emergency department elearning modules - bradford.pdf

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Document Produced by B Wilson, A Khan, S. King July 2009, Review Nov. 2009

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The Bradford Emergency Department E-Learning and Core Competency Workbook.

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/N<IG!N<I!:<!AGGFGG!AX@G!]9<;KAE!,_!,,!L<Go!1!AX@G!L<G!,_!9FC!

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%@G?>GGFG!G@C9@Y@?A9?F!<Y!0#!@9:F;HAE!]NFA;:![E<?BG_!

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[<X!<;!UJb!<Y!#^

1<<BG!Y<;!(!IAHF!@9HF;G@<9!]AEIAPG!A[9<;KAE!@Y!@9!,_!,,_!fD4M^

%@G?>GGFG!G@C9@Y@?A9?F!<Y!(!IAHF!@9HF;G@<9

1<<BG!Y<;!/(!FEFHA:@<9W=FL;FGG@<9

%@G?>GGFG!:NF!G@C9@Y@?A9?F!<Y!/(!FEFHA:@<9W=FL;FGG@<9

1<<BG!Y<;!<:NF;!Y@9=@9CG!!4!=FE:A!IAHF_!5!IAHF

%@G?>GGFG!G@C9@Y@?A9?F!<Y!=FE:A!A9=!5!IAHFG!]NPL<BAEAFK@A^

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$GBG!G:>=F9:!@Y!:NFP!NAHF!A9P!e>FG:@<9G

'HF;AEE

50% 50%

communication clinical


25

)*.!(FA?N@9C

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fJh!N<;@q<9:AE!:<!fD_!A9:F;@<;!AX@EEA;P!E@9F

fMh!N<;@q<9:AE!:<!fJ_!K@=4AX@EEA;P!E@9F

1FHFE!U!59=F;G:A9=@9C!]ALLE@F=!G?@F9?FG^

%@G?>GG!:NF!?<KK<9!EFA=!;FHF;GAEG!A9=!:NF@;!

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1FHFE!V!59=F;G:A9=@9C!]A=HA9?F=!G?@F9?FGWKA9ACFKF9:^

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0NAGF!Dh!;FG:@9C!KFK[;A9F!L<:F9:@AE_!N@CN!8!LF;K@A[@E@:P

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KA@9:F9A9?F!<Y!:N@G!FEF?:;@?AE!C;A=@F9:!@G!=>F!:<!HA;@<>G!@<9!L>KLG!A9=!FX?NA9CF!KF?NA9@GKG_!@9?E>=@9C!:NF!-Am48m!@<9!

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26

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(NF!0*,!EA[!@G!Y>EE`!

(AGBh!%F:F;K@9F!:N@G!LA:@F9:Gd!G>@:A[@E@:P!Y<;!:N;<K[<EPG@G`

2A;B@9C!?;@:F;@A -<:

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#FH@FIG!LA:@F9:h!AGBG!:@K@9C!<Y!LA@9

'YYF;!A9AECFG@A

)G:A[E@GNFG!LA:@F9:G!B9<IEF=CF

7A;YA;@9

+AFK<LN@E@A

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5LLF;!6!E<IF;!.,![EFF=@9C

/F;@<>G!HAC@9AE![EFF=@9C

0;FC9A9?P

+PLF;:F9G@<9!/PG!"0!nUTTKK+._!%@A!n!SUT

+@G:<;P!G>CCFG:@HF!<Y!%@GGF?:@<9

$<;:@?!A9F>;PGK

0;FH@<>G!G:;FL:<B@9AGF

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'HF;AEE

20%

70%

10%

examination communication clinical


27

(N;<K[<EPG@G!+@G:<;P


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:F;KG!<Y!K@9>:FG_!N<>;G_!=APG`

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E<GG!<Y!#!7AHF_!%APGh!g!IAHF!]nT`TD!GF?!@9!=>;A:@<9!A9=!nUJb!NF@CN:!<Y!:<:AE!g#/^

,9!9<94/(!FEFHA:@<9!2,!:NF!:@K@9C!@G!HA;@A[EF!A9=!:NF!)*.!GN<IG!N<;@q<9:AE!/(!=FL;FGG@<9!

A9=!=FFL!@9HF;:F=!(!IAHFG`

1FHFE!U!59=F;G:A9=@9C!]ALLE@F=!

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1A?:A:F!=FNP=;<CF9AGFh!;@GFG!GE<IEP_!LFABG!

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(;<L<9@9!,h!;@GFG!e>@?BEP_!LFABG!SU!N<>;G_!

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1%+S!;@GFG!SQ!N<>;G_!LFABG!DQ!N<>;G_!;FKA@9G!FEFHA:F=!Y<;!J!=APG


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=APG!@9!(,2,!,,"`

Score Risk Factor 0-1 4.7% 2 8.3% 3 13.2% 4 19.9% 5 26.2% 6-7 40.9%


28

0A;A?F:AK<E!'HF;=<GF!+@G:<;P

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$GBG!A[<>:!FHF9:G!EFA=@9C!>L!:<!:NF!G>@?@=F!A::FKL:

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$GBG!A[<>:!LAG:!KF=@?AE!N@G:<;P!@9?E>=@9C!

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rQ!=@G?NA;CF!AY:F;!KF=@?AEEP!Y@:!A9=!LGP?N!?<9G>E:

nQ!E@BFEP!:<!;Fe>@;F!N<GL@:AE!A=K@GG@<9

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'HF;AEE

20%

30%

50%

history communication clinical


29

0A;A?F:AK<E!'HF;=<GF!+@G:<;P


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30

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80%

10%

10%

communication clinical procedure


31

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32

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10%

20%

70%



33

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Neurological disorders Group 1 Group 2

1. Simple Faint Definite provocational factors with associated prodromal symptoms and which are unlikely to occur whilst sitting or lying. Benign in nature. If recurrent, will need to check the 3 “Ps” apply on each occasion (provocation/prodrome/postural).

