevant to his gut. On examination, the patient was very pale, and grey-haired. His skin was slightly yellow. There was a systolic murmur at the base of heart, and the liver was enlarged by 3 cm, smooth and slightly tender. Vibration and joint position sensation were completely lost in both feet, and the loss of vibration sensation extended to the pelvis. Knee jerks were diminished and ankle jerks were absent, but the plantar responses were upgoing. Case history 2 A 58-year-old Irishman who smokes 40 cigarettes a day gives a history of a chronic cough for many years. In winter he brings up purulent sputum which is occasionally bloodstained, and he has episodic fever and ill health. Prior to the present admission, he has lost weight and his breathing has become more difficult. On examination he has a pyrexia of 39.5C, is centrally cyanosed and finger clubbing is noted. He is breathless at rest. Chest expansion is poor; the percussion note impaired in the right axilla and breath sounds, although faint, are vesicular. Crepitations are audible in the right mid zone posteriorly and in the right axilla. Scattered rhonchi are audible. Sputum is sent for 'culture and sensitivity' and the report is 'a mixed growth of organisms'. The chest X-ray shows an opacity in the apical segment of the right lower lobe. Case history 3 A 28-year-old man complained of painful, tender swellings on his shins. Two weeks previously he had had a sore throat associated with 'flu-like' symptoms and had been given penicillin by his family doctor. On further questioning he admitted to having lost 4 kg in weight during the past 3 months. In addition, he had a cough productive of little sputum and had, on two occasions, coughed up a small amount of blood. On examination, the only abnormal physical signs were the presence of several 1-3 cm diameter, raised, red, tender lumps on the anterior surface of both legs.

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9 Vomitus
When a patient is sick, the contents of the stomach are ejected through the mouth. These ejected stomach contents are correctly known as vomitus. Vomitus usually consists of partially digested food, but may consist of bile, blood or a foul-smelling, brown fluid. Vomiting, or emesis, is one of the principal symptoms of disorders of the digestive system but it is also a symptom of many other illnesses. When vomiting is a symptom, the consistency of the vomitus and the frequency of vomiting are noted. The patient is asked whether nausea precedes vomiting, if pain is present and whether it is relieved by vomiting. It is also important to ascertain whether vomiting occurs in connection with the taking of food and, if it does, whether it occurs immediately after or some time after a meal. Interview A nurse who is taking t.p.rs has a chat with Mr Smith Patient Nurse Patient Nurse Patient Nurse Patient Nurse Patient Nurse Patient Nurse Patient Nurse Patient Nurse Patient Nurse Patient Hello, nurse. Hello, Mr Brown, how are you feeling this morning? Not too bad, thanks, but I am feeling a bit queasy. Have you been sick? Not this morning, but I was sick as a dog just after you went off duty yesterday afternoon. Oh? After youd had your tea? No. Before tea. All of a sudden I was violently sick. Did you have nausea before you were sick? Pardon? Did you feel queasy before you were sick? No. It came on suddenly. Did you have any pain? No. None at all. I was feeling fine. Then I was sick. Then I felt fine again. But youre feeling a bit queasy now? Well, Im not really sure, perhaps Im imagining it. Its nothing to worry about. Well tell Dr Mayor when he does his round and see what he says. I suppose it could be the chocolates. Chocolates? Well, I had visitors yesterday afternoon. They brought me a box of Black Magic. I was a bit lonely when my visitors went theres one chocolate left would you like it?

Vocabulary
vomitus. be sick... feel sick. bring up food.. content.. eject.. partially digested food bile. foul-smelling fluid emesis principal digestive system consistency.. frequency. nausea.. precede. present.. relieve...
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ascertain.. in connection with immediately

meal. queasy.. as sick as a dog..

all of a sudden to come on to go off

Exercise 1 Answer these questions

1 2 3 4 5 6 7 8 What are ejected through the mouth when a patient is sick? What are the ejected contents of the stomach correctly known as? What does vomitus usually consist of? What may vomitus consist of? What is vomiting one of the principal symptoms of? What details are noted when a patient is sick? What is the patient asked? What is also important to ascertain?

Exercise 2 Practise these sentences. Make up a dialogue between a doctor and a patient.
How are you feeling this morning? Have you been sick? Did you have nausea before you were sick? Did you feel queasy before you were sick? Did you have any pain? How long have you been sick? Do you feel better after being sick/after vomiting? How often do you vomit? How much do you vomit? What colour is the vomit? Have you noticed any coffee grounds, bile, blood in your vomit? When do you vomit? Is it related to eating? Do you feel sick before you vomit or does it just happen? Do you retch? Not too bad, thanks. Im feeling a bit queasy. I was as sick as a dog (cat) yesterday afternoon. All of a sudden I was violently sick. It came on suddenly. It went off suddenly. Perhaps Im imagining it. Its nothing to worry about. Well tell Dr Higgins and well see what he says. Descriptive words Colour: black; blood; coffee-grounds; green. Character: copious; frothy; residues of food; sour-smelling; watery fluid.

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Exercise 3
Fill in the following dialogue. Then listen and check. (Internal Med. 1/9) D: P: D: P: D: P: D: P: D: P: D: P: D: P: D: P: D: P: ? Oh, I vomit, it seems all the time. ? About two months ago. ? About once a day, sometimes more. ? Well, it isnt really regular. ? Worse, I think. ..? Oh, its usually more like bile. ? ? It seems to be a sort of yellowish green colour. .? No, never. .? Well, yes, doctor. I do belch a lot and I seem to suffer from a lot of wind just lately.

Exercise 4
Read the following statements after listening to the dialogue. Choose the correct statement from each pair below. 1 A He feels only nauseous. B He vomited as well. A It started two month ago. B It started two weeks ago. A Its worse after eating. B Its not related to meals. A He brings up something more like bile. B He brings up undigested food. 5 A It seems to be red. B It seems to be a yellowish green colour. A Sometimes it looks like ground coffee. B It never looks like coffee grounds. A He rarely belches. B He belches a lot.

2 3

6 7

Exercise 5
Vocabulary work. Most of the expressions below are relevant to the topic of nausea and vomiting. There are three which are not. Tick these three. difficult to keep anything down spurt out in a stream spread to the shoulders looks like ground coffee my mother had migraines few spots of red blood bring up feel sick throw up projectile burp belch undigested food varicose veins feeling queasy keep retching little clots of blood feel nauseous
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10 Faeces
In the adult, normal faeces are brown, semi-solid and have a characteristic odour. Faeces consist of indigestible or undigested food, altered bile pigments, water, mucus, cells from the intestinal tract, and bacteria. When observing faeces, the following points are noted: the frequency of defaecation and whether flatus is passed, the colour and consistency of the stools, and the presence of any abnormal substances or objects. Fresh blood in a stool is usually due to bleeding in the lower bowel. Altered blood in the stool is due to bleeding in the stomach or small intestine and produces dark, tarry stool - melaena. The absence of bile pigments and the presence of large amounts of fat produce stools that are putty-coloured and extremely offensive. Constipation is a condition in which the passing of stools is difficult and infrequent. Diarrhoea is a condition in which frequent loose or liquid stools are passed.

Stomach trouble Mr Smith has a history of stomach trouble. He has an appointment at a medical out-patients clinic at 15.30 on Tuesday, August 3rd . He arrives on time, and after a few minutes, the doctor is ready to see him. Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Good afternoon. Mr Smith, isnt it? Yes. Good afternoon, doctor. Sit down, please. Now, let me see, youve been having trouble with your stomach, havent you? Yes. I have this pain, and my stools are all black and tarry. How long have you had the pain? Oh, for about three years. But its been getting much worse since the beginning of June. Do you have it all the time? No, it comes on about an hour to an hour and a half after Ive had a meal. Does it last long? No. I usually have a biscuit and a glass of milk, and then it goes off. Have you ever vomited any blood? Never. Have you been feeling weak or tired or cold? Well, I have been feeling a bit weak since I came home from my holidays. When was that? Two weeks ago. For how long have you been passing these tarry stools? Since last Friday. Are they loose? No, theyre not. Theyre all black and hard. How often do you have your bowels open? Once a day. I usually take a laxative. Well, thank you, Mr Smith. Now would you mind undressing? Id like to examine you.

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Exercise 1 Answer these questions

1 2 3 4 5 6 8 9 What are normal faeces like? What do faeces consist of? What are noted when observing faeces? What is fresh blood in the faeces due to? What is altered blood due to? What does the absence of bile pigments produce? What is constipation? What is diarrhoea?

