4 'r:

- prol l n \ Descr r hethctr r ncnr '

? r r ,d '.
"' "' ts"" i' ' "'
,..'n i n th c nh n tns

Wh i r : h o l t l . , t s e - s r - . : r r : : '- i l c D l i a t e f o r u r b a n o r b u i l t-
u p a r e a s ?F o r r u r a j r r a , r : ' a '- '. ':r e : . s o n sa n d e x a m p le s.

Wh L c l r t V p e . [ r e 1 : -. : .: :.l]tyoutcountry?

f) nc qtnl nr k tnor Ir ,r , I "t ( r r F ) nnF :l tor r nr r )

- ,t

Listening
for detail
/-
r [ \ l p rLl;^+^'^ +^ ^ ^^'^- - ^- ^^
>Lc r r LU d Lv l r v El ) dti on betw eer r .r doc tor and a
't ,i , ' il
patient.Write down asmany detarlsr. voll Lanabout
' l ***-
i;'55s,,
what you hear.Compareyour answe15\\'lth a partner.
t- nm nl c tc r r nnv nf the for m on ...nr oc
,,- .,t."t1 I l\

( i l i l L l S t e nt O t n e C O n V e -1- r ;^5- a L t od- ^r-B ,- ,.] r l .^ ^

i - a - l l d r l L lL r l c r lL
-, O m p a l e

notes aga1n.

Check your details with the rest of the class

 medicine5
E mergency

In thi s uni t
o rapi dtensechange

?
o adverbsof manner
r thi rd partyi ntervi ew i ng
a compari son
c conti nui ngprofessi onal devel opment

Vocabulary
Adverbs:describinghow things happened
1 Adverbscan help to describehowthings happened
and help to make a diagnosis.Lookat these statements
fromlistenin4 l and underline the adverbs.

...ut{.ttt4ndlttq Barbara, *oft, j,^*t

^/
ffutd. wetnkJ tojet h,eru,prighta/4d
slu ttalted. h,,itchlft! qtw\evbl,ent{y.

Underline the most appropriate adverbinthese

sentences.
1 The fainting? It just happenedabruptly / gradually /
s/owly.The next thing I knew she was lying
completely fl at on the pavement.
2 The patient suddenlybecamepale and startedto
sweat,but notprofusely / rapidly / enormously.
3 After the attack,Mr Jonescameto rapidly / slowly/
leisurely,whichquestionswhether it was a seizure.
4 Embarrassingly / Gradually/ Clearly,lsoiiedmyself
and wet myself.It wasn't very pleasant.
5 Shewas lying flat, but bystanderswere trying to Patientcare
keepher upright, so shewas twit ching slowly/ I Decidewhether theseitems aretechnicalor non-
convulsively / suddenly. technlcal.Then match them with correspondingwords
6 As he couldn't seegood / clearly/ visual/y,he got and phrasesin Vocabulary2.
quite frightened.
post-icta1
7 In a selzure,there is typically / rarely/ seldomno
b fit
prodrome,but this is not alwaysthe case.
c to be lncontinent of stool
8 After collapsing,he didn't get betler spontaneously/
d syncope
slowly/ gradually.Thepatient was a bit drowsy for
e d vvdrr LrtLE )rBrr
-,.,^--i-^-i^-
quite a while aft erwards.
f to beincontinentof water
9 He recoveredcompletely/ partially / poorlyfrom the
o suprne
accident.Nowhe's perfectly OK.
h to gointo spasm, but not reallyjerking
10 Fainting and vomiting don'treliably / partially /
1 to tell the difference(between)
clearly discriminate seizuresfrom faints.
Ideally,when speakingto a patient,you should use
Work in pairs.Decidewhether the statementsin 2 are
non-technicalwords. Sometimes,you can make the
Iikely to be said by a patient or a medical professional.
mistake of using technicalwords.Work in pairs and
practisegiving lay terms or your own explanationsfor
the technical words above.

EX A MPLE
pArIENr: I'm sorry,butwhat'sa prodrome?
What doessupinemean?
D ocroR : It' sa...Itmeans...It' sw here,..
6 U nit 1

?
comecve r (v)sud de nl yf eel
999 (n )the n umb erd ialledf or
emer ge ncyca llsin the U K

Speaking 2 Placesentences1.2.8.9. and 15on the timeline.

Work in pairs.Studythe information in the form you

completedfor Listeningl. Taketurns role-playing a a-b-c 1 d-e-
doctor asking questionsto elicit the information from
the patient who fainted inthe street.
J'JJJI Now

Completethe sentencesusing the verbs in bracketsin

the correctpasttense.

1W e (walk) along the street when she

(pass)out suddenly.
>ne (havenever)the pain before
till now, but she (expenencejsome
bleeding the flrst time.
3 Afterhe (admit),he
(become)suddenlyworse,but he'sstarted
o languagespot respondingto treatment.
Rapidtensechange 4H e (never suffer) a fit before, but he

Understandingthe sequenceof eventsand hencethe (feel)unwell sincethis morning.