No driving restrictions. DVLA need not be notified.

No driving restrictions DVLA need not be notified

2. Loss of consciousness/ loss of or altered awareness likely to be unexplained syncope and low risk of re-occurrence These have no relevant abnormality on CVS and neurological examination and normal ECG.

Can drive 4 weeks after the event.

Can drive 3 months after the event.

3. Loss of consciousness/ loss of or altered awareness likely to be unexplained syncope and high risk of re-occurrence Factors indicating high risk: (a) abnormal ECG (b) clinical evidence of structural heart disease (c) syncope causing injury, occurring at the wheel or whilst sitting or lying (d) more than one episode in previous six months. Further investigations such as ambulatory ECG (48hrs), echocardiography and exercise testing may be indicated after specialist opinion has been sought.

Can drive 4 weeks after the event if the cause has been identified and treated. If no cause identified, then require 6 months off.

NB Cough Syncope as above Can drive after 3 months if the cause has been identified and treated. If no cause identified, then licence refused/revoked for one year.

4. Presumed loss of consciousness/loss of or altered awareness with seizure markers The category is for those where there is a strong clinical suspicion of epilepsy but no definite evidence. The seizure markers act as indicators and are not absolutes – unconsciousness for more than 5 mins. -amnesia greater than 5 mins -injury -tongue biting -incontinence -remain conscious but with confused behaviour -headache post attack

1 year refusal/revocation.

5 years refusal/revocation.

5. Loss of consciousness/loss of or altered awareness with no clinical pointers This category will have had appropriate neurology and cardiac opinion and investigations but with no abnormality detected.

Refuse/revoke 6 months

Refuse/revoke 1 year


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30%

20%

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10%

history examination management clinical


35

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36

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30%

20% 20%

30%

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37

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INF9!A!=<?:<;!I@:N!:NA:!GB@EE!:<!L;<H@=F!:N@G!L;<?F=>;F!@G!L;FGF9:`


38

0AF=@A:;@?!#FG>G?@:A:@<9!]";FA:N@9C!%@YY@?>E:P^

+@G:<;Ph!(N@G!LAF=@A:;@?!LA:@F9:!NAG![;FA:N@9C!=@YY@?>E:@FG`

(AGBh!0;FLA;F!:<!;F?F@HF!:N@G!LA:@F9:`!$GGFGG!A9=!:;FA:!:NF!LA:@F9:`!

2A;B@9C!?;@:F;@A -<:

*<KLEF:F=

0A;:@AEEP

*<KLEF:F=

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$GGFK[EFG!)%!:FAK

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$[EF!:<!?AE?>EA:F!7)(&$.!A9=!>GFG!=<GACF![<A;=!<;!

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(ABFG!NA9=<HF;!Y;<K!)2(WLA;AKF=@?WYAK@EP

%FK<9G:;A:FG!A!$"*%)!ALL;<A?N

$GGFGGFG!A@;IAP!]A@;IAP!KA9>HF<>;FG!A9=!A@;IAP!

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$GBG!Y<;!N@CN!YE<I!<XPCF9!H@A!9<94;F[;FA:NF;!KAGB

$GGFGG![;FA:N@9C![P!E<<B_!E@G:F9!A9=!YFFE!][HK!

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*<KKF9:G!<9!FYY<;:_!FYY@?A?P!A9=!FYYF?:!<Y![;FA:N@9C

(A?NPL9<FA_!A@;!F9:;P_!?NFG:!FXLA9G@<9_!;F?FGG@<9_!

A??FGG<;P!K>G?EF!>GF_!AEA;!9AGAF!YEA;F_!G:;@=<;!A9=!

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A9=!?<KKF9:G!<9!KF9:AE!G:A:F

$GBG!Y<;!:FKLF;A:>;F!A9=![E<<=!G>CA;

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/>KK<9G!NFEL!ALL;<L;@A:FEP

#FYF;GWNA9=<HF;G!LA:@F9:!@9!A!?EFA;!KA99F;

'YYF;G!FXLEA9A:@<9!:<!LA;F9:G!A9=!@9H@:FG!e>FG:@<9G

'HF;AEE

20%

20%60%

examination communication clinical


39

0AF=@A:;@?!#FG>G?@:A:@<9!]";FA:N@9C!%@YY@?>E:P^


7NA:!A;F!:NF!A9A:<K@?AE!=@YYF;F9?FG![F:IFF9!@9YA9:G!A9=!A=>E:!>LLF;!A@;IAPp

(NF!@9YA9:!NAG!A!K<;F!G>LF;@<;!@9!9F?B

(NF!@9YA9:dG!)L@CE<::@G!@G!GN<;:F;_!A9CEF=!K<;F!<HF;!CE<::@G

,9YA9:!f<?AE!?<;=G!A;F!GEA9:F=h!A9:F;@<;!?<KK@GG>;F!K<;F!@9YF;@<;

,9YA9:!1A;P9X!@G!?<9F4GNALF=h!9A;;<IFG:!A:!G>[CE<::@?!?;@?<@=!;@9C

,9YA9:!:@GG>FG!A;F!/<Y:F;_!K<;F!LE@A[EFh!KAP![F!CF9:EP!YEFXF=!<;!;<:A:F=!A9:F;@<;EP

,9YA9:!:<9C>F!@G!;FEA:@HFEP!EA;CF;`

,9YA9:!NFA=!@G!;FEA:@HFEP!EA;CF;h!9A:>;AEEP!YEFXF=!@9!G>L@9F!L<G@:@<9`!