Exercise 2 Practise these expressions and sentences BOWELS

Medical words: faeces, stools, to defaecate Colloquial words: motion, to have bowels opened, go to the toilet, to use a bedpan (hospital) Now, let me see. Youve been having trouble with your stomach, havent you? How long have you had the pain? Do you have it all the time? Does it last long? Have you ever vomited any blood? For how long have you been passing these tarry stools? Have you been feeling weak? When was that? How often do you have your bowels open/opened? Is this a life-long habit? What do the motions look like?/Are they quite well formed?/Are your stools loose? What about the colour? Has it changed?/Are they darker in colour? Have you ever seen any blood in your motions? Have you ever noticed an unpleasant smell? Do you ever have diarrhoea or constipation? Do you have to go in a hurry? Do you have to strain to pass your motions? (tenesmus) Do you take laxatives? Do the motions float on the water after flushing lavatory? Do you ever have any pain on passing your motions? Do you get the pain before, during or after passing your motions? Do you suffer from wind? Have you noticed any special food upsets your bowels? Have you lost any weight? Would you mind undressing?

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Exercise 3
Complete the following dialogue with the doctors possible questions. Then listen and check. D: ..? P: No. Sometimes I get constipated and sometimes I have diarrhoea. D: When you say you have diarrhoea, do you mean the stool is .. or that you ? P: I have to go four or five times a day. D: ..? P: Yes, I have real problems holding it. D: .? P: The last time it was loose and watery, but very dark. D: .? P: No, I havent noticed anything like that. D: .? P: Yes, I have noticed some blood but no mucus. D: ? P: It seems to be mixed in with the stool, doctor. D: I see. And when you are constipated, ..? P: If I cant go for three days, only the laxative helps. D: ..? P: Yes, occasionally, but the laxative helps with that too. D: ? P: No, not particularly.

Check your vocabulary

faeces adult.. semi-solid. characteristic.. odour indigestible.. undigested altered.. bile pigments... mucus cells... intestinal tract. bacterium. bacteria note frequency. defaecation.. flatus. pass... consistency.. stools. presence... abnormal substance object.. due to.. lower bowel small intestine produce dark.. tarry. melaena absence fat.. putty-coloured. extremely.. offensive... constipation. condition.. difficult. infrequent. diarrhoea. frequent loose. liquid appointment weak. tired.. hard.. have your bowels opened pass your motions.. strain. straining (tenesmus).. laxative. flush the lavatory wind.. upset your bowels.. lose weight.. go to the toilet. wipe yourself... feel bloated.. enema occasionally flatulence. belching particularly..

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Exercise 4 Listen to the dialogue in Exercise 3 again. Then correct the sentences below.
1 2 3 4 5 6 The patient has a regular bowel movement. . He has no problems going to the toilet. . It is difficult to flush the stools away. . He has noticed some mucus in his stool. .. He has noticed some blood on the surface of the stool. . Only enemas help him. ..

Exercise 5
Find the sentences which have a similar meaning to each sentence below. When you have completed the exercise, listen and repeat the questions. 1 2 3 4 5 6 a) b) c) d) e) f) Is it actually painful to have a bowel movement? Have you ever tried taking any laxatives that you can get in a chemist? Do you have wind moving around your bowels? Does your tummy ever feel distended? Do you pass wind? Do you have a tendency toward flatulence? Do you take anything for your bowels? Do you ever suffer from excessive wind? Do you break wind? Does it hurt when you open you bowels? Do you ever feel bloated when you are constipated? Do you feel gassy? (US)

Exercise 6 Do you remember the use of since and for? Look at these examples. Then complete the sentences below.
Its been getting much worse since the beginning of March. Ive been feeling a bit weak since I came home from my holidays. Ive been passing these tarry stools since last Saturday. Ive had the pain for about two years. Shes been waiting for three hours. Hes been in hospital for months. We use since when a definite point in time is mentioned. We use for when a length of time is mentioned.

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1 2 3 4 5 6 7 8 9 10

Ive coughed up blood several times I last saw the doctor. He hasnt had any trouble with his chest . 1988. Ive been waiting to see the physiotherapist . half an hour. Have you passed any tarry stools .. you last saw me? Hes been in theatre an hour. Shes been having stomach trouble . months. Theyve been waiting to see him .. 8.30. Shes been complaining of pain . the last three weeks. Hes had heart trouble . years. Ive had trouble with my breathing .. I had pneumonia.

Exercise 7 Look at these examples. Then change the sentences below in the same way.
a) He began studying orthopaedics in 1996. Hes been studying orthopaedics since 1996. She started working at this hospital last Monday. Shes been working at this hospital since last Monday. 1 2 3 4 5 6 7 It started hurting in the middle of February. .. He started coughing up blood last June. . I started passing tarry stools on Thursday. . The gynaecologist started operating at 9.30. .. She began smoking heavily at Christmas. .. He began vomiting blood this morning. . The pain started getting worse last Easter. . Hes been waiting for three hours. Ive been feeling ill for a month.

b) He began waiting three hours ago. I began feeling ill a month ago.

1 It started hurting about two weeks ago. 2 He began complaining about the pain a year ago. 3 I started attending the out-patients clinic three months ago. 4 He began bringing up phlegm four days ago. 5 He started feeling weak a fortnight ago. 6 It began raining half an hour ago. .... 7 She started taking laxatives six months ago. 8 They started living in Norway five years ago.

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REVISION
/UNITS 7-10/
Exercise 1
Fill in the dialogue. Then listen and check. Practise it with your partner. D: I'd like to ask you about your ................................... . Can you tell me ......... .................................................., for example, chicken pox, measles, mumps or German measles? P: When I was small, I had ............., ................... and whooping cough, but I don't think I ever had .......................... . D: ................................................ for anything, or have you ever ........................? P: Well, I had my tonsils out when I was a child. D: ........................................................................................... since then? P: Yes, I have diabetes. D: When were you first told that you had diabetes? ............................................? P: ..................................... I was always thirsty, tired and depressed. D: Are you receiving any treatment for your ......................? P: I've been having ................ ever since. D: ................................................ with all your immunisations? P: Yes. D: Good. Let me have a look at the ...................................... .

Exercise 2
Read the questions below then listen to both dialogues (Br and US) again and tick the correct answer. a) What does the patient tell the doctor about her childhood diseases? A She never had any of the childhood diseases the doctor listed. B She had rubella. C She had chicken pox and measles. b) Has the patient ever been in hospital? A Yes, once, when she had her tonsils out. B Yes, once; she had her appendix removed. C No, she has never had to stay in hospital. c) How old was she when she developed diabetes? A 44 B 14 C 40

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Exercise 3
Here are some useful phrases you need when inquiring about a patients personal past medical history. Match the two sets of words below you would expect to find in the same context. 1 2 3 4 chicken pox appendicitis insulin shots high blood pressure A B C D hospitalisation major health problem treatment childhood disease

Exercise 4
Fill in the dialogue. Then listen and check. Practise the dialogue with your partner. D: .................................................................................................... P: Not that I know of, Doctor. D: Nothing like diabetes, high blood pressure, or heart disease, strokes, cancers, mental illness or anything like that? P: Oh, I see! My father died of a heart attack, and I have two aunts who have diabetes. D: .................................................................................................. P: He was 68. D: ................................................................................................. P: He had heart attack. D: ................................................................................................ P: Oh no; it was very sudden. D: And your aunts? Do you know what kind of diabetes they have? Do they have to take insulin or tablets, or are they just on a diet? P: They just take some pills, I think. D: You are married, I see. ............................................................ P: Yes, a boy and a girl. D: ......................................................................... P: Yes, they are.

Exercise 5
On the basis of the dialogue indicate whether the following statements are true or false. a) b) c) d) There are no illnesses in the womans family. Her father suffered from a long disease. Her father died of a heart attack. Her children both have diabetes.