tensesis important for correctdiagnosis.What arethe 5H e (yawn) repeatedly,which he
tensesofthe highlightedphrases? (not do) before,and then he just
:Wewere shopping in Cambridge Street in town, when
(faint).
suddenlyBarbara,my wife,2just fainted. 3Wetried
6 Afterhe (fail),he
to get her upright and ashestarted twitching quite
violently. slt was quite scary.6Shecame round very (start)twitching violently when we
rapidly.But 7wedialled 999 and a paramedicappeared (try)to get him up.
almost instantly and then the ambulance almost 7 When she (lie)on the ground, she
rmmediately afterwards.8Shehad been complaining
(not shake)at all.Then shejust stood
of feeling a bit unwell, and ehad almost fainted and
: :she felt a bit woozy. tlShewas a bit dizzy and 12she up.
r,,zsyawning repeatedly andthen all of a sudden, 8 What actually (happen)when she
'=ere she was, Iying on the ground. When I come to (fall)?
-,--- i :::: :-he passedout once before about a month
9H e (bite)his tongue and he
agr Sftrchasn't been feeling well on and off over the
..---:: .Llhthought it was the heat. (mess)himself and he
(feel)a bit groggy since

::; l:- Cor.t)

t:.L
-
 b u t t o nb a t t e r y( n )a s m a l lr o u n o€; :
battery

?
Useeachofthe tensesin bracketsonceonly asyou
expand these notes into sentences.
1 We eat in a restaurant.I suddenlyfeel woozy.I faint.
This never happen before.(SESP, PC,PresPerfl
2 Ahmed never be ill beforebut feel unwell yesterday.
He abruptly crled and then passout. (PastPerf,SP,SP)
3 We travel by train to the city. He not eat sincethe
morning. He vomit and we come straight here.(Sf;
PastPerf, SP,PC)
4 Mary havefainting fits for the past few days.Shedo
a lot of running around when it happen secondtime.
Shenever havethem before.And none of us have
them, either. (PC,PresPerf Cont,PresPerf, SP, PresPerfl
5 Sheget out bed when she come over all giddy,but
she have it before, so we think nothing of it. (Sf;5l
PastPerf, PC)

Work in pairs and describeyour day so far, pointing out

'. whatyouhave done sofartoday
+ things you haven't done yet
t' things youwere doingwhile doing something else
'" andthings you had done beforeyou did something.
6 Role-playthese situations.
1 StudentA, go to page 114.StudentB,take a history
from StudentA. Write notes asyou listen and decide
what the patient's complaint is.
2 StudentB,go to page 116.StudentA, take a history
from Student B.
Speak ing
W ork i n groues.)::-::' .' ,-..a:i ..-ci l c' rerhe mai n signs
and symptornsvc: 'i,-:;.c expeCrn a case
1 where an othen,,':sei: 30-year-oldman presents
with pneurr,or:aai A&E or
2 where a n-.otherpresentsat A&E with a child who
has swallor.veda button battery.

) Girto Grammar referenceI ll8 You are going to role-playthe history.Decidewhich two
of theseitems you want to focuson in the assessment
of the role-play.Givereasonsfor your choice.
t]'e qpnr r pnr p nfthe tgngg5

the grammatical accuracyof the tenses

the accuracyofthe descriptionelicited by the doctor
the useof non-technicallanguage
fluency
Work with a partner from another group.Eachchoose
one of the two scenariosin L Agree on the two items
you want to be assessedon.Takea history from your
patient. The patient should make a few notes about the
doctor'sperformance.When you have finished,give
feedbackto your partner about your own performance
and then invite comments from your partner.
Rememberto begin wlth positive comments and use
constructivecriticism.
8 U nit 1

traffi<-busting(adj)able

^
to get throughroad
conge stio n
{raa ,,n , rc =:<r

It's my job
',\:.at do you think the work of a cycleparamedic 4 Is the bike the most effrcientrapid responsemeans
::.r,'olves?What do you think are the advantages or is this not mentioned?
:: a cycleparamediccomparedto a conventional 5 Doesthe cycleparamedlcresponsetime in the West
ambulance? End exceedor equal the government benchmark?
Work in pairs.Skim the text and the questionsin 3 4 Workin groups.lstheemergencysystemsimilaiin
quickly and decidewhat the text is about. your own country? Giveexamples.How do you think
the system describedbelow could operatein urban /
Answerthe questions.
rural areasin your country?
1 Do cycleparamedicsin London'sWest End
arrive at the sceneas rapidly as or more rapidly than
conventionalambulances?
Is the paramedic'sbike equippedwith only a basic
FirstAid Kit or more sophisticatedequipment?
In seriouscases,arethe conventionalambulance
andthe cycleparamedicssent simuitaneouslyor are
the latter sent first?

JohnRhys
My name is JohnRhys,and l'm one of a team of four
cycleparamedics of the LondonAmbulanceService's
traffic-busting bicyclea m bulanceservice. We attend
999 emergencycallsin the Cityof London- the
fi nanc ialc ent r ec a l l e dth e Sq u a reM i l e .T h eb i k ei ts el f
is the sameas those usedby the successful cycleunits
operatingin London's West End,which regularlyreach
oatientsfastertha n conventiona I am bulances.
Theteam'sbikesarefitted with blue lightsand sirens,
catrya rangeof equipment,includinga heart-starting
oxygen,pain-relieving
defibrillator, gas,and evena
maternitypackfor deliveringbabies.
Wherethe patientis believedto be in a life-
th r eat eningc ondi ti o nw, e a res e n ta t th e s a meti m e touristswhovisitthe areaeachyear.Usingthe bike
as a regularambulancecrewso that we can start givesusanopportunity to savepotentially
vital
treatmentbeforethey arrive.Wherethe patientis seconds in startingtreatment,especially
in the narrow
understoodto be sufferingfrom a more minor injury streetswhichwe cannegotiate morequicklyand
o r illnes swe
, ar ein i ti a l l ys e n to n o u r o w n a n dth e n easilythanambulances. Forexample, mycolleagues
areableto requestfurther assistance - freeingup in theWestEndCycle Response Unitregularly reach
ambulances to attendother,more potentiallylife- 100percentof the mostserious,'Category Al 999calls
th r eat ening, 999c a l l se l s e w h e rei n th e C i ty . withineightminutes.This responseismuchquicker
llore than 300,000peoplework in the Cityof London thanthe government standardfor thiscategory of
a"d their numbersareswelledbv the severalmillion callof75percent.
 : - a '; a ' :t