7NA:!A;F!:NF!9<94A9A:<K@?AE!=@YYF;F9?FG![F:IFF9!:NF!LAF=@A:;@?!A9=!A=>E:!A@;IAPGp

S`!3<>9C!@9YA9:G!NAHF!;FEA:@HFEP!EFGG!<XPCF9!;FGF;HF!A9=!A!C;FA:F;!<XPCF9!?<9G>KL:@<9`

U`!3<>9C!@9YA9:G!]EFGG!:NA9!ALL;<X@KA:FEP!U4V!K<9:NG^!A;F!<[E@CA:F!9<GF![;FA:NF;G`

V`!3<>9C!?N@E=;F9!]FGLF?@AEEP!SU4UD!K<9:NG!<Y!ACF^!NAHF!A!;FEA:@HF!L;<LF9G@:P!:<!AGL@;A:F!

Y<;F@C9![<=@FG!]Y<<=_!?<@9G^`

D`!2<;F!L;<9F!:<!1@YF4:N;FA:F9@9C!@9YF?:@<9Gh!?;<>L_!FL@CE<::@:@G_!;F:;<LNA;P9CFAE!A[G?FGG_!

[A?:F;@AE!:;A?NF@:@G

J`!.AG:;<FG<LNACFAE!;FYE>X!@G!e>@:F!?<KK<9!@9!@9YA9:G`!


+<I!=<!P<>!?AE?>EA:F!:NF!.*/!<;!@9YA9:G!A9=!?N@E=;F9p


40

0GP?N@A:;@?!)XAK@9A:@<9

+@G:<;Ph!(N@G!LA:@F9:!@G!?<KK@::F=!GFEY!NA;K!mW4!ACC;FGG@HF

(AGBh!$GGFGG!:N@G!LA:@F9:!A9=!=F:F;K@9F!:NF@;!G>@?@=F!;@GB

2A;B@9C!*;@:F;@A -<:!

*<KLEF:F=

0A;:@AEEP!

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*<KLEF:F=

7AGN!NA9=G_!,9:;<=>?:@<9_!?<9Y@;KG!@=F9:@:P!<Y!LA:@F9:

$LL;<L;@A:F!@9:F;H@FI!;<<K_!?NALF;<9F!<;!GF?>;@:P

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*<9G@=F;G!<;CA9@?!?A>GF!A9=!AGBG!Y<;![AGFE@9F!<[GF;HA:@<9!

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GA:>;A:@<9_![E<<=!G>CA;_!:FKLF;A:>;F

'[:A@9G!N@G:<;P!<Y!FHF9:G_!02+_!%+_!LGP?N@A:;@?!N@G:<;P

$GGFGGFG!$LLFA;A9?F!W![FNAH@<>;

$GGFGGFG!/LFF?N

$GGFGGFG!2<<=!k!=FL;FGG@<9_![@<E<C@?AE!GPKL:<KG_!G>@?@=AE!

:N<>CN:G

$GBG!A[<>:!+AEE>?@9A:@<9G

$GGFGGFG!(N<>CN:!=@G<;=F;

$GGFGGFG!*<C9@:@HF!Y>9?:@<9!@Y!;Fe>@;F=

$GGFGGFG!,9G@CN:

$GBG!A[<>:!GFEY!NA;K_!G>@?@=F_!K<:@HF_!LEA99@9C

5GFG!/$%!0)#/'-/!G?<;F!:<!AGGFGG!G>@?@=F!;@GB

2AEF!GFX!]S^

$CF!rSRP;G!<;!nDJP;G!]S^

%FL;FGG@<9!<;!N<LFEFGG9FGG!]U^

0;FH@<>G!G>@?@=F!A::FKL:!]S^

)X?FGG@HF!AE?<N<E!<;!=;>C!>GF!]S^

#A:@<9AE!:N@9B@9C!E<GG!]U^

/FLA;A:F=_!I@=<IF=!<;!=@H<;?F=!]S^

';CA9@GF=!A::FKL:!]U^

-<!G<?@AE!G>LL<;:!]S^

/:A:F=!Y>:>;F!@9:F9:!]U^


*AE?>EA:FG!G?<;FG_!/>KKA;@GF!Y@9=@9CG_!A9=!KA9ACFKF9:

'HF;AEE

10%

10%

80%

examination communication management


41

0GP?N@A:;@?!)XAK@9A:@<9


,9!:NF!?<9Y>GF=!ACC;FGG@HF!LA:@F9:!E@G:!M!<;CA9@?!?A>GFG!<Y!:NF!LA:@F9:dG!?<9=@:@<9`!],Y!P<>!>GF_!

Y<;!FXAKLEF_!GFLG@G_!5(,_!L9F>K<9@A_!:N@G!I@EE!?<>9:!AG!<9F!KA;B^

*-/!@9YF?:@<9!]2F9@9C@:@G!W!F9?FLNAE@:@G^

*-/!:>K<>;

+PL<CEP?AFK@A

%;>CG!W!AE?<N<E!@9:<X@?A:@<9!<;!I@:N=;AIAE

+PL<X@A

/>[A;A?N9<@=!NAFK<;;NACF

0<G:@?:AE

$?>:F!KF:A[<E@?WF9=<?;@9F!=@G:>;[9?F


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LA:@F9:p!

#@GB!AGGFGGKF9:!Y<;!H@<EF9?F

5GF!=FG@C9A:F=!@9:F;H@FI!;<<K!k!AEA;K_!<>:IA;=!<LF9@9C!=<<;_!I@9=<I_!?EFA;!<Y!L<:F9:@AE!