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Exercise 6
Please select the correct definitions for the following useful phrases relating to a patients family history. a) as far as you know b) insulin injections c) illnesses that run in the family d) to be on a diet e) to suffer from a disease 1 2 3 4 5 to be very ill with something in your opinion to eat carefully injections for people with diabetes medical problems among relatives

Exercise 7
Fill in the dialogue about patient's social history. Listen and check. Practise the dialogue.
D: P: D: P: D: P: D: P: D: P: D: P: D: P: D: P: D: P: D: P: ................................ at the moment? No, Ive just been made redundant. Oh, Im sorry; ...............................? I was a civil servant in Customs and Excise. I see. Was it an ....................... or were you .......................... all day? No, I was desk-bound, Im afraid. Was it managerial - did you ...................................................? Yes. I was in charge of a large department. I see, quite stressful. Now, tell me, .................................? Yes, unfortunately, quite a bit. Oh, really, .........................? Oh, about forty a day. ........................ have you been smoking? Since I was about fourteen. Have you ever .........................................? Yes, Ive tried to give it up several times, but without success. ...........................................? Do you drink? Yes, sometimes with my friends. .......................................................... a day? Lets see... a couple of pints in the pub at lunch time, a whisky in the evening and about half a bottle of wine with our meal. D: Thats quite a bit. .......................................... when you started drinking? P: Oh, when I was about 17 or 18, I suppose. D: ........................................ do you live in? P: We live in a small flat; its our own but we are still paying the mortgage on it, of course.

Exercise 8
Indicate whether the following statements are true or false. a) b) c) d) e) The patient had a white-collar job. The patient realises that smoking is harmful. The patient started drinking and smoking at the same age. He likes to drink whisky and beer, but prefers not to drink any wine. The patient and his family rent a small house.

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Exercise 9
Read the four sets of questions below. Choose the one from each set which does not mean the same as the others. 1 A B C 2 A B C Do you have a job? Are you employed? Is your job stressful? Have you stopped smoking? How much do you smoke? Have you given up tobacco? 3 A B C 4 A B C Have you ever been drunk? How much alcohol do you drink a day? What is your alcohol consumption? Is your rent expensive? Do you have a big mortgage? Does your landlord charge a lot?

Exercise 10
Here are several questions the doctor asked her patient. Unfortunately, the questions got mixed up; rearrange them in logical order. a) b) c) d) e) What do you mean by "feeling poorly"? What do you think brought it on this time? What is the problem today? Let me listen to your heart and lungs. When did you first notice the symptoms?

Exercise 11
Fill in this dialogue. Then listen and check. D: P: D: P: D: P: D: P: D: P: D: P: What ? Well, Ive been feeling poorly. I see. Feeling poorly. What ? Ive been getting very short of breath. Hm How long ? For about 18 months, I think. And were there any symptoms before then or ...? I hadnt noticed anything before then. So you hadnt had .? No, not that I can remember, doctor. I see. Was there anything that ..? Well, nothing, really. Except maybe it gets really bad when I go up to London to see my sister. D: Lets take a look. Ill listen to your and . to begin with.

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Exercise 12
Below are groups of questions. Select the correct title for each group. When you have finished practise the questions. Duration Factors that alter the problem Location Onset Character Radiation Related symptoms a) .................................................................. Can you show me where it hurts? Can you point with your finger to the spot where it hurts? Where does it hurt? Where is your pain? Where is the symptom located? (formal) e) ................................................................. Does anything relieve the symptoms or make them worse? What do you do when it happens? Is there anything that makes it better or worse? Is there any position that makes it feel better or worse? f) .................................................................. Does the pain move to another part of your body? In which direction does the pain go? Does the pain seem to move anywhere else? Has the pain spread? Has the pain affected any other part of your body? g) ................................................................. What brings it on? Do you have any symptoms related to this problem? Is it related to eating/coughing/your mood/ tiredness/broken skin/body position/ movement? Do you notice any side effects? Does anything else happen at the same time? How long is it after you take the medicine before you feel better?

b) .................................................................. Could you describe what the pain feels like? What kind of pain do you feel? Is it getting more or less severe? How bad is the pain? Does it wake you up at night? Does it interfere with your everyday life? Is the pain better or worse now? c) ................................................................... How long have you had this pain? How long does it last? Do you have it all the time or does it seem to come and go? Is it constant or intermittent? Did it happen suddenly or gradually? How often do you get it? d) ................................................................... When does it come, when does it go? When did this pain start? What were you doing at the time this pain started? When was the last time you were without pain? When was the first time you noticed that something was wrong? Have you had anything like this before?

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Exercise 13
Write in the appropriate forms of the questions. D: P: D: P: D: P: D: P: D: P: D: P: . It started just a few days before my period. . It hurt really badly for about two or three days. . Id say, it was a sharp, cramping feeling, unbearable. . Yes, to my lower back, and all the way to my knees. . Well, it seemed to get a bit better if I took some tablets, but it was still pretty bad. . Oh, yes, I vomited a lot, I felt weak and bloated.

Exercise 14
Match the following groups of phrases with the appropriate sentence beginning on the left. Is your vomiting? A mucus/undigested food/blood

Is your nausea caused by?

B a strange odour/any particular smell/ any odour

Do you vomit?

C every day/early in the morning/ during the night

Does the vomit contain?

D related to meals/spontaneous/ self induced E stress, fear or depression/certain places/ car or motion sickness F keep food down/keep liquid down/ bring anything up

What you bring up, does it have?

Is it difficult to?

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Exercise 15
Here are some responses from a patient who suffers from nausea and vomiting. Formulate appropriate questions which could have elicited these answers. D: P: D: P: D: P: D: P: D: P: D: P: ? I keep retching and have actually vomited. ? It happens very often. ? When I eat, it gets better. .? I bring up food mostly. ..? Its never black like that. ...? I burp an awful lot.

Exercise 16
Below are several sentences which are related to shortness of breath. Choose the appropriate words or expressions from the box and complete the sentences. Then listen and repeat. tests a) b) c) d) e) f) g) stop flat relieved difficulty breathing in short of breath

Do you have any .. breathing? Whats harder . or breathing out? Can you lie .. in bed? Is it by sitting up in bed? Are you .. when you are resting? Do you have to .. frequently when you climb the stairs? Have you ever had any breathing .?

Exercise 17
Below are some types of coughing. Match each expression with the appropriate definition or description. to bark to be hoarse to wheeze a coughing fit to whoop

1.. to make the characteristic sound accompanying the deep intake of air following a series of coughs in pertusis 2.. to breathe with difficulty and with a whistling sound 3.. a sudden, acute attack of coughing 4.. to speak with a harsh, raspy low sound 5.. to utter an abrupt, explosive cry that sometimes sounds like a dog

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Exercise 18
Formulate questions based on the patients answers in the following dialogue. Then listen and repeat the questions. D: P: D: P: D: P: D: P: D: P: D: P: D: P: .? Ive had difficulty breathing for about two weeks. .? I wheeze in the early hours. ..? Breathing out is harder. ..? Im short of breath when Im working. ..? Yes, I can sleep on my back. ..? Yes, I wake up several times because Im short of breath. .? I usually get up and walk around when it happens.

Exercise 19
You will hear patients complaints about cough. Write out the necessary questions that could have elicited these responses. Question 1 Question 2 Question 3 Question 4 Question 5 Question 6

Exercise 20
There are several questions and answers below, which relate to a patients bowel movements. Match the questions with the answers. 1 2 3 4 Do you feel that you want to move your bowels but you cant? Can you tell me what your stool looks like? What colour? A No, very hard. B Yes, I just sit down and try but nothing happens. C They are little round balls. D They are usually brown. E Actually I get more regular at the time of my menstrual period and the times between that I do feel more constipated.

What about the consistency? Are they soft? 5 Have you noticed that you get more constipated at certain times of the month, or season, or after certain foods?

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Exercise 21
Match the sets of responses a patient can make and the doctors questions.

1 2 3 4 5 6

Do you have any rectal problems? Is it foul smelling? How often do you go to the toilet? Has the quality of your stool changed any lately? Are you having any trouble with it or is it normal? Do you have piles/haemorrhoids?

a) Twice a day./ Once a week. / Daily. b) ....Its normal./Im usually constipated./ I have diarrhoea. c) Yes, it has a foul smell./ Its terrible./ No, it smells normal. d) Yes, I have trouble sitting for long periods./ No, I dont./ Yes, but they were operated on last year. e) ..It itches./ It bleeds./ Its painful. f) ..Its thinner than usual./ Its black and tarry./ Its white and floats.

Exercise 22
Match the verbs with the various objects or body parts that they are used with in the examination of patients. a) b) c) d) e) f) g) h) i) take off strip to lie on give me straighten stick out hold take put 1 2 3 4 5 6 7 8 9 a deep breath your wrist your arm your clothes your arms by your sides the couch/table your breath the waist your tongue

Exercise 23
Match the instructions with the phrases which should follow them. a) b) c) d) e) f) I'd like to examine you. Give me your wrist. Let's take your blood pressure. Let's have a look at your eyes. Turn your head. Open your mouth. 1 2 3 4 5 6 7 Stick your tongue out for me. Look up for me, please. Would you take off your clothes. Breathe out quietly. I'm going to take your pulse. I want to check the pulse in your neck. Will you straighten your arm for me please.
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g) I want to listen to your heart.