C u i d e l i n e ps u b l i s h e db y t h e A m e r i c a nl i e a - : ! . , : : , -. .'
statethat for everyminuteof delayin gettir:a1: . : .- .- -
s f s u c c e s s f ur le s u s : , : : -
i n c a r d i a ca r r e s t . t h ec h a n c e o
decrease by 10 percent.

o Languagespot 4 Work in pairs.Compareyour life now as a student /

worker with the past.Usethese adjectives/ adverbs:
Comparativeand superlativeadjectives hard / easy;stimulating / dull; relaxing / stressful;
and adverbs
complicated/ simple.Givereasonsand examples.
Look at /t's my job. Can you find examples of
)) Co to Grammar referencep 1lB
comparativeand superlativeadjectivesand adverbs?
E XA M P L E
...reachpatientsfu;lstthan conventionalambulances Listening2
Completethe sentenceswith a word from the list. Descriptionof an emergencyincident
Add any necessarywords to indicate comparativeor
Lookat the picture
superlativeand make any necessarychangesto the
and describethe
adjectiveor adverb. as as

sıkuykurlu canlı h arasıma

equipment. What do
drowsy frequent lively long ke you think is the benefit
to
bad serious shallow violent wet golsa of such equipment on
ş!ddetl! olacok
.
s!g cycleambulances?
zarf
I This time Jessicatook longer to improve
than before. f) risten to a case
Shedidn't twitch as v!dent asthe last time.
study about an
incident at Heathrow
3 I t s the wworst I have ever had. It was agony. Airport. Write down as
4 Is this attack than the last time. or much detail asyou can,
not as bad? Comparenoteswith a
less drowsy partner.
5 He's than he was about ten minutes
ago.He'scoming to gradually f) tisten again and write down the verb only in each
missing step.
6 Natalia appearsa bit than the last
1 Gary Edwardshad been relaxing.
timewe sawher. She'srunning around.
2 He developeda severepain in his chestand arms.
7 How haveyou been coping with the weather?It's
He lost uncons!cous
much wetter
.
J
than last year.
HErbreathing is skallower than before. 4 His respirationceased.
q called 999
9 Peopleseemto be coming in with this
6
more frequently than last year.
7 A cycleparamedicarrivedfasterthan the ambuiance.
Expandthe part ofthe sentencesin italics adding
8 He continuedresuscitation.
a comparativeor superlativein eachcase.Insome
sentences,both more and lessmay be used. 9
than
b!gger
1 He is much big the last time you brought him to seeus. 10 Paramedics,dispatchedin an ambulance,turned up
hosp!tel
the bast

2 This is byfar goodhospital I have everbeen in. a few minutes later.

the most pa!nsevere

3 How does this compareto severepain you've had?

than to walth than
11
eas er

4 lt's easyto walk now itwas beforethe operation.

profuserly
more
Work in pairs and completethe rest of the missing
5 He was sweatingprofuselybefore.
!rregularly theen
more details.
6 His heart is beating irregularlybefore.It's almost
back to normal. stressed thon less
In groups,discusswhetherthis type of rapid response
7 I'm pleased.Johnis stressedhe was last year. would work in your country. Give reasons and
8 He needsexerciseto getthe full movement back. examples.
mwork exerc!se
i
l O Unit 1

(v)start

?
' j- ir ' la: : -
3 Correctthesestatementsaboutthetextbychanging
or removingwords.
' 1 All doctorskeepa written log of their CPD.
- -'-- \'-)r)
) trvto ke enr r nt odat ewit hc ur r ent 2 TheCollegeof EmergencyMedicineinstigatedthe
: - ' . . conm ent si n m e d i c i n e ?
How?
nroressofannrarsal .
- - s rt important to continue studying throughout
3 The GMCdocument GoodMedicalPractice(2001\
Vour medicalcareer? Why?
contributedconsiderablyto the revisionofthe
3 Lookat the title. What do you think Continuing
Collegeguidelineson CPD.
ProfessionalDevelopmentinvolves?
4 CPDis a processthat repiacesformal educationand
Find words in the text which havethe samemeaning training.
asthesewords. 5 The responsibilityfor keepingup to datelieswith
1 experienced,gonethrough the Colleseof Medicine.
2 put together,drafted,compiled,composed
3 altered,changed,modified
4 set up, introduced,started
5 lying behind,underpinning
6 pertinent,applicable
7 requirements,what you require