IFAL<9G

,9Y<;K!GF9@<;!KFK[F;!<Y!9>;G@9C!G:AYY!P<>!A;F!GFF@9C!LA:@F9:

*NALF;<9F_!<;!J!K@9>:F!?NF?BG!H@A!I@9=<I

]A;;A9CF!Y<;!GFLA;A:F!e>@F:!;<<K_!A;;A9CF!G>YY@?@F9:!NFEL

*<9G@=F;!GF=A:@<9_!)9G>;F!:;A@9F=!G:AYY!AHA@EA[@E@:P_!L;<:F?:!GFEY^


,9!:NF!H@<EF9:!LA:@F9:!IN@?N!=;>C!@G!;F?<KKF9=F=!@9!:NF!-,*)!C>@=FE@9F!Y<;!GF=A:@<9!]C@HF!

=<GF!A9=!;<>:F^p

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mW4!NAE<LF;@=<E!J4STKC!,2


42

*NFG:!#<F9:<C;AK!,9:F;L;F:A:@<9

+@G:<;Ph!(N@G!?NFG:!X4;AP!@G!Y;<K!A!LA:@F9:!IN<!NAG!L;FGF9:F=!I@:N!

GN<;:9FGG!<Y![;FA:N`!

(AGBh!%FK<9G:;A:F!N<I!:<!@9:F;L;F:!:N@G!?NFG:!X4;AP!>G@9C!A!

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2A;B@9C!?;@:F;@A -<:

*<KLEF:F=

0A;:@AEEP

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%F:F;K@9FG!9AKF!<Y!LA:@F9:_!=A:F!<Y!Y@EK_!ACF!<Y!LA:@F9:`

$GBG!Y<;!A![;@FY!N@G:<;P!<Y!L;FGF9:A:@<9

5GFG!A9!@9@:@AE!<HF;AEE!;FH@FI

1<<BG!Y<;!<[H@<>G!A9=!FXLF?:F=!Y@9=@9CG!

$=Fe>A?Ph!?<KKF9:G!<9!:NF!Y<EE<I@9C

"<;=F;Gh!F9:@;F!E>9C!Y@FE=G!H@G@[EF

0F9F:;A:@<9h!:N<;A?@?!HF;:F[;AF!GFF9![FN@9=!NFA;:![<;=F;

#<:A:@<9h!?EAH@?>EA;!NFA=G!:<!GL@9<>G!L;<?FGG!=@G:A9?F

,9GL@;A:@<9h!L<G:F;@<;!;@CN:!ST:NWSS:N!;@[G!H@G@[EF

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2AP!>GF!Y@9CF;!:<!:;A?F!FA?N![<9F

/<Y:!:@GG>FGh!+FA;:!]?A;=@<:N<;A?@?!;A:@<^_!KF=@AG:@9>K_!N@EA_!

=@ALN;ACK

1>9CGh!>GFG!EFY:!:<!;@CN:!GPKKF:;P_!?<KLA;FG!@9:F;:N<;A?@?!

KA;B@9CG!A:!FA?N!@9:F;?<G:AE!GLA?F!I@:N!:NA:!<Y!:NF!<:NF;!G@=F

5GFG!A!GPG:FKA:@?!ALL;<A?N!IN@EF!I<;B@9C!:N;<>CN!*Z#

$[EF!:<!?EAGG@YP!=@YYF;F9:!LA::F;9G!<Y!@9?;FAGF=!L>EK<9A;P!

<LA?@Y@?A:@<9G

&<?AE!$@;GLA?F!%@GFAGFh!L9F>K<9@A_!0)_!9F<LEAGK

%@YY>GFWK>E:@Y<?AEh!L>EK<9A;P!<F=FKA_!L9F>K<9@A_!

NAFK<;;NACF_!9F<LEAGK

&@9F!;F:@?>EA;!LA::F;9h!$?>:Fh!@9:F;G:@:@AE!L>EK<9A;P!<F=FKA_!

@9:F;G:@:@AE!L9F>K<9@:@Go!*N;<9@?h!EPKLNA9C@:@?!KF:AG:A:@?_!

GA;?<@=_!?<EEFCF9!HAG?>EA;!=@GFAGF_!Y@[;<G@9C!AEHF<E@:@G_!

;FG<EH@9C!L9F>K<9@A

*<A;GF!;F:@?>EA;!LA::F;9h!+<9FP?<K[!E>9C!]F9=G:ACF!

L>EK<9A;P!Y@[;<G@G^_!**&!<;!L9F>K<9@A!I@:N!>9=F;EP@9C!*'0%

#F:@?>E<9<=>EA;!LA::F;9h!GAKF!AG!;F:@?>EA;

2@E@A;P!LA::F;9h!("_!Y>9CAE_!fA;@?FEEA_!/@E@?<G@G_!/A;?<@=_!*<AE!

I<;BF;G!E>9C_!)<G@9<LN@E@?!C;A9>E<KA

-<=>EA;!LA::F;9h!]nV?K^_!9F<LEAGK_!Y>9CAE!<;!LA;AG@:@?_!GFL:@?!

FK[<E@_!#NF>KA:<@=!9<=>EFG_!7FCF9F;dG!C;A9>E<KA:<G@G

$[EF!:<!Y<;K!A!=@YYF;F9:@AE!=@AC9<G@G![AGF=!<9!:NF!

N@G:<;P!<Y!L;FGF9:A:@<9_!ACF!A9=!Y@9=@9CG

'HF;AEE

50%

30%

20%

communication clinical procedure


43

*NFG:!#<:F9:F;<C;AK!

,9:F;L;F:A:@<9

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7NA:!A;F!:NF!E<[FG!<Y!:NF!E>9CG!

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#@CN:!E<IF;!E<[Fh!AL@?AE_!A9:F;@<;!

[AGAE_!KF=@AE![AGAE_!EA:F;AE!

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7NA:!A;F!:NF!;FGL@;A:<;P!?A>GFG!<Y!?E>[[@9Cp

1>9C!?A9?F;_!KA@9EP!EA;CF4?FEE!]VJb!<Y!AEE!?AGFG^_!9<:!GFF9!Y;Fe>F9:EP!@9!GKAEE!?FEE!E>9C!