Exercise 24 Here are some useful expressions for ambulance men. Translate them into English. Mi a neve? Betzze a nevt, krem. Hol lakik? Van telefonja? Mi a foglalkozsa? Hol s mikor szletett? Van nnl betegkrtya? Elkrhetnm a TB krtyjt? Ki a legkzelebbi hozztartozja? Ns/Frjnl van? Hol lakik? Mi a telefonszma? Ki a krzeti orvosa? Krem, ljn le. Nyugodjon meg. Krem, szlljon be a mentkocsiba! Vigyzzon a fejre! Fekdjn a vizsglasztalra. Ne mozogjon! Krem, ljn fel. Szlljon ki a kocsibl. Megy egyedl, vagy segtsek? Most elviszem a sebszetre. Lehet, hogy vrnia kell. ljn le, s vrjon, mg szltjk. Most elmegynk a rntgenosztlyra. Jjjn velem. Balesetnl: Mi trtnt? Mikor trtnt? Hny sebeslt van? rzi ezt? Hol fj? Fj a keze vagy a lba? Tudja mozgatni a kezt s a lbt? Pontosan hol fj? Most ellenrzm a pulzust. Fordtsa el a fejt. Adja ide a karjt. Megmrem a vrnyomst. Vegye le az ingt. Most mr felltzhet. Azt hiszem, nhny bordja eltrt. Be kell vinnnk a krhzba megrntgeneztetni. Van mellkasi fjdalma? Nagyon fj? Szr vagy tompa a fjdalom? Most felteszem a hordgyra s berakom a kocsiba. Ne aggdjon. Minden rendben lesz. Be fogom ktzni a sebt. Az orvos majd begipszeli a lbt.

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APPENDIX
Something about Health Care in Great Britain
The National Health Service
The National Health Service was started in 1948 and provides free medical care to all inhabitants in Great Britain. People contribute to it through National Insurance which they have to pay over a certain income. Although the NHS is crippled by overgrown bureaucracy and frequent changes, the standard of medical care has remained high. There are still people who take out private medical insurance through BUPA, PEP or Norwich. Often private health insurance is part of their package an employee gets and therefore paid by the company. One of the reasons for the increasing popularity of such schemes is the NHS waiting list: if you require a hip replacement, for example, there is a long wait for it. There are often over a million people on the waiting lists at any time for all kinds of operations. Not everything is free under the NHS either. Free eye tests and dental treatment for adults are a thing of the past. Unless you are exempt for some reason e.g. you are under 16, pregnant or unemployed, it is very difficult to find a dentist who is willing to treat you on the NHS. You also have to pay a prescription charge of 5.65 for any prescription you have been given. Since April 1990, all patients new to the area and people over the age of 75 are offered a full health control.

Everyone has his or her own family doctor who is known as a General Practitioner or GP. General practitioners can give advice, issue a medical certificate (sick note) and prescription or may send you to a hospital to see a specialist in more serious cases. When you become ill, you make an appointment at the doctors surgery. Surgeries, where often a group of doctors work, are friendly places: doctors wear their own clothes and not white coats, there are magazines to read in the waiting room and a corner with toys for children to pass time. There are usually two surgeries a day. When open surgeries are held you do not have to make an appointment and patients are seen on a first come, first served basis. There might, however, be times when surgeries are by appointment only. It is very unusual to wait for more than forty-eight hours for your appointment. Normally the waiting time is much less. If you are unable to take yourself to the surgery, the doctor can instead make a home visit. This is also free of charge. Patients are, however encouraged to go to the surgery if at all possible. If you want your doctor to make a home call, you need to phone the surgery before a set time, usually before 10 a.m. so that he or she can plan the home visits. You can make appointments on the phone. All you need to say is: Hello. Id like to make an appointment with Dr . next week/as soon as possible. When you arrive at the surgery, you go to the reception and say the following: Hello. My names .. . Ive got an appointment with Dr . They ask you to take a seat as you almost always have to wait even if you have an appointment at a certain time.

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If your GP feels that you need hospital treatment, he will write a letter to a specialist at the hospital. You will then receive an appointment to see this doctor at the out-patients department.

The Family Practitioner Services in GB The family practitioner services in Great Britain cover the medical attention given to individuals by doctors, dentists, opticians and pharmacists of their own choice. Almost all of the general practitioners in Great Britain take part in the service. More than four-fifth of them take part in the National Health Service in partnership or group practice. Both doctors and dentists normally work in their own surgeries in health centres. To enter practice they have to apply to the Medical Practices Committee. Every person over the age of sixteen can register with a GP and a dentist of his own choice, and the same can be done for those under sixteen by their parents or guardians. In other words this means complete freedom of choice for any resident. However, a balanced distribution of doctors throughout the country can be facilitated by determining the maximum number of patients' names permitted to be on a doctor's list. This number is 3,500 but the average number is about 2,200. GPs are paid according to the amount of work and responsibility they undertake so the number of patients' names on their lists have much impact on their earnings. Access to other parts of the N.H.S. obtained by the patient normally through their own GPs, but local authority home nurses, midwives and health visitors are attached to doctors' practices, and their attachment is becoming more widespread.

Hospital and Specialist Services in GB Hospital and specialist services provide hospital accommodation of all kinds, including district general hospitals with treatment and diagnostic facilities for in-patients, day-patients and out-patients, hospital maternity departments, infectious diseases units, psychiatric and geriatric facilities, convalescent homes, rehabilitation centres and all forms of specialised treatment. Hospital medical staffs are employed either full-time and salaried, or part-time. Part-time medical officers are usually paid on a sessional basis and they are free to accept private patients. Most hospitals in Great Britain are part of the N.H.S. A small number of them, most of which run by religious orders, remain outside the service. Some of these serve a special group of patients; others are maintained for the chronic sick or for convalescents. Beside these, there are private nursing homes as well. Hospitals include scores of teaching hospitals which are groups of hospitals, convalescent homes, branches, annexes or treatment centres. Through its social workers, the hospital service plays a major part in the rehabilitation and resettlement of patients whose illness has been long or whose disability results in changes in their lives. It also plays a significant part in the treatment of drug dependence. All medical practitioners are required to notify the Home Secretary of any person they consider to be addicted to dangerous drugs. N.H.S. provides also termination of pregnancy in certain cases under certain conditions, freely available Chest Radiological Service, Blood Transfusion Service and Bacteriological and Virological Laboratory Service.

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Minimum Qualification for Registration in GB Only people whose names are on the medical or dental registers can practise as doctors or dentists under the N.H.S. The minimum qualification for registration as a doctor requires five or six years' training in medical school and hospital with an additional year's experience as a resident assistant doctor in a hospital. The minimum qualification for a dentist requires four or more years at a dental school. The training of a State Enrolled Nurse requires a two-year course. The hospital training of a State Registered Nurse requires 3 years. The training of nurses may be in general, sick children's, mental or mentally sub-normal nursing. Most pupil midwives are already registered general nurses or sick children's nurses. For them the twoyear midwifery training period is reduced to 18 months. Health visitors are registered general nurses with midwifery or approved obstetric experience who have completed a one-year course in health-visiting. Dieticians, medical laboratory officers, occupational therapists, orthoptists, physiotherapists, chiropodists, radiographers and remedial gymnasts may obtain state registration after a professional training lasting two to four years. For social workers the training consists of a basic university degree, diploma or certificate in social science. They help those patients who have difficulties connected with their illness. Speech therapist need a good general education and three years' professional training.

General Practitioners in Hungary General Practitioners in Hungary don't operate on an appointment system. Patients turn up in the surgery when their ailments are minor or at least not very serious. When half of the population is down with flu a GP works well over 10 hours a day. He doesnt have the time to give every patient a thorough examination but not all of them need it. Some only come to get an injection as a part of their treatment or to have their blood pressure taken. Others only want to prescribe them the medicine they regularly take. Although making out prescriptions and signing medical certificates for those who are unfit to work and have to be put on the sick-list takes up a lot of his time, a GP does his best to find time at least for routine examination. When the patient's ailment can't be diagnosed without further examination like an x-ray or blood test, he sends him with a letter to the lab or the x-ray department. And also when the patient needs a specialist's care and treatment, he also sends him to a specialist. When he finds the ailment very serious, he sends the patient to hospital. If he finds his case critical, he calls an ambulance. If a patient has a high temperature or he is so seriously ill that he can't go to the surgery his receptionist arranges for him to go to see the patient at his home after surgery. He generally visits 5 to 30 patients on his round.