(iu i d e l i n e so n C on ti nu i ng P roi essional[) er .elopnr ent

Thevastmajorityof Emergency
Medicine Thisrevision guidelines
of the College on CPDisan obligatory
requirement
for all
(EM)doctorspractise
continuing CPDisbasedon: practising physicians
Medicine
Emergency
development(CPD);
professional however, . A frameworkfor ContinuingProfessional and it is up to eachdoctor[you]to keepup
not alldoctorskeepa record.
CPDhas Development-I heAcademyof Medical to date.
undergone
a dramatic
evolutionandwas RoyalColleges(February
2002) TheGMCsetout in paragraph
10of Good
initially
formalized
by an agreement
in , Guidelines
on CPDFacultyof Accidentand (September
MedicalPractice 2001)
1993by the Conference
of MedicalRoyal Emergency Medlcrne-HenryGuly,past 'Youmustkeepyourknowledge
andskills
lties.Thefirstguidancefor
Collegesand Facu Directorof CPD(2003) up to datethroughoutyourworkinglife.ln
continuingmedicaleducation (CME)for the . TheGMCguidelines
on CPD(April2004) particular,
you shouldtakepartregularly
College
of Emergency
Medicine
wasdrawn . TheGMCdocumentcoodMedicalPractice in educational
activities
whichmaintain
up in November
1995.Sincethentherehave (2001
) andfurtherdevelopyourcompetence and
beenmanychanges
dueto the introduction performanceJ
of appraisal
andrecommendations by the Pr inc iples
u n d e r l y i n gC o n t i n u i n g CPDmustbe relevantto you
However,
GMC(General Medical
Council),
andthe Professional
Development andmeetyourneedsto allowmaintenance
guidelines
wereamendedin January1999 Continuing
Professional
Development of a highqualityof patientcare.Continuing
andJanuary
2000.The
mostrecentedition (CPD) learningprocess
isa continuing that professional
development
shouldbe
:'the guidelines
waswrittenin September complements
formalundergraduate
and reflective, allowingyouto
lifelonglearning
:: i3. postgraduate
education
andtraining.
CPD developwithinthe specialty
of emergency
5 nceappraisal hasbeeninstituted and youto maintain
requires and improveyour andshouldalsosupportyou in
medicine,
' = .:iida tionisine vita ble
des pit et hedelayin standards allareasof yourpractice.
across developing
outsideor subspecialty
interests.
:-= -plementation,
the documentation
of CPDshouldalsoencourage
andsupport
: ' : :' :f CPDh asb ecom em or er elev ant . specific in yourpractice
changes andcareer ICPDGuidanceGMCApril2004]
development.
 Checklirt

^
Assess your progressin this unit.
Tick(/) the statementswhich aretrue.
I canchangetensesrapi dl y
I can understand
adverbsof manner
I cando thi rd partyi ntervi ew i ng
I can understand
comoari son
Project conti nui ngprofessional
I canunderstand
devel opment
Work in groups.Are jobs in A&E departments/ Emergency
departments popular in your country?Why / Why not?

What methods are common in your country for obtaining Keywords

jobs,e.g.recruitment by job advert,curriculum vitae (CV)
Adverbs
followed by an interview? abruptl y
embarrassi ngl y
What do you understandby a job specif.cation/ job spec?
spontaneously

N ouns
Writing apprai saI
A job application bystander
Contin uing Professiona
I Development
Lookat this extract from a job applicationform for a post in the job specification
emergencydepartment of a large city hospital. paramedi c
rapi dresponse
Setzu re
Jobapplication w arni ngsi gn
Statewhy youthinkyoushouldbe considered
for thispostBiving Adjectives
. s uit ab i l i ty
fo rth e p o s t gi ddy
. relevant groggy
experience
woozy
. t r ainin g
o qualit i e s Verbs
d ispatch
fai nt
Wrlte a descriptionof your suitabilityfor the postor a postin soi l
your speciality.Rememberthe information must be individual to twitch
you and contain genuine details. wet

5p*ck$r:g Ureful refer*ffi(m

In an interview, remember that what you sayneedsto match Oxford Handbookof EmergencyMedicine
accuratelywhat you havewritten in your job application.Work 3rdedi ti on,W yatt
et al ,
in pairs.Giveyour descriptlonfrom your job applicationin lsBN978-0-r_9-920607-0
Writing E to a partner Taketurns asking eachother about the
detailsyou wrote.Checkthe descriptionfor accuracy.

Make surethat what you are sayingdoesnot sound as if you have

learnt it by heart.Avold repeatingexactlywhat you havewritten.
U S X F U L X X P R E SSIONS
WhenI was in ...
A f f p r 'IJ ""-f i' -n- ""i < h p r l
' a- -

What makesme suitableforthepost is...

TherelevantexperienceI haveis ...
I'vefollowed varioustraining courseslike ...
As regardsmy qualities,...
 1 2 Unit 2

Checkup
1 Describethe pictures.

Vocabmffmry
Fractures
1 Match the descriptions1-8 with the types of
fracture a-h.
meydanagelmek
I 1 simple bas!t which occurswhen certain
bonesare likely to break from 6
2 avulsion avüls!yon
!
tekrarlansen

repeatedminor injuries
r 3 spiral sarmal

where the ends of a bone are 7

4 comminuted kfçlanmş
r
driven into eachother
5 crush ezmek karmaışık
a complexfracture which
-

h
6 stress
y stres
resultsin more than two bone
parça
-7 impacted etk!lenm!ş fr e om pntc
mac m

8 hairline saç!zg!s!
y
where the volume of bone is
azaltılmış
reducedbecauseit has been
sıkıştırılmış
cnm qed
nrcq

1 where there is a single fracture

of the bone with only two main
f-^ ^* ^-+-
lI4SrrrtrltL)
çıkarmak

Z f where a bit of bone is pulled off

with a ligament or muscle

What type(s)of injuries do you think can occurin 8 g whichis notveryclearand

yerdeğ!şt!rme
there is no cleardlsplacement
eachcase?