?A9?F;_!,9:F;G:@:@AE!E>9C!=@GFAGF_!(>[F;?>E<G@G_!/>LL>;A:@HF!E>9C!=@GFAGF!]E>9C!A[G?FGG_!

FKLPFKA_![;<9?N@F?:AG@G_!?PG:@?!Y@[;<G@G^_!2FG<:NFE@<KA


44

+FA=!,9\>;P

+@G:<;Ph!(N@G!LA:@F9:!NAG!G>YYF;F=!A!+FA=!,9\>;P

(AGBh!$GGFGG!:NF!LA:@F9:!A!=F:F;K@9F!9FF=!Y<;!@9HFG:@CA:@<9G!A9=!

Y<;K>EA:F!A!KA9ACFKF9:!LEA9`

2A;B@9C!?;@:F;@A -<:

*<KLEF:F=

0A;:@AEEP

*<KLEF:F=

*<KLEF:F=

7AGNFG!NA9=G_!@9:;<=>?:@<9

5GFG!A!$"*%)!ALL;<A?N!=>;@9C!L;@KA;P!G>;HFP

$GBG!Y<;!N@G:<;P!<Y!FHF9:G_!>GFG!AEE!;FG<>;?FG!AHA@EA[EF

]LA:@F9:_!I@:9FGGFG_!$K[>EA9?F!0#&_!9>;G@9C!9<:FG^

$GGFGG!$@;IAP!A9=!KA9ACFG!ALL;<L;@A:FEP!@9?E>=@9C!

9FF=!Y<;!?F;H@?AE!GL@9F!?<9:;<E!mW4!@KK<[@E@qA:@<9

$GGFGG!";FA:N@9C!A9=!KA9ACFG!ALL;<L;@A:FEP_!@9?E>=@9C!

<XPCF9!A9=!"f2!HF9:@EA:@<9

$GGFGG!*@;?>EA:@<9!A9=!KA9ACFG!ALL;<L;@A:FEP_!@9?E>=@9C!

,f!A??FGG![E<<=G!A9=!,f!YE>@=G

%F:F;K@9FG!K<G:!ALL;<L;@A:F!E<?A:@<9!:<!KA9ACF!:NF!

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$GGFGG!%@GA[@E@:P!>G@9C!:NF!.EAGC<I!?<KA!G?AEF!A9=!

=F:F;K@9FG!9FF=!Y<;!@9:>[A:@<9!].*/!rQ^

)XL<GFG!LA:@F9:!AG!9FF=F=

$GBG!Y<;!:FKLF;A:>;F!A9=![E<<=!G>CA;

$GBG!Y<;!N@G:<;P!<Y!FHF9:G!I@:N!;FCA;=!:<!

AGGFGG@9C!AK9FG@A!<Y!FHF9:G!]@Y!9<:!L;@<;^

$GBG!A[<>:!0AG:!KF=@?AE!N@G:<;P!][EFF=@9C!=@G<;=F;G^

$GBG!A[<>:!=;>C!N@G:<;P!]@F!IA;YA;@9^

$GBG!A[<>:!G<?@AE!N@G:<;P!]GAYF!=@G?NA;CF^

$GGFGGFG!*-/!A9=!0-/!AG!9FF=F=

$GGFGGFG!9F?B

$GGFGG!NFA=!I<>9=!@Y!L;FGF9:

&<;K>EA:FG!A!;FAG<9A[EF!A9=!GAYF!KA9ACFKF9:!LEA9!

@9?E>=@9C!@9HFG:@CA:@<9!]X4;AP_!*(^!A9=!:;FA:KF9:!]:F:W:<X_!

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%@G?NA;CFG!LA:@F9:!I@:N!NFA=!@9\>;P!A=H@GF_!

A9=!Y<;KG!GAYF:P!9F:!AG!ALL;<L;@A:F


'HF;AEE

40%

20%

40%



45

+FA=!,9\>;P


7NA:!A;F!:NF!EAPF;G!<Y!:NF!GB>EEp

/B@9_!0F;@<G:F>K_!"<9F_!%>;A!KA:F;_!$;A?N9<@=_!0@A!KA:F;

7NA:!A;F!:NF!A9A:<K@?AE!=@YYF;F9?FG![F:IFF9!:NF!Y<EE<I@9C!:PLFG!<Y!@9:;A?;A9@AE![EFF=Gp

/>[=>;AE!NAFKA:<KAh![F:IFF9!:NF!=>;A!A9=!A;A?N9<@=!KA:F;

)X:;A=>;AE!NAFKA:<KAh![F:IFF9!:NF!=>;A!KA:F;!A9=!:NF!GB>EE

/>[A;?N9<@=!NAFK<;;NACFh![F:IFF9!:NF!A;A?N9<@=!A9=!L@A!KF9@9CFAE!EAPF;G

%@YY>GF!AX<9AE!@9\>;Ph!%AKACF!:<!7N@:F!2A:F;!:;A?:G


7NA:!A;F!:NF!-,*)!@9=@?A:@<9G!Y<;!@KKF=@A:F!*(!+FA=!L<G:!:;A>KAp• GCS less than 13 on initial assessment in the emergency department. • GCS less than 15 at 2 hours after the injury on assessment in the emergency

department. • Suspected open or depressed skull fracture. • Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid

leakage from the ear or nose, Battle’s sign). • Post-traumatic seizure. • Focal neurological deficit. • More than one episode of vomiting. • Amnesia for events more than 30 minutes before impact.

,Y!E<GG!<Y!?<9G?@<>G9FGG!<;!AK9FG@A• Age 65 years or older. • Coagulopathy (history of bleeding, clotting disorder, current treatment with warfarin). • Dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an

occupant ejected from a motor vehicle or a fall from a height of greater than 1 m or five stairs).