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Ambulance Drivers in Great Britain

From September 1986 the ambulance service has been divided into two systems. Emergency and non-emergency drivers. The non-emergency drivers are men who are either over 50 or who, for health reasons cannot work as emergency drivers. These drivers work only day-shifts and have no on-call duties. The training for non-emergency drivers is three weeks long and emergency drivers have eight weeks training. After the training, the new ambulance drivers are monitored for 12 months and go on a refresher course every five years. Emergency drivers work a 39-hour week. It is a 15-week shift system with six weekends off. In addition to these categories, it is the aim of the Ambulance Service to have one Paramedic on each vehicle. Paramedics have undergone an extended training course of one year. They have worked alongside doctors learning to carry out medical procedures such as; intubation, infusion and defibrillation. During the 1980s the ambulance staffs own union was formed the APAP (Association of Professional Ambulance Personnel). However, only a minority of drivers are in this union. The majority choose to be in NUPE (National Union of Public Employees) or COHSE (Confederation of Health Service Employees). Ambulance officers are usually in NALGO (National Association of Local Government Officers).

Admissions
In Britain, most people who fall ill are treated at home by their family doctors. Not all illnesses can be treated at home, however, so many people are admitted to hospital at some time during their lives. They are admitted either as arranged admissions or as emergency admissions. Arranged Admissions A patient who goes into hospital as an arranged admission has previously attended an outpatients clinic to which he has been sent by his family doctor. At the clinic he is examined, his previous history is taken and all the necessary investigations are carried out. If admission is recommended, his name is put on a waiting list and when a bed in an appropriate ward becomes vacant, he is sent a letter which tells him when to report to the hospital for admission. With this letter, most hospitals enclose a leaflet telling the patient what he will need while he is in hospital. The leaflet also outlines the general ward routine and gives details of visiting hours. Emergency Admissions Nowadays, many people go into hospital as a result of accidents or sudden illnesses. These patients are called emergency admissions. They are often seriously ill and in need of immediate care and attention. Unlike arranged admissions, little or nothing is known about emergency admissions or their previous histories. They are usually taken to the casualty and emergency department by ambulance. They are often unconscious. Sometimes they are accompanied by friends or relatives who are able to supply at least their personal particulars. In the casualty department, they are examined and the necessary emergency treatment is carried out. If possible their previous histories are taken. The appropriate war is notified that a patient is being sent up so that the necessary preparations can be made.
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The Staff of a Hospital

Medical staff
The range of medical posts in a hospital, from the most senior to the most junior are: Consultant Medical Assistant Senior Registrar Registrar Staff Doctor Senior House Officer Pre-registration House Officer. Consultant The Consultant, the most senior grade in medical posts, has the ultimate decision on patient care. A team of doctors is known as a firm, meaning a unit, and one hears the expression, for example, Im working on Mr Blacks firm, which means in his team. A large firm may have as many as five consultants, but each one carries formal responsibility for his own patients. A consultancy is a permanent post but it can be full time or part time, allowing a doctor to spend some time in private practice. Part-time appointments are calculated in terms of half-day sessions of 3 hours. Both full and part-time consultants may work on a sessional basis at more than one hospital. In order to be a consultant, the highest qualifications are required including, for example, the postgraduate diplomas such as FRCS for surgery, the MRCP for physicians, the higher degrees such as MD and MS and accreditation by the appropriate higher specialist training committee of one of the Royal Colleges. The male surgeons are addressed as Mr X and the female surgeons as Miss or Mrs Y; the other consultants as Doctor Z. Medical Assistant Doctors occupying these posts have many years experience, but may not possess the appropriate qualifications to be eligible for consultant posts. Senior Registrar The Senior Registrar is a potential consultant who has worked as a Registrar for two years in his specialty in a teaching hospital after two years in a general hospital. He will have the highest degrees of his chosen specialty. As with the consultants, the surgical senior registrar would be addressed as Mr X, Miss or Mrs Y and the others as Dr Z. Registrar Registrars are addressed as Doctor or Mr X, Miss or Mrs Y according to whether they are medical or surgical. The Registrar will practically always have a higher qualification. A Surgical Registrar will do the routine surgery, for example, appendicectomy, hernia etc, without the supervision of a more senior surgeon but he will only perform major operations with a more senior surgeon present.

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Staff Doctor This is a new grade introduced for those who do not wish to progress up the career ladder to the Consultant post. They will have spent a minimum of three years in the Senior House Officer grade. Senior House Officer The Senior House Officer will have completed the necessary qualifying period as a House Officer and will probably be studying for a higher qualification. Appointments may be for periods of 6 months upwards and such posts are frequently part of a rotating training scheme. SHOs are almost always required to be resident in the hospital when on duty. They look after the routine medical care of the patient. (houseman) Pre-registration House Officers Since 1953 it has been compulsory for newly qualified doctors to serve one year as a preregistration house officer before being admitted to the Register. Pre-registration posts exist in the majority of general hospitals. These doctors are considered in law to be doctors only for the purpose of a specific post. They carry heavy responsibility for the day-to-day running of many firms.

Nursing staff
Approximately 10% of nursing staff in NHS hospitals are men. The percentage is much higher in mental hospitals. It is difficult to recognise the different grades of the nursing staff of a hospital since every hospital is free to choose its own uniform. In addition, many senior nursing staff no longer wear uniform. However, although the dress worn by nursing staff differs from hospital to hospital, the grades are the same and are as follows. Director of Nursing Services This post carries overall responsibility for the nursing services within one or more hospitals, and for nursing administration. It may also involve a general management function. Senior Nurse There may be several Senior Nurses responsible to Directors of Nursing Services for the management of, for example, a small hospital, a number of wards or a specific service such as those for elderly people or mentally ill. Senior Clinical Nurse She is a qualified and experienced nurse (RGN) and is in charge of a particular clinic or operating theatre. She is addressed either as Sister or by her own name. A male Senior Clinical Nurse is addressed as Mr X or Charge Nurse.

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Ward Sister/Charge Nurse She is also a fully qualified and experienced nurse (RGN) and has responsibility for organising and running a ward or department. She is addressed as Sister. A Charge Nurse is the male equivalent of a Ward Sister. He is addressed as Mr X. Staff Nurse He or she is accountable to the Ward Sister or Charge Nurse and is addressed as Staff Nurse or often as Staff. This is the first post that nurses trained as RGNs on RMNs (see later) will hold. State Enrolled Nurse/State Registered Nurse He or she is a qualified nurse who has completed the shorter SEN course. State Enrolled Nurses/State Registered Nurses cannot become Ward Sisters or Charge Nurses without obtaining an RGN qualification. The current SEN training has been discontinued. Student Nurses These are nurses in training. Nursing qualifications There are a number of nursing qualifications, but those most frequently held are: Registered General Nurse (RGN). It usually takes three years to gain this qualification and examinations have to be passed at the end of each year. There are separate nurse trainings for registration as a general sick childrens (RSCN), psychiatric (RMN) or mental handicap (RNMS) nurse. Nursing Auxiliaries or Nursing Assistants Most Hospitals employ a number of untrained men and women as Nursing Auxiliaries or Assistants. They assist with patient care and give a valuable service in relieving the qualified nurse of many duties. Nursing Cadets Many hospitals take young people as Nursing Cadets when they leave school at 16, before they start their formal training at the age of 18. Cadets work in many departments to gain wide experience, although they are not allowed to work on the wards before they are 17, nor are they allowed to work on maternity, gynaecological or terminal illness wards.