Are these accidentspreventable?Why / Why not?

3 h which is seen
sonaç
in lonq bonesas a
bükülme
result of twisting iniuries
Work in pairs.Describea fracture to your partner,who
then givesthe name.
i
 A cc ident s13

l F thi { {,rfi {t
o know l edgeaboutfractures
a descri bi ng fracturesand acci dents
$ P resentS i mpl e,P resentC onti nuous,P resentP er f ect
6 gi vi ngi nstructi ons
w i th the i mperati veandneed

o languagespot
Talkingabout the present
f,) Vou are going to hear three statementsby either a
-'E doctoror a patient.Listenand decidewho is speaklng
and what they are talking about.
(|} tisten again and write down the order in which the
tensesareused.
D 1 PresentContinuous- PresentSimple-
PresentPerfect-
p 2 PresentContinuous- PresentSimple-
PresentPerfect-

D 3 PresentContinuous- PresentSimple-
PresentPerfect-

In your own words explain why eachtense is being

used in the three statements.
Readthe statementsmade by patients and doctors.
Onetenseln eachitem is wrong.Which one is it?
çarßmak
i I just slam the door on my finger and it's bleeding a
lot. It's really painful
2 The X-ray is coming back and it showsyou have a
hairline fracture here and here.Is it hurting you at
the moment?
Yes,the doctor'sgiven me a telephone number and
l"isteningE tal maflar

written instructions in caseanything is happening

alçı alç
1
with the plaster cast.But honestly,I'm fine. I'm not
vetbtenses
Understanding !ğneler !ğneler
getting pins and needlesor anything like that.
f) fisten and match eachconversationwith a picture Yes,I've seenthe doctor and he'sgiven me some
in Checkup. painkillers.1'vejust waited for the nurseto come
b back. When shecomesback,I can go home.
1_ onarmark ger!ne düşünen
It mends rather nicely,consideringyou have had a
2_ a kúfü olduleça
rather nasty fall. But avulsionfracturesheal qulte
C !yîleşt!rmek
3_ well.
Are you wearing your neck braceall the time? Yes?
f) tisten again and write down the tenses(a-c)of the And
yen den kazam make
do you beginto regainmovement?
verbs asthey occurin eachconversation. manehats hake
t arkalerha
get rm l

I immobilize his arm with a backslabPOPand the

e P re q e n i S i m nlp göstermak
X-rayshave been done.They demonstratethe
azunsuklar
b PresentContinuous whole lengths of the radius and the ulna. I think he's
c PresentPerfect feeling comfortable.
1 2 l
}} ur i l J ?) r tr ,r r t " {" . r r " tr f
C b b
hurt hurt cry
Brvc
b
break C
fracture C

happen G
look a
i
i
i
i
 14 U nit 2

AbrahamColles,
1773-1843,
Professor
of Surgery,Dublin

Vocabulary Speaking
Causesof injury 1 Look at the X-rays.Identify the type of fracture for
patients a and b.
I Completethe sentencesusing the verbsbelow.
çarpmal yer nden çclearmak d şmuek nmele
t
banged f dislocated t fell etmele
t
landed
çebermak kaymak paramparça ez lmale
f pulled sökmanke
t
slipped f smash f squashed
kökünden tökerzlenmek tökertlemerte bükühmek

stubbed stumbled t tripped t twisted

bükmak geçmek
t twisted f went over
fewsetreek kaldaruom tang
,
~
1I tr!pped on a loosepaving stone as I was
walkins down the street and fell flat on
myface.
tur!sted
7 2I and lost my footing and
tar!stad myankle.
r

ayal par!ngt
3I banged my toe on a chair. I may have
fracturedit, but I hope I haven't.
4I banged my knee on the metal table.I am
smash
surprisedI didn't my kneecapto
d!zkapağı
preces.
tur!sted
Work i.npairs.Choosean X-ray and createa history
5i mv ankle when I went over and for the patient. Includethese details:name, sex,age,
now I can barely walk. I don't think it's broken or the presenting complaint (what the problem is,how /
burkmak
anything. It's more llkelyto be a sprain. where / when it happened,etc.),need of analgesia,and
sl!pped any other details you wish to add.
6I on the wet floor and went over and
landed Work with a partner from another pair with a different
on my bottom.
ment over scenarioand take the history up to the point ofsending
The motorbike onmyankle and
ez!lmek the patient for an X-ray.
crushedmy leg
I think I've d!slocated
4 Explainthe X-ray to the patient.
my shoulder and I can
zarzor

barely move it.

9I squashed
zorklama det
my finger in the door and it's It's my job
throbbine llke mad Work in pairs.What do you think the job of a radiologist
10 I pulled this nick out of the side of mv involves?How has the radiologist'swork changedin
fingernail and now it's infected. the last half century?

