Notes in Urgent Care A Course Companion and Practical Guide - Elsevier E-Book on VitalSource (Retail Access Card), 1st Edition

• Suitable as a study aid for the Royal College of Surgeons of Edinburgh’s Diploma in Urgent Medical Care
• Clinical information condensed into a concise, easily accessible and relevant format
• Urgent conditions broken down by specialty
• Useful tips for working in urgent medical care systems, using technology, risk management and human factors

CONTENTS Acknowledgements Symbols and abbreviations Useful reference material Foreword

PART I – MANAGEMENT Chapter 1 - Working in Urgent Medical Care Systems The development of urgent care systems - a brief history The development of urgent care systems - challenges The development of urgent care systems - evolving solutions Alternative urgent care models The evolution of urgent care workforces Patient choice and behaviour UUC operational environments NHS 111 services GP out of hours services Working in multi-disciplinary teams 999 call handling and dispatch The characteristics of good and bad urgent care services Working effectively with acute and urgent care services Providing support to urgent care staff Supporting workers after traumatic events

Chapter 2 – Using Technology in Urgent Medical Care Definitions and meanings Drivers for change - overview Drivers for change - system Drivers for change - individual Future technology Relevance of health technology in UUC settings Urgent Treatment Centres Example near-patient investigations Use of PPE Indwelling catheters Hand decontamination Remote care and monitoring Telemedicine

Chapter 3 – Managing Safe Dispositions Role and responsibilities of the referring clinician De-escalating situations Factors influencing referral decisions Factors influencing risk-based decision-making Decision-making and referral in remote consultation Remote consultations - safeguarding considerations Supportive care and avoiding admissions Compulsory mental health admission The Mental Capacity Act (MCA) 2005 Assessment of capacity Deprivation of liberty safeguards (DoLS) Child safeguarding Adult safeguarding Raising concerns Whistle blowing Prevent/Channel Domestic violence and abuse Human trafficking Modern slavery Female genital mutilation Patient transfer and transport Role of clinicians in transfers The ambulance response programme

Chapter 4 – Risk Management and Urgent Care Preparedness Hazard and risk Risk management and system design in the context of urgent care Learning from significant event analysis (SEA) and serious untoward incidents (SUIs) Principles of emergency preparedness, response and recovery The role of urgent care services in relation to a major incident Management of major incident situations The psychological needs of those involved in a major incident Business continuity relevant to urgent care services

Chapter 5 – Human Factors Human factors in healthcare and patient safety The swiss cheese model The SHEEP model The WHO surgical safety checklist Crew resource management Cognitive bias Decision-making in urgent care Communication within and between teams Teamworking Leadership Bad leadership Managing fatigue and stress Error investigation and management Root cause analysis

Chapter 6 – Operational Performance Local and national operational guidance Settings for patient care Urgent Treatment Centres Professional roles in urgent care Communication in healthcare settings Consultation models Monitoring the delivery of patient care Targets Applying principles of equality and diversity

PART II - CLINICAL Chapter 7 – Providing Urgent Medical Care Emergency and Time-Critical Conditions Anaphylaxis Cardiac arrest Choking Meningitis Sepsis Status epilepticus Unconsciousness

Dealing with Symptoms 2WW considerations Acute abdominal pain Chest pain Collapse / syncope Haemoptysis Hyperventilation

Breast 2WW considerations Breast lump Mastitis

END OF LIFE CARE General principles Care of the dying Emergencies – catastrophic haemorrhage Emergencies – cauda equina compression lumbar spine below L1 Emergencies – hypercalcaemia Emergencies – metastatic spinal cord compression (MSCC) Emergencies – neutropenic sepsis Emergencies – superior vena cava obstruction (SVCO) Symptom management – anorexia Symptom management – anxiety Symptom management – breathlessness Symptom management – constipation Symptom management – cough Symptom management – delirium & confusion Symptom management – diarrhoea Symptom management – fatigue Symptom management – gastrointestinal obstruction Symptom management – hiccups Symptom management – insomnia Symptom management – nausea & vomiting Symptom Management – oral health Symptom management – pain Symptom management – respiratory secretions

Cardiology Angina Acute coronary syndromes - unstable angina / NSTEMI Acute coronary syndromes - STEMI Aortic dissection Brady and tachy-arrythmias Electrical Injury Left ventricular failure / pulmonary oedema Pericarditis Uncontrolled atrial fibrillation Uncontrolled hypertension

Dental Acute dental and gum infection

Dermatology Abscess Cellulitis

Ear Nose and Throat Bell’s palsy Loss of hearing Otitis externa Otitis media Sinusitis TMJ dysfunction Tonsillitis Vertigo

Endocrine, Haematology & Metabolic 2WW considerations Addisonian crisis Hyperglycaemic crisis / diabetic ketoacidosis Hypoglycaemia Hyperkalaemia Hypokalaemia Hypernatraemia Hyponatraemia Thyrotoxic crisis

Gastroenterology and General Surgery 2WW considerations Acute appendicitis Acute cholecystitis Acute pancreatitis Anal pain Constipation Diverticulitis Gastroenteritis Gastrointestinal bleed - lower Gastrointestinal bleed - upper Haemorrhoids Hernia Intestinal obstruction Peptic ulcer

Mental Health General Considerations Acute distress including bereavement Mental health ‘crisis’ Depression and suicidal ideation Severe behaviour changes

Musculoskeletal Low back pain Olecranon bursitis

Neurology 2WW considerations Acute confusional state / delirium First fit Headache Migraine Status epilepticus Stroke / CVA Subarachnoid haemorrhage TIA

Obstetrics and Gynaecology 2WW considerations Abnormal vaginal bleeding Ectopic pregnancy Gynaecological pain Pre-eclampsia Menorrhagia Vaginal bleeding in pregnancy Vaginal discharge

Ophthalmology Blepharitis Conjunctivitis Corneal abrasions and ulcers Peri-orbital cellulitis The red eye

Respiratory 2WW considerations Acute asthma - moderate Acute asthma - life threatening COPD Pleural effusion Pneumonia / LRTI Spontaneous pneumothorax

Urogenital 2WW considerations Acute epididymitis / epididymo-orchitis Acute prostatitis Balanitis Renal c