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Paramedical staff
In addition to the medical and nursing staff of a hospital there are the many other people who work in the allied professions, including the following: Chiropodists Treatment under the NHS is mainly for the elderly. Dietitians Most hospitals have one or more dietitians and facilities for the preparation of special diets. The dietitian will assist the medical staff by advising their patients on diets. In many hospitals the dietitian takes part in outpatient clinics to give advice to patients referred to her by consultants. Pharmacists All general hospitals will employ qualified pharmacists, and other specialist hospitals like psychiatric and mental handicap probably will too. Physiotherapists These people are trained to give treatment by massage, exercise, hydrotherapy and electrotherapy, to help restore specific bodily functions. Remedial Gymnasts These are involved in rehabilitation following operations and medical accidents, such as strokes. They help patients to overcome disabilities by use of corrective exercises. Occupational Therapists These are found in many general hospitals and in all specialist hospitals. They are extremely important in the work of rehabilitation by training patients in activities which help restore their mental and physical capability, and where this is not possible by assisting them overcome their handicaps by the provision of suitable aids. Radiographers Radiographers take X-rays and operate equipment in X-ray Departments for diagnostic purposes. Some radiographers who are specialists in radiotherapy treatment operate radiotherapy machines under the direction of radiotherapists. Medical Laboratory Scientific Officers These people work in departments responsible for analysis of specimens.

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Speech Therapist Most hospitals employ at least one speech therapist who will see patients as part of their rehabilitation after strokes, etc. Nearly all these members of hospital staff wear white coats but they frequently have labels to show their professional function. All paramedical staff except trainees must pass the appropriate professional examinations. Social Workers All social problems that have contributed to the patients illness or that arise as a result of it are referred to the social workers. The social workers spend much of their time in hospitals but since the 1974 Act they are part of the team of social workers employed by the Local Authority.

Administrative and Support Services staff

There are many other groups of staff employed within the hospital with whom the doctor will have less contact but who are equally essential to the functioning of the hospital. Amongst these are the domestic, catering and laundry staff, building and maintenance craftsmen and porters. These are often called the Support Services staff. Finally there are administrative and clerical staff who work in a number of departments: medical records, salaries and wages accounts, personnel and general administration.

TALKING TO PATIENTS
Good communication between doctor and patient is vital. No medical terms should be used that the patient cannot understand. The instructions should be clear and simple. In the following outline of the different stages of taking a case history some examples of the kind of language used are given. 1. Greeting patient. "Good morning, Mrs Rayner. Come and sit down." 2. Invitation to patient to describe symptoms. "Well now, how can I help you?" or "Well, Mrs Rayner, what's the trouble?" These two openings are commonly used by some doctors. Others refer to the GP's letter and say, for example: "Your doctor says you've been having trouble with your back. Tell me about it." 3. Taking of history. Examples of language used in case histories can be seen in the dialogues. The most important questions are the following: "Can you tell me whether you have had any childhood diseases, for example chicken pox, measles, mumps or German measles?" "Have you ever been in hospital for anything?" "Have you ever had an operation?" "Are you up-to-date with your immunisation?"
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"Are you receiving any treatment for your .......?" "Are there any illnesses that run in your family?" "How did your father/mother/uncle/aunt die?" "How old was your father when he died?" "What did he die of?" "Have you any children? Are they healthy?" 4. Instructions for undressing for clinical examination. Be specific. If you wish to do a thorough physical examination it is useful to say: "Would you mind taking off your clothes except your pants and bra (for women). Lie on the couch and cover yourself with the blanket" (or whatever your particular hospital provides). Otherwise you might say, for example: "Slip off your shoes and socks" (for examination of feet of men and children) "Roll your sleeve up" (for examination of elbow or lower arm). It is essential that you learn the names of garments worn by your patients. 5. Instructions for position on couch and during clinical examination. It is no use asking your patient to lie in the prone position. He will not generally understand this term. Say instead: "Please lie on your tummy." Other examples of instructions for position are: "Please turn over and lie on your back." "Roll over onto your left/right side." "Bend your knees." "Sit up." "Lean forward." "Get off the couch and stand up." "Walk across the room." During the clinical examination you may wish to examine certain parts of the body by instrument and you must prepare your patient for this. Doctors often use the words "I'm going to/I'm just going to" to express something about to happen. Here, for example, an examination by sigmoidoscope: "I'm just going to have a look in your back passage to make sure everything is all right. I want you to lie on you left side with your bottom right over the edge of the couch. I'm going to examine you with my finger and then with an instrument which will feel like my finger only cold. Let yourself go loose. Try and relax. This will feel cold. Take a deep breath in. This will feel rather like the last one. Breathe in again. This may make you feel as if you want to have your bowels opened, but don't worry, you won't. I'm just going to blow some air in now. Good. I've almost finished. Good." Notice the constant reassurance the doctor gives by the use of "just", "don't worry" and "good". 6. Instructions to dress.

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Do not walk out of the room leaving your patient unsure of what to do next. "You can get dressed now and then come out to me" is helpful. For a disabled or elderly patient who finds dressing difficult, it is kind to add: "Don't hurry. Take your time." 7. Information of diagnosis, treatment or further tests. Some doctors talk to their patients while they are in the cubicle, others when the patient is dressed and comes out to the doctor. It depends on the arrangements at a particular hospital. a) No treatment. Sometimes it is possible for the hospital doctor to make an immediate diagnosis and reassure the patient at once: "Well, Mrs Turner, there doesn't seem to be anything wrong with you. I'm sure this will clear up on its own but if you continue to be worried about it, go to your GP and he will arrange for you to come and see me again." b) Tests. Much more often, the hospital doctor will order tests. "Well, Miss Bartley, I can't find anything seriously wrong with you but I'd like you to have your chest X-rayed and an EEG. Go to the Appointments desk before you leave the hospital." Most patients want to know what the tests involve. Here is an example of the actual words you may use to a patient who has to have a brain scan: "You will be asked to lie on a couch. The couch will move through a shallow tunnel. You will be able to see on either side and nothing will touch you. The X-ray machine is fitted inside a tunnel and it takes individual pictures of different parts of the head rather like the slices of a loaf of bread. No special preparation is needed for this procedure. The radiographer may put a headband on your head to position you but you will not feel restricted. The radiographers can see you and speak to you but they will not actually be in the same room. It will only take about fifteen minutes and you will be able to go home." c) Drugs. As it will usually be some time before the results of the tests are available, the doctor will prescribe drugs if necessary. "I'd like to have an X-ray of your shoulder and neck. I'll give you a prescription for some tablets to ease the pain." Your letter to GP will notify him of the drugs prescribed. d) Hospitalisation. It is sometimes necessary to bring the patient into hospital for observation. This is particularly true of children and the elderly. Words are chosen to avoid alarming the patient and the patient's relative: "I'd like you to come/I'd like Johnny to come into hospital for a few days/a week so that we can keep an eye on you/him to find out what exactly is causing this trouble." e) Surgery. There are, of course, conditions which can only be dealt with by surgery:

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"Well, Mr Green, you've had this trouble for months. We've tried tablets without any success so now I'm going to refer you to a surgeon to arrange for you to have an operation." f) Psychiatry. There are patients who are referred to hospital by their GPs and after countless tests nothing is found to be wrong. In spite of being reassured the patients still return to the hospital complaining of the same symptoms. At some point, the physician may decide to refer a patient to a psychiatrist: "Well, Mrs Brown, we've done all the necessary tests and can't find anything wrong with you but I know you still feel unwell so I'm going to refer you to a psychiatrist and hope he can help you." g) Imparting bad news. It is sometimes necessary to give news to the patient that is unwelcome, frightening, bad. Choice of words is important and can help reduce the shock. The phrase I'm afraid is commonly used to signal bad news. "I'm afraid this is a serious condition. You'll need an operation." "I'm afraid your gangrenous leg hasn't responded to treatment. We shall have to amputate it." "I'm afraid your mother died during the operation. Her heart wasn't strong enough..." It is helpful to a patient if a doctor shows understanding. "I know this is bad news for you but there is a lot we can do to help you."

h) Reassurance. All patients need reassuring whether their complaint is trivial or life-threatening. It is a complex subject and is not limited to verbal communication. The physical presence of a doctor can reassure: his appearance, manner, attitude and intonation all play a part. In spite of the complexities of the subject, certain verbal patterns of reassurance are common: "Don't worry about this. It's quite a common condition and should clear up in a week or so." "This is not a serious condition. These tablets should help." "The only way to treat this is by an operation. It is a routine surgery and you should be back to normal two month after the operation." It is important that a doctor stresses the positive aspect of a patient's condition and that the patient realises that whatever happens he can rely on the doctor's support. In lifethreatening illnesses, the reassurance the doctor can give is to be near in the times of crisis: "You will no doubt want to go home as soon as possible but we are here to help you whenever you need us." It is now recognised that it is quite difficult for patients under stress to take in a lot of information. Many hospitals, therefore, produce information sheets and cassettes with explanations of necessary procedures and operations. The patient can study these at home. An example of part of a detailed leaflet explaining a barium enema is in the Appendix to illustrate the simplicity of the language used, avoiding medical terms. Instructions for the time of the procedure and preparations necessary would also be provided.