Work in pairs.Haveyou evertreated someonewho has Readthe text and answer the questions.
aslında

injured themselvesas in 1 above?Describethe case. 1 Where didMatthewJenkins originallyfindthat

çek!a!
radiology appealedto him?
2 How doeshe describethe RoyaiCollege'sbooklet?
amaç

3 What is the main purposeof radiology?

4 What doesthe radiologistseeas his role?
5 Why is it important to include the details mentioned
on the requestform?
6 Why is the radiologist'sday busy?
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 A cci d ent s15

I am gladto saythat i n th iscountrythereis no needto carryout testsasa form of

insurance.lt is not in th iscountrydesirable,or i ndeednecessa
ry,that overprotective
and
overexam inationwork should bedonemerelyand purelyas I sayto protectoneselfagainst
pos s ible
li t i g a t i o n .
-Judge Fallon,quotedby OscarCraig,ChairmanCasesCommittee,MedicalProtectionSociety.
- OxfordHandbookof EmergencyMedicine

Work in groups.Do you think the radiologist'sjob

flilatthewfenkins will becomelessor more complex in the future? Give
reasonsand examples.

M y nam eis M at t h e wJ e n k i n sa n d I a m a ra d i o l o gi st at a * Describea situation where a radlologlsthelpedyou in

almacık

h os pit alin M anc h e s teIr.d e c i d e dto ta k e u p ra d i o l ogyas vourwork.

uzmarılık çes!tl!
a specialtyafterworkingin variousother departments

r!ca
first. lt was in the A&E departmentthat my interestwas
agabreah hotara

first aroused.I was at a lossinitiallyas a youngdoctor

Writing
tupeğ t m
out of m edic alt r a i n i n ga sto h o w to m a k ea re q u est Describinga fracture
to the radiologydepartmentevenfor somethingas
Completethe list of the information which is neededto
basicas an X-ray.But I soonfound my feet.A veryuseful
keslavut

guidefor doctorsis the RoyalCollegeof Radiologists' describea fracture.

k tanpçlkr
booklet,Making the BestLtseof a Departmentof Clinical' 1 the age of the patient and how the fracture occurred

agragn
Radiology, (5thedition,London2003).Thisis a must- 2 if it is simple or compound
havefor doctorsdealingwith radiologydepartments 3 name the bone
öner len

and is highlyr ec o m m e n d e d .
4 describethe position of the fracture (proximal,

Lno
nodedos!n!n tectoman
The primaryaim of radiologyis to provideinformation supracondylar)
değ şt rmeke
i n or dert o alt erth e ma n a g e me not f th e p a ti e n t
5

-
Sona

andt he out c omeo f th e d i s e a s eS. omy fu n c ti o na s

:
mar s tutmak

a r adiologisis o n fi rma d i a g n o s i se,x c l u de

t t o h e l ptarcomharmace 6
kapsam
s om et hingim po rta n t,d e fi n eth e e x te n t,a n d mo ni tor 7
the progressof a d isease. Most of the requestsfor X-rays 8
that we receivein the departmentnow comethough
I
electronically ratherthan face-to-face with a clinician.
öyleyse !lg!h!
It is t her ef or eim p o rta n tth a t a l l re l e v a nct l i n i c a l
!çenmeke 2 Match the different elementsto this description.
i nf or m at ioninc lu d i n gth e me c h a n i s m o f th e i n j ury
dah l olmans
with the sideinvolved. bloodtests.recent
şüphel
radiological fi ndings,a nd suspected 2 9 -y e,a,r-oW vndnt vnotor"cy d,t *t w ftIv w Typ a
c l i n i c adl i a g n o s i iss g i v e no n the I co'ynpou d/ fra"ctl^.red/1p,fr hlovneru.y. It &

ma
foode
requestform.Without the benefitof vni'vnrn6ll'y diaple&A, oL'vd,i,ywolu e*Llvz
b e i n ga b l eto e x a mi n eth e p ati ent, hu.'vnq"aL thaft w (71vvw vtB,t+t w a&<^^lnr
hayatî
a l l o f th i s d e ta i li s c ru c i a l . co'n1Dtofii,,e/...
darrum

F o rm ss h o u l da l s os ta teh o w the
soruşturma çözrmek
investigation will help resolvethe
karşı Write descriptionsfor the X -raysin Speakingon page
c l i n i c apl ro b l e mfa c i n gth e doctor 14.In eachcasethe patient is a 4O-year-oldfemale
and stateany investigations on policeofflcer.
the requestform ifthe doctor
yerçlmak
th i n k sth e yw i l l ta k ep l a c e .

!
E a c hd a ym y s c h e d u l e
i s fu l l a s I try
th e n e e d sa n d
to b a l a n c e
" prioritiesof different
departments.
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 16 Unit 2

Speaking Reading
1 Workin groups.Whichof theseX-raysshowsan
avulsionfracture?What dothe otherX-ravsshow?

+lnpeuB ur ernpe4 dpq p

Moqls pallnd r Beforeyou read the text, answerthe questions.
meydama galmerk
3l{uE eq}Jo arn}JErJuorsFuv q 1 Where do you think the majority of accidentsoccur:
plrqJ e ur mrue; eqllo arnperg alaldruoJul e the home,work, or. in the street?
!yatkn
sraMsuv 2 Which groups of societyare more prone to
toplum
accidents?
öneneb!l!r
Checkyour answers.Preparea short presentationofno 3 Are accidents at work generally preventable?
more than five minutes explaining one or more of the
Skim the text and match the headingswith the
following:
appropriate paragraph A-D.
* the X-ray
1 Accidentsinthe home C
e the likely causes
2 Accidentsinthe workplace D
c the symptoms
3 Accidentsand children A
r the treatment.
4 Accidentsandthe elderly B
Chooseone or more studentsfrom your group to
Find words and phrasesin the text which have the
presentthe X-ray to the rest of the class.Make the
samemeaning asthese.Items 1-7 are not in the order
presentationand invite comments atthe end of the
they occurin the text.
presentation. bel!rt!lm!s doğalolarak
1 stated 5 asamatterofcourse
zayıflık
4 Give constructive feedback for each presentation, 2 deaths aras nda
6 weakness
katılmak
fack rter
choosingtwo of these criteria:organization,relevance, 3 amongthe poor 7 attending
teşv k ed c