7NA:!A;F!:NF!FKF;CF9?P!=FLA;:KF9:!:;FA:KF9:G!Y<;!;A@GF=!@9:;A?;A@9@AE!L;FGG>;Fp

#A@GF!:NF!+FA=!<Y!:NF![F=!:<!VT!=FC;FFG

fF9:@EA:F!:<!E<I!9<;KAE!L*'U

2A@9:A@9!?F;[;AE!LF;Y>G@<9!L;FGG>;F!A9=!L;FHF9:!NPL<:F9G@<9

2A99@:<E!UTTKE!UTb

(;A9GYF;!:<!9F>;<G>;C@?AE!>9@:


46

-F?B!)XAK@9A:@<9

+@G:<;Ph!(N@G!LA:@F9:!NAG!G>G:A@9F=!A9!@9\>;P!:<!:NF!9F?B!A9=!@G!9<I!

?<KLEA@9@9C!<Y!9F?B!LA@9`!

(AGBh!%F:F;K@9F!:N@G!LA:@F9:G!9FF=!Y<;!?F;H@?AE!GL@9F!@KK<[<E@qA:@<9_!

AGGFGGKF9:!A9=!X4;AP`!!)XAK@9F!:NF!LA:@F9:G!>LLF;!E@K[`!

2A;B@9C!*;@:F;@A -<:

*<KLEF:F=

0A;:@AEEP

*<KLEF:F=

*<KLEF:F=

7AGNFG!NA9=G_!@9:;<=>?:@<9_!?<9Y@;KG!LA:@F9:!@=F9:@:P

.A@9G!HF;[AE!?<9GF9:!A9=!FXLEA@9G!L;<?FGG!<Y!FXAK@9A:@<9

)G:A[E@GNFG!KF?NA9@GK!<Y!@9\>;P!A9=!9FF=!Y<;!@KK<[@E@qA:@<9!

]%A9CF;<>G!KF?NA9@GK!<Y!@9\>;Ph!YAEE!Y;<K!n!S!K!<;!J!G:A@;Go!

AX@AE!E<A=!:<!NFA=!k!Y<;!FXAKLEF_!=@H@9Co!N@CN4GLFF=!K<:<;!

HFN@?EF!?<EE@G@<9o!;<EE<HF;!K<:<;!A??@=F9:o!F\F?:@<9!Y;<K!A!K<:<;!

HFN@?EFo!A??@=F9:!@9H<EH@9C!K<:<;@GF=!;F?;FA:@<9AE!HFN@?EFGo!

[@?P?EF!?<EE@G@<9`^

$GBG!A[<>:!LA@9!A9=!<YYF;G!A9AECFG@A

%F:F;K@9FG!@Y!GAYF!:<!AGGFGG!9F?B!

]/AYF!AGGFGGKF9:!?A9![F!?A;;@F=!<>:!@Y!LA:@F9:h!IAG!@9H<EHF=!@9!A!

G@KLEF!;FA;4F9=!K<:<;!HFN@?EF!?<EE@G@<9o!@G!?<KY<;:A[EF!@9!A!G@::@9C!

L<G@:@<9!@9!:NF!FKF;CF9?P!=FLA;:KF9:o!NAG![FF9!AK[>EA:<;P!A:!A9P!

:@KF!G@9?F!@9\>;P!A9=!:NF;F!@G!9<!K@=E@9F!?F;H@?AE!GL@9F!:F9=F;9FGGo!<;!

@Y!:NF!LA:@F9:!L;FGF9:G!I@:N!=FEAPF=!<9GF:!<Y!9F?B!LA@9`^

2A@9:A@9G!@9!E@9F!@KK<[@E@GA:@<9!A:!AEE!:@KFG!]>GFG!NFELF;!A9=!

?NF?BG!:NFP!A;F!A[EF!:<!ALLEP!@9!E@9F!@KK<[@E@GA:@<9^`

#FK<HFG![E<?BG!A9=!<LF9G!<>:!:NF!?<EEA;_!]9<!G>==F9!<;!

FX?FGG@HF!K<HFKF9:G^

,9GLF?:G!9F?B!;FC@<9!Y<;![;>@G@9C_!GIFEE@9C_!I<>9=G!F:?

0AELA:FG!?F9:;AE!*4/L@9F!Y<;!:F9=F;9FGG!<;![<CC@9FGG!A9=!:NF9!

LA;AHF;:F[;AE!;FC@<9!FA?N!G@=F

$GGFGGFG!=F;KA:<KFG!]E@CN:!:<>?N!I@:N!?<::<9!I<<E_!LA@9!I@:N!

GNA;L!<[\F?:^h!*J!;FC@KF9:AE![A=CF_!*M!:N>K[_!*O!K@==EF!

Y@9CF;_!*Q!E@::EF!Y@9CF;_!(S!@99F;!AGLF?:!FE[<I

$GGFGGFG!2P<:<KFG!]2#*!G?AEF!T4J^h!*J!GN<>E=F;!A[=>?:@<9_!

*M!FE[<I!YEFX@<9_!I;@G:!=<;G@YEFX@<9_!*O!FE[<I!FX:F9G@<9_!*Q!

Y@9CF;!YEFX<;G_!(S!Y@9CF;!A[=>?:@<9

$GGFGGFG!;FYEFXFGh!*J![@?FLG_!*M!G>L@9A:<;_!*O!:;@?FLG_!

*Q!Y@9CF;!YEFX<;G

$GBG!LA:@F9:!:<!;<:A:F!NFA=!DJ!=FC;FFG

$GGFGGFG!LA:@F9:!ALL;<L;@A:FEP

$LLE@FG!@KK<[@E@qA:@<9!ALL;<L;@A:FEP!]@Y!9FF=F=^

/>KKA;@GFG!Y@9=@9CG!A9=!KA9ACFKF9:!LEA9

'HF;AEE

20%

10%

10%

60%

examination communication management history


47

-F?B!)XAK@9A:@<9

1FHFE!S!59=F;G:A9=@9C

7NA:!A;F!:NF!Y<>;!@KL<;:A9:!A9A:<K@?AE!?>;HFG!<Y!