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Types of Musculoskeletal Injuries

Musculoskeletal emergencies are usually of three types: Fractures Dislocations Sprains In order to determine which type of injury the victim has sustained the FIRST RESPONDER must assess the situation by determining the mechanism of injury, obtaining a history, performing a patient survey. The mechanism of injury will offer a hint as to type of injury. If a bone is directly struck by a solid object, such as a car bumper, the bone will most likely be broken at the point of impact. Injuries in an area other than the place directly struck by a solid object are known as indirect injuries. Check for fractures or dislocations at joints close to the point of impact. A twisting injury can result in a sprain, dislocation or fracture. This is most often seen in injuries where the foot or hand is flat on the ground and the upper part of the limb is twisted. Pathologic fractures are breaks due to disease or brittle bones. Very little impact will break the bone. An example of this type of injury is the broken hip often seen in the elderly. A brief history will help to determine the type of injury. Question the victim or a witness if the victim cannot respond. Ask: Is there discomfort? Where? How did the injury occur? Was there direct impact? Where? Does the person have a serious illness or problem with the skeletal system? The patient survey for musculoskeletal injuries should be performed after primary survey (= checking for respiration, pulse, bleeding, state of consciousness, skin) has been conducted and life-threatening conditions have been treated. When looking for signs of fractures, dislocations and sprains, be sure also to check for the presence of a pulse distal to or below the injured area. Assessment should include: examining for wounds, bruises, deformities; observing the patients position (Is it unusual?); checking for feeling; checking for a pulse distal to the injury; examining for loss of movement.

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FRACTURES A fracture is a break in a bone. Fractures, as in soft tissue injuries, are classified as open or closed. Open fractures are fractures in which the skin is broken and there is a wound over the fracture site. A bone may even protrude through the wound. Open fractures are often called COMPOUND FRACTURES. Closed fractures are fractures in which the skin over the fracture site has not been broken. Closed fractures are often called simple fractures. Just as both open and closed soft tissue injuries can result in severe blood loss, so can open and closed fractures. Infection due to contamination is a complication of open fractures. Fractures are further classified by the actual appearance of the bone. There is no positive way to tell which type of fracture an injured victim has sustained without an x-ray. However, an intelligent guess as to the type of fracture can be made if the mechanism of injury is known. Types of Fractures Greenstick Fracture This fracture goes only partially through the bone. It is a break straight across the bone at right angles to the long axis of the bone. This occurs only in children and due to the pliability of bones. Transverse Fracture This fracture line is across the bone at right angles to the long axis of the bone. It goes through the bone. These are usually due to a direct impact. Oblique Fracture The fracture line is at an oblique angle to the bone. Spiral Fracture The fracture line twists around the bone. Twisting injuries are usually the mechanism of injury. Comminuted Fracture The bone is broken into more than two fragments. Impacted Fracture The bone ends are jammed or driven together. SIGNS AND SYMPTOMS OF FRACTURES. Whatever the type of fracture, there are general signs and symptoms with which the FIRST RESPONDER should be familiar. 1. PAIN or TENDERNESS. Pain is usually felt at the fracture site. 2. DEFORMITY. The extremity may have an unnatural angle or become shorter than the other limb. 3. SWELLING and DISCOLORATION. Swelling may be immediate or it may not appear for hours. The bruised colouring is due to bleeding into the tissues and may not be seen immediately. 4. GRATING. The broken bone ends may rub together when the patient moves, producing a grating sound. NEVER TRY TO ELICIT THIS SIGN. The broken bone ends could damage nerves and blood vessels by their movement. 5. LOSS OF USE. The patient may not be able to use the arm without pain, or the ability to move the limb may be gone. Do not be misled, however; all breaks will not result in loss of use. 6. EXPOSED BONE. Bone fragments may be seen in open fracture.

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DISLOCATIONS A dislocation is the displacement of a bone end from its joint. The injury involves tearing of the ligaments which hold the end if the bone in place. Although any movable joint can become dislocated, the most frequently dislocated joints are the shoulder, elbow, fingers, hip and ankle. SIGNS AND SYMPTOMS OF DISLOCATIONS. Signs and symptoms of dislocations are very similar to those of fractures. 1. PAIN. There is either severe pain or a feeling of pressure over the dislocated joint. Some people only complain of pain on movement of the affected joint. 2. SWELLING. Swelling is due to the escape of fluid into the tissues. 3. DEFORMITY OF JOINT. This is the main sign of a dislocated joint. It simply does not look natural. 4. LOSS OF MOVEMENT. 5. LOSS OF FEELING BELOW THE INJURY. This will occur if nerves are being compressed. The FIRST RESPONDER should always check the pulse distal to the injury in any musculoskeletal injury. No pulse will mean immediate medical care is needed in order to prevent permanent damage. 6. LOCKED JOINT. The joint is literally locked in an unnatural position. SPRAINS The sprain is an injury to a ligament. The ligament is partially torn. Sprains are usually caused by a twisting of the joint. The knee and ankle are common areas for sprains. Sprains can be quite serious and should be treated by FIRST RESPONDERS as if they were fractures. SIGNS AND SYMPTOMS OF SPRAINS. Sprains resemble fractures and dislocations with two exceptions: Bones do not break through the skin, and sprains usually do not make a joint appear deformed. 1. PAIN 2. SWELLING. Swelling is usually immediate. 3. DISCOLORATION. There will be bruising. DIFFERENTIATING FRACTURES, DISLOCATIONS AND SPRAINS Specific signs can be used to tell a fracture from a dislocation or sprain. However, the FIRST RESPONDER does not have to be afraid of making incorrect assessment. If possible, DIFFERENTIATE and TREAT ACCORDINGLY. If the differentiating signs are not readily apparent or present, but the injured complains of pain or loss of use, then ASSUME the injury is a FRACTURE and TREAT ACCORDINGLY! DIFFERENTIATING SIGNS: It is a FRACTURE if there is an angle in an extremity where there is no joint, there is a bone protruding through the skin. It is a DISLOCATION if there is a deformed appearance to a joint.

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If in doubt, treat any musculoskeletal injury as a fracture! Never force a deformity to straighten if it increases pain.

FRACTURES, DISLOCATIONS AND SPRAINS: FIRST CARE PLAN 1. Remove clothing from the injury. Sleeves and pant legs may be cut off. 2. Cover all wounds with a clean (sterile, if available), dry dressing. 3. Never reposition protruding bones! 4. Check pulse distal to the injury. Maintain information for the EMT, paramedic or physician. 5. Splint DISLOCATIONS in the position in which they are found. Do not attempt to straighten a dislocation, UNLESS there is no distal pulse. If hospital attention is only one to two hours away, the FIRST RESPONDER should not straighten the pulseless limb unless a physician (by telephone) instructs that it be done. 6. STRAIGHTEN an ANGULATED FRACTURE before splinting, using a firm, steady pull. Angulated fractures are those with angles in places other than the joint. DO NOT STRAIGHTEN A FRACTURE WHICH INVOLVES A JOINT. TREAT IT AS A DISLOCATION AND SPLINT IT IN THE EXISTENT POSITION. 7. Straighten deformities of the neck and spine ONLY if an airway cannot be maintained any other way. 8. Pad the splint to prevent pressure on the limb and discomfort to the patient. 9. IMMOBILIZE the joints above and below the injury. 10. Splint all fractures and dislocations before moving the patient. 11. If unable to identify a specific injury or if in doubt SPLINT! Splint all musculoskeletal injuries. Splint joint-involved injuries as they lie! Straighten angulated fractures and splint.

SPLINTING Immobilization is the main FIRST CARE treatment for fractures, dislocations and sprains. Immobilization prevents further injury and decreases pain. This is accomplished through SPLINTING. When splinting an injured area, the primary objective should be foremost in your mind; that is, TO PREVENT MOVEMENT OF BONE ENDS OR DISLOCATED JOINTS. Correct splinting by the FIRST RESPONDER can shorten recovery time by decreasing complications. Splinting will help to - prevent lacerations which could convert a closed fracture to an open fracture, - minimize damage to muscles, nerves and blood vessels caused by broken ends of the bone, - minimize restriction of blood flow, - decrease pain due to movement of the bone, - prevent severe bleeding and - minimize swelling.