Jlu enry, clinicalaccuracy,g rammatical accuracy. 4 encouraging

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 Accidents17

pressuresore(n)decubitusulcer
multifactorial(adj)involvingmany
featuresor elements
chippanfires(n)firescreatedfrom
cookingchipped potatoesin hotfat

4 Answer the questionsabout the text.

1 Among children,which group had the greatest
mortality rate? s to th years old
.
soc!o groups

.
2 Among which group are accidentsmore frequent? The lower

-econom!c
3 What kind of help should be offeredto the elderly
duyarlı
who are susceptibleto falls?
kaymaklar
4 What arethe main sourcesof accidentalfires in
homes?
kaçınıyor
5 What are doctorsresponsiblefor averting?

Accidents
yönengeler
A In 2004,therewere230child NICEguidelines were issued During2005/ 2006therewere
ölümler meden gle meslek!
değerlend!rme
fatalitiesdue to accidents in 2004on the assessment and 148,713occupational injuries
önleme

in Englandand Wales,the preventionof fallsin older reported,of which212werefatal.

highesnum t b e rsb e i n gi n people.Theystatethat older All placesof work are potentially sonday bankes
!l!s!nden b!r!
f ive-to fourteen-year-olds. The peopleshouldbe askedroutinely dangerous whetheran oil rig,a
enmyaggın kömürmadenc!l!ğ!
commonest causeof accidental if they havefall.e-n in the past coal mine,a factory,an office,or
sunmak

injuryin childrenpresenting year.Thosewho havefallen,or a kitchen.TheHealthand Safety

düşünülem yönet c bel!nlenm!ş kurallar
to UKhospitalsisfalls.Others thoseconsidered at riskof falling, Executive hasstipulatedrules
boğuşu boğulma
includesuffocatingand choking, shouldhavea multifactorial aboutsafetyin the workplace.
yanık değerlend!rme
burnsand scalds, and poisoning. fallsriskassessment and should It alsohasthe necessary powers
Demat m müdahaleler !nşelemek zorlamak
A recentreport by the Audit be considered for interventions to inspectand enforcethem.
kom nyon yupranmalş
Commission andthe Healthcare includingthoseto improvetheir Safetyequipmentmustbe worn.
kuwwet kaıldırmak takt r ed ld

Commission statesthat eachyear strengthand balanceand remove Risksmustbe appreciated. Every

katılımlar tekl!keler
therearetwo millionattendances anyhomehazards. workplaceshouldhavea safety
to accidentand emergency C In EnglandandWalesin 2004, officerwho isresponsible for
savuraun

departmentsby childrenasa therewere 3,892accidental deaths identifyingdangerand advocating

r€sultof accidents that might have in and aroundthe home.Those action.As doctors,we havea
önlenm ş gören haberdar
önterm erder olmack

beenprevented. Accidents are mostat riskof seriousor fatal duty to be awareof measures to
omake ğne
ergel oyaı
morecommonin the lowersocio- injuryin the homeareyoung preventinfectionand needle-stick
economicgroups. c h i l d renandthe el derl y. Fal l s injury.
cırılganlık
Frailtyand healthproblemsmake arethe mostcommontype of
özelk kle

the elderly.particularly thoseover accident.

!ffa!ge tesk lants kat ld
,
the ageof 75,at increased riskof In 2004,fire brigadesattended
accidents, usuallyoccurringin the 442,700fires in the UK.Therewere
home.Fallsarethe mostcommon 508fire-related deathsand 14,600
yeters!z
cause.Inabilityto get up after non-fatalcasualties. A large
oran

fallingputsthe personat riskof proportionof fires in homeswere

basınkyaraları kazaraelam

hypothermiaand pressure sores. accidental, the maincauses being

yankışkullanım c hazhar
Hipfracturesafterfallsarea major misuseof equipment/ appliances
hcastalık ökümoranı fr töz

causeof morbidityand mortality. a n dc hi ppanfi res.