AE@C9KF9:!<9!EA:F;AE!9F?B!X4;APp

$9:F;@<;!HF;:F[;AE!E@9F

0<G:F;@<;!HF;:F[;AE!E@9F

/L@9<EAK@9A;!E@9F

(@LG!<Y!:NF!GL@9<>G!L;<?FGGFG

1FHFE!U!59=F;G:A9=@9C

7NA:!A;F!:NF!@9=@?A:@<9G!Y<;!?F;H@?AE!GL@9F!X4;APGp

0A:@F9:!?A9!9<:!A?:@HFEP!;<:A:F=!:NF!9F?B!DJ!

=FC;FFG

-<:!GAYF!:<!AGGFGG!K<HFKF9:!<Y!:NF!9F?B

-F?B!LA@9!A9=!K@=E@9F!:F9=F;9FGG!LE>Gh!ACF!nMJ!<;!

=A9CF;<>G!KF?NA9@GK`

(<!A@=!@9!>;CF9:!FX?E>G@<9!<Y!?4GL@9F!@9\>;P

7NA:!A;F!:NF!-,*)!?;@:F;@A!<Y!=A9CF;<>G!@9\>;P!

;FCA;=@9C!?F;H@?AE!GL@9F!@9\>;@FGp

%A9CF;<>G!KF?NA9@GK!<Y!@9\>;Ph!YAEE!Y;<K!n!S!K!<;!J!G:A@;Go!AX@AE!E<A=!:<!NFA=!k!Y<;!FXAKLEF_!=@H@9Co!

N@CN4GLFF=!K<:<;!HFN@?EF!?<EE@G@<9o!;<EE<HF;!K<:<;!A??@=F9:o!F\F?:@<9!Y;<K!A!K<:<;!HFN@?EFo!A??@=F9:!

@9H<EH@9C!K<:<;@GF=!;F?;FA:@<9AE!HFN@?EFGo![@?P?EF!?<EE@G@<9`

7NA:!A;F!:NF!@9=@?A:@<9G!Y<;!*(!<Y!:NF!?F;H@?AE!

GL@9F!@9!:;A>KAp

.*/rSV_!0A:@F9:!NAG![FF9!@9:>[A:F=_!0EA@9!

Y@EKG!A;F!@9A=Fe>A:F_!*<9:@9>F=!?E@9@?AE!

G>GL@?@<9!=FGL@:F!9<;KAE!Z4;APG_!0A:@F9:!@G!

[F@9C!G?A99F=!Y<;!K>E:@4;FC@<9!:;A>KA!

1FHFE!V!59=F;G:A9=@9C

7NA:!A;F!:NF!-)Z5/!1<I4#@GB!*;@:F;@A!Y<;!

?F;H@?AE!GL@9F!;A=@<C;ALNPp

*F;H@?AE!GL@9F!;A=@<C;ALNP!?A9![F!<K@::F=!

INF9!AEE!:NF!Y<EE<I@9C!A;F!L;FGF9:h

-<!L<G:F;@<;!K@=E@9F!:F9=F;9FGG_!-<;KAE!

AEF;:9FGG_!-<!FH@=F9?F!<Y!@9:<X@?A:@<9_!-<!Y<?AE!

9F>;<E<C@?AE!=FY@?@:_!-<!LA@9Y>E!=@G:;A?:@9C!

@9\>;@FG

7NA:!A;F!:NF!?<KL<9F9:G!<Y!:NF!<Y!:NF!

*A9A=@A9!/L@9F!#>EFp

/FF!<LL<G@:F


48

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=@YYF;F9:@AE!=@AC9<G@G!A9=!KA9ACFKF9:!LEA9`

2A;B@9C!?;@:F;@A -<:

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0A;:@AEEP

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$GBG!Y<;![AGFE@9F!'"G

$GBG!Y<;!"E<<=!/>CA;!A9=!(FKLF;A:>;F

(;FA:G!E@YF!:N;FA:F9@9C!FEFKF9:G!INF9!Y<>9=!

]NPL<X@A_!E<I!"2^

$GGFGG!LA:@F9:!Y<;!NFA=!@9\>;P

(ABFG!A!N@G:<;P!<Y!FHF9:G!EFA=@9C!:<!A::F9=A9?F

$GBG!A[<>:!:@K@9C!A9=!=>;A:@<9!<Y!?<9Y>G@<9

(ABFG!A!:N<;<>CN!LAG:!KF=@?AE!N@G:<;P

(ABFG!A!:N<;<>CN!%;>C!N@G:<;P!]@9?E>=@9C!AE?<N<E_!

9A;?<:@?G_!<L@A:FG_![F9q<=@AqFL@9FG!A9=!=;>CG!I@:N!

A9:@?N<E@9F;C@?!A?:@H@:P^

,Y!>9A[EF!:<!<[:A@9!N@G:<;P_!:NF9!FXL;FGGFG!9FF=!:<!

?<9:A?:!.F9F;AE!0;A?:@:@<9F;WCF:!N<GL@:AE!9<:FG

0F;Y<;KG!A!;FH@FI!<Y!GPG:FKG

)XAK@9FG!:NF!Y<EE<I@9C!AG!ALL;<L;@A:Fh

*F9:;AE!9F;H<>G!GPG:FK_!0F;@LNF;AE!9F;H<>G!GPG:FK_!

*A;=@<HAG?>EA;!GPG:FK_!#FGL@;A:<;P!GPG:FK_!$[=<KF9_!