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Splints are of two general types, rigid and soft. A rigid splint is stiff or hard, and is attached to a limb to provide stability and to immobilize the limb. A soft splint is also used to immobilize an area. Air splints immobilize limbs by the use of air pressure. Traction splints exert a steady, even pressure while immobilizing the fracture. Traction is used to prevent an overriding of the bone ends due to muscle contraction. Familiarity with all types of splints will allow the FIRST RESPONDER to assist the EMT or paramedic, if necessary. When applying a splint, use traction on the long dimension of the injured part with a gentle, steady pull. Rigid splints are made of any material that is not flexible. They can be made of wood, aluminium, cardboard, rolled blankets and rolled newspapers. They are either long and extend the length of the extremity, or short and extend halfway up the extremity. Rigid splints may be used on both fractures and dislocations. When immobilizing a fracture, immobilize the joints above and below the fracture. When immobilizing a dislocation, immobilize the bone above and below the dislocated joint. Soft splints are any splints not made of rigid material. Examples of soft splints are air splints, slings, swathes and pillows. Soft splints are used to prevent movement in an effort to minimize complications and prevent further injury. Air splints are made of plastic and are available in many shapes and sizes. Some have zippers for easy application. Air splints are tubes which are inflated to exert pressure over an area, immobilizing it. The sling is ideal for immobilization of an upper extremity. The swathe is added to prevent any movement of the injured part. In order to make a sling, the rescuer will need a triangular bandage. These are commercially available, or they can be made from any cloth. The swathe is a triangular bandage folded to make a cravat. Any long bandage or piece of material will suffice. Pillows can be used to immobilize an arm, leg, hand or foot. Simply position around the injured area and tie it in place with cravats. When no equipment is available, immobilize a leg or an arm by binding it to the body with a belt or cravat.

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Shock
Shock is not a disease. It is a syndrome or group of symptoms that relates to the failure of the body to oxygenate the tissues. Without tissue oxygenation, the body cannot meet its metabolic needs. Therefore, shock affects all body processes. Without treatment these processes come to a grinding halt and the body just shuts down! Some degree of shock can be attributed to every injury; but prompt treatment may stop it from progressing to life threatening degrees. Types of Shock Shock is caused by anything which decreases tissue perfusion. Such causes as blood loss, vascular changes and allergic reactions result in four types of shock. CARDIOGENIC SHOCK the failure of the heart to pump the amount of blood needed to the body HYPOVOLEMIC SHOCK the loss of blood or fluid resulting in an inadequate amount of blood containing oxygen NEUROGENIC SHOCK the enlargement or dilitation of blood vessels, resulting in an inadequate amount of blood to fill the vessels. ANAPHYLACTIC SHOCK a special type of shock due to an acute allergic reaction. Shock is a failure of the circulatory system to meet the oxygen and metabolic needs of the body. It affects every body system. Untreated, death results. SIGNS AND SYMPTOMS OF SHOCK. The FIRST RESPONDER should become so familiar with the signs and symptoms of shock that assessment becomes second nature. The body simplifies this assessment for the FIRST RESPONDER because, whatever the cause, the signs and symptoms will be the same. 1. RESTLESSNESS. One of the first signs of shock is restlessness or anxiety. Any patient who is restless should be observed for shock even if no other symptoms are present. The restlessness is due to a decreased amount of oxygen available to the body. 2. RAPID, WEAK PULSE. The heart will try to compensate for the lack of oxygenation by trying to pump the blood out to the body at a faster rate. Though it may help for a short time, the faster rate only weakens the system; and a weak or thready pulse is felt by the rescuer. 3. DECREASED BLOOD PRESSURE. Monitor blood pressure! It is important to know that in later stages the pressure will drop. Aggressive treatment of a shock victim may decrease or even forestall the drop in blood pressure. 4. PALE OR BLUE FACE. The face may be very pale or blue in color. A bluish tinge to the skin is indicative of oxygen deprivation. 5. ABNORMAL RESPIRATIONS. Breathing will be rapid. It may also be shallow, labored or gasping. The rate may be irregular. 6. COLD, CLAMMY SKIN. The skin will be cold and clammy. Some patients may experience profuse sweating. Fingertips and toes will be extremely cold and may be blue in color. 7. THIRST. As fluid volume is depleted, the patient will experience extreme thirst.

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8. NAUSEA AND VOMITING. Nausea and vomiting are nervous reactions. 9. DULL EYES; DILATED PUPILS. As the patient progresses into deeper shock and becomes more oxygen-depleted, the pupils of the eyes will dilate. 10. CHANGES IN LEVELS OF CONSCIOUSNESS. One of the best parameters for evaluating progressing shock is the patients level of consciousness. As shock becomes more severe the patient will exhibit signs of confusion and drowsiness and will eventually lapse into unconsciousness. Some patients will have fainting episodes. SHOCK: FIRST CARE PLAN The FIRST RESPONDER cannot reverse the shock process. Sophisticated techniques and medication are required not only to halt the process but also to remedy the damage done. However, severe shock can be prevented. Since shock affects all body processes, the whole person needs treatment. You must be aware of all FIRST CARE needs and not just one aspect of the illness or injury. 1. 2. 3. 4. 5. 6. 7. 8. Establish and maintain the airway. Begin Basic Life Support, as necessary. Control bleeding. Summon help. Give oxygen. Splint fractures. Handle patients gently. Maintain body heat. /The goal is to prevent loss of body heat. Do not overheat the body or the oxygen demand will be increased by the bodys need to burn more energy./ 9. Give the patient nothing to eat or drink. /Eating or drinking may cause the patient nauseated and vomit. In a semiconscious patient, aspiration could occur./ 10. Elevate the lower extremities. /The patient should be placed in a supine (lying on the back) position with the head turned to the side. Elevation of the legs will increase the blood supply to the heart. Splint leg fractures before elevating them. If a conscious patient has a head injury, the head should be raised to about 30. This will reduce pressure on the brain. Elevate the legs also! Do not elevate the head of an unconscious patient. If the patient complains of breathing problems, simply raise the head and shoulders.

To stop shock, treat the whole person.

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Contents
Unit 1 A Morning in Casualty ..2-4 Exercises 1-6 .5-6 Aches and Pains .7 Polite requests 8 Exercises 9-12 9 Kate Simpson /Reading/ 10 Exercises 1-4 11 REVISION 12-14 Unit 2 On the Wards15 Wards and Departments ..16 Exercises 1-4 .16-17 Kate on the Wards /Reading/18 Everyday English: Telephone 19-20 REVISION .21-24 Unit 3 My right leg is killing me ..25 I skidded with my motorbike .26 Exercises 1-4 27 Everyday English: Nationalities ..28 A good holiday after all 29-30 REVISION 31-32 REVISION OF UNITS 1-3 33-39 Brian was knocked down 33 Exercises 1-3 .34 In the Theatre 35 Exercise 2 ..36 Brian on the Ward 37 Exercises 3-7 38-39 Unit 4 Ive got a terrible pain 40-42 Exercises 1-5 43-46 I feel very sleepy 46 Unit 5 That looks like a nasty cut! 47-48 Exercises 1-4 49-51 Unit 6 The intensive care doctor /Reading/ .52-53 Exercises 1-8 54-59
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The doctor and the law /Reading/ 60-62 Unit 7 Taking of History 63-68 1 Past Medical History .63-64 2 Family History 64-65 3 Patients Social History 65-66 4 History of Present Complaints 66-67 Character of the Pain (Exercise 5) ...68 Unit 8 Respiration, the Cough and Sputum ..69-70 Exercises 1-4 .71-74 Unit 9 Vomitus ..75 Exercises 1-5 ..76-77 Unit 10 Faeces 78 Exercises 1-7 79-82 REVISION OF UNITS 7-10 ..83-92 APPENDIX ...94-112 Something about Health Care in Great Britain 94-96 The National Health Service ..94 The Family Practitioner Services in Great Britain 95 Hospital and Specialist Services in Great Britain ..95 Minimum Qualification for Registration in Great Britain 96 General Practitioners in Hungary .96 Ambulance Drivers in Great Britain .97 Admissions ..97 The Staff of a Hospital .98-102 Medical staff ..98-99 Nursing staff .99-100 Paramedical staff ..101-102 Administrative and Support Services staff 102 Talking to Patients ..102-105 Types of Musculoskeletal Injuries 106-110 Shock ..111-112 Charts: Character of the Pain /Vocabulary/ Parts of the body /Pictures 1-4/ Clothes /Pictures 5-6/ Crossword

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