2F9:AE!G:A:F!@9?E>=@9C!?<C9@:@<9

$[EF!:<!Y<;K!A!=@YYF;F9:@AE!=@AC9<G@G

';=F;G!@9HFG:@CA:@<9G!AG!ALL;<L;@A:Fh

$".!Y<;!?A;[<XPNAFKACE<[@9!A9=!L'U_!&"*_!56)_!1&(_!

*AE?@>K_!"E<<=!?>E:>;FG_!>;@9AEPG@G_!"SU!A9=!(&(!@9!:NF!

FE=F;EP_!=;>C!:<X@9!G?;FF9_!*(!NFA=

,9G:@:>:FG!(;FA:KF9:!AG!ALL;<L;@A:F

'XPCF9_!%FX:;<GF_!(N@AK@9F_!/FLG@G!0A:NIAP_!=;>C!

A9:@=<:FG_!F:?``

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'HF;AEE

20%

30%

30%

20%

examination communication clinical history


49

$?>:F!*<9Y>G@<9AE!/:A:F


7NA:!@G!:NF!=@YYF;F9?F![F:IFF9!=FE@;@>K!A9=!=FKF9:@Ap

%FE@;@>K!@G!A!G>==F9!<;!A?>:F!]N<>;G!:<!=APG^!=@G:>;[A9?F!@9!?<C9@:@<9!A9=!A!

=F?;FAGF=!EFHFE!<Y!?<9G?@<>G9FGG`!!,:!@G!A!KF=@?AE!FKF;CF9?P!A9=!@G!:;FA:A[EF`

,:!@G!AEG<!?<KK<9!@9!LA:@F9:G!I@:N!=FKF9:@A`

%FKF9:@A!@G!L;<C;FGG@HF!=F:F;@<;A:@<9!<Y!?<C9@:@<9!I@:N!A!?EFA;!?<9G?@<>G9FGG`!!,:!@G!

CF9F;AEEP!@;;FHF;G@[EF`

!


7NA:!A;F!:NF!?<KL<9F9:G!<Y!:NF!.EAGC<I!*<KA!/?AEFp

Glasgow Coma ScaleGlasgow Coma ScaleGlasgow Coma Scale

Eye Opening spontaneously

to speech

to pain

none

4

3

2

1

Verbal Response orientated

confused

inappropriate

incomprehensible

none

5

4

3

2

1

Motor Response obeys commands

localises to pain

withdraws from pain

flexion to pain

extension to pain

none

6

5

4

3

2

1


7NA:!A;F!:NF!?<KL<9F9:G!<Y!:NF!$[[;FH@A:F=!2F9:AE!(FG:!/?<;Fp

$[[;FH@A:F=!2F9:AE!(FG:!/?<;F

S` +<I!<E=!A;F!P<>p

U` 7NA:!:@KF!@G!@:p!]9FA;FG:!N<>;^

V` $9!A==;FGG!Y<;!;F?AEE!A:!F9=!<Y!:FG:!4!:<![F!;FLFA:F=![P!:NF!LA:@F9:_!F`C`!DU!7FG:!(F;;A?F

D` 7NA:!PFA;!@G!@:p

J` 7NA:!@G!:NF!9AKF!<Y!:N@G!LEA?Fp

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O` 7NA:!@G!P<>;!%A:F!<Y![@;:N

Q` 7NF9!IAG!:NF!/F?<9=!7<;E=!7A;p

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ST` *<>9:![A?BIA;=G!Y;<K!UT!:<!S

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50


51

Doctor Starts

Work in the

Normal Fashion

Sel

f L

earn

ing

On Shopfloor Off Shopfloor

Doctors

Undertakes

On-line

Module

One-

To-O

ne

Tea

chin

g

Doctor

Returns to

Shopfloor for

Assessment

And Teaching

Ref

lect

ion

Doctor Returns

to Normal Duties

with New

Knowledge

Understading

Competency

Focused

Continued

Learning

Appraisal

Doctors

Obtains

Feedback and

Completes

eportfolio and

Competency

Reflective

Practice

Self

Reflection

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$9ALNPEAX@G_!$GGFGGKF9:!<Y!:NF!/F;@<>G!,EE!$=>E:_!$GGFGGKF9:!<Y!:NF!/F;@<>GEP!,EE!*N@E=_!

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! ! ! ! S! U! V! D! J

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$"._!/P9?<LF_!$9ALNPEAX@G_!$=HA9?F=!1@YF!/>LL<;:_!%@YY@?>E:P!";FA:N@9C!]0AF=@A:;@?^_!

0GP?N@A:;@?!+@G:<;P_!*NFG:!Z4;AP!,9:F;L;F:A:@<9_!+FA=!,9\>;P_!-F?B!,9\>;P_!$?>:F!*<9Y>G@<9

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!!!!7<;GF!! !!!!-<!,KL;<HFKF9:!!!!!!!!!!/<KF!@KL;<HFKF9:!!!!!!!!!!!!!!2A\<;!,KL;<HFKF9:

O`!7F;F!P<>!A[EF!:<!<[:A@9!A!?<KLF:F9?Pp!]*@;?EF!<9F^! ! ! 3FG! ! -<

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Q`!+<I!I<>E=!P<>!;A:F!:NF!:N@G!:FA?N@9C!FXLF;@F9?F!?<KLA;F=!I@:N!P<>;!L;FH@<>G!:FA?N@9CGp

!!!!7<;GF!! !!!!-<!,KL;<HFKF9:!!!!!!!!!!/<KF!@KL;<HFKF9:!!!!!!!!!!!!!!2A\<;!,KL;<HFKF9:!

3<>;!<L@9@<9!KA::F;Gu!

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! ! ! ! ! ! ! ! ! ! ! ! (NA9B!3<>u


52

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