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18 Unit 2

s,rfety* et (n)a re mindert o t he

patientthat theycancomeback
if th erearea nych an gesor if
anythin gh ap pe ns

ilistem$mg
ffi Note:avoidusingyou haveto ...andyou must...(on
its own without r/).
Accidentpreventionmeasures
Underline the alternatlvesin italics which are correct.
f) Listento the extract from a taik on accident
In somecases, more than one may be correct.
prevention measuresand tick (/) the items which are
mentioned. 1 If the arm swellsin the plaster cast,comeback/ you
X needto comeback/ you'II comebackand seeus.
1 - Advice about preventing accidentsis more
2 Don't hesitateto / Youaregoing to / you needn't
the responsibility of the government.
V contact us if it gets worse in any way.
2 - Whenweusethewordaccident,this
3 If your fingers becomediscoloured,raise/ you need
somehow signiflesthat something cannot
to raise/ you're going to raiseyour hand and try to
be avoided.
V keep it up.
3 - Simplesafety measuresand thinking
4 If the plaster castbecomestight ,you needto come
U
about the future can reduceaccidents.
back/ comeback/ try to comebackimmediately.
4 - Patientscanbe alertedtoanvriskv
5 Ifyourhandbecomesparalysed,don't wait,just
situations.
X comein / you needto comein / you needn'tcomein.
5 - P e o p l e n e e d to b e mo re a w a re o f
6 If you get any pain ln your arm, don't leaveit / you
accidentscausedby Ieisurethan by home
needn'tto leaveit / you don't needto leaveit - come
improvements.
v
straight in.
6 - Hails and stairways needto have good
7 If you get any circulation problemslike pins and
lighting.
needles,youneedto get / getyourself/ don't hesitate
7 - v
Lo o s e ru g s a n d fl o o ri n g a re d a n gerousfor
to getyoursef backhereimmediately.
old people.
8 If the castbecomesdamagedor loose,replace/ we're
What other precautionsneedto be taken at home? going to needto replace/ we needto replaceit.
Think ofthe kitchen and heatins.
i I Grarnm:rrl eference, j. l,

o languagespot
politelybut firmly
Sayingwhat's necessary
=, In certain situations when you are giving patients
information, there is not really any negotiation -
on discharging a patient or where there is no
alternative,for example.In any situation, you need
to providea'safetynet'in casesomethinghappens.

Youneed... ...to comebackand see

Don'thesitate ... us if anything unusual
nappens.

If anything ...comebackand seeus

unusual immediately.
happens,... ...you don't needto ring -
justcomein.

Y ouneed to ... ...restyour legfor awhile.

You'regoing to
haveto ...
2O Unit3

Checkup
the pictures.
1 Describe

Matchthe lay statementswith the picturesin l.

yara
listeningI
1 I'rn coveredin cutsandbruises. b Spotthe difference
2 I think I'vepulled a musclein my leg. C
3 I've got crampall down this leg. a c Q tisten. write down details of what the patient said.
,
susanzluke

4 I'm dying of thirst. d Compareyour notes with a partner.

in the pictures
What otherinjuriesarethe sportspeople Q tistento anotherversion of the same conversation.
proneto?Giveexamplesfrom your experience. Which details are different?

In groups,discussthe questions. What is the difference in the questions that the doctor
Areyou interestedin sportsmedicine?Why / V1/hy not? usesin each conversation?
What arethe advantagesof following a careerin sports Which technique is better for the patient? Which
medicine?.A,rethereany disadvantages? approach do you find easierto use?
 S portsmedi ci ne2l

In thi s uni t
a usingdifferenttypesof questions
a usi ngcol l oqui al
l anguage
a gi vi ngw arni ngsand usi ngpersuasi on
a usi ngw eak/ unstressed syl l abl es
i n speech

Vorabulary
Verbsof movement
c
In conversationl inlistening lthe doctor was just
about to give the patient some instructions.What
instructions do you think she might give the patient
':...-::-----' "
to checkthe wrist?
y y
Work in groups and match the instructions to the E
pictures.

I
E y

y
y
y y

Work in pairs.You are going to checka patient who

has a shoulderinjury from the gym. Decidewhat
y instructions you would usefor the drawings below.
Then take turns giving instructions to the patient.

U SE FU L E X P R E S S ION S
I'd (just)likeyouto ... oK.
Could/ canyoujust...forme? Fine.
I needyouto... Thankyou.
y göğüs
ls
1 Bring your knee towards your chest.
e 2 Straightenthe leg atthe knee.
çere
j 3 Putyourchin onyour chest.
e 4 Lookover eachshoulder.
5 a
Standup straight without support.
çaßranzlammack
d 6 Crossyour legsover. Bacarklor saprotla
,
eğ!lmek yana yerkeşt!rme
k 7 Leanyour head sidewaysplacing your ear on your

S 8
shoulder.
Point your toes at your head. -q
f 10
h 11

C 72
Y Fan out your toes as far as possible.
Bendthe knee asfar as you can.
bükmak
Curl your toes and then straighten your toes.
Keepyour kneestogether and spreadthe anklesas
far as possible.
1
i
 22 Unit3

No classof questionsistorrect'.Sometimes
you needto askone type ofquestion;
sometimesanother.Get good at shifting
from one kindto anotherandyou will
soonlearnto judgethe mostimportant
questionsfor the patient in front ofyou.
- OxfordHandbookof ClinicolMedicine

Signsand symptomj 3 tvtatchthe medicaltermswith wordsand phrasesin 2.

PatientYocabulary (adhesive)capsulitis bullae torticollis
furuncle hyperkeratosis paraesthesia
I Lookatthepicture.
\Alhat does it show
andwhat is the
colloquial term for
o language3pot
these? Typesof questions
2 Completethe I Usethecuestomakequestions.
sentencesusing l Havefallover? Have you falles over

?
!f you tr!p
the wordsbelow 2 Cantell ifyoutrip inthe street? Can you tell street
me

n the

Youwilluseone youhurt? B!d you hurt yourself

?
3
probstem

?
the
bodypartmore 4 What thinkthe problem? whant do you
th!nk arbout

?
thanonce.What 5 Who aroundwhenpainsetin? who s croud
when
pa!nsets
the

dothe sentences 6 Could describe what happen me? Could you descr!be what happened

?
mean? 7 How long you have chest pain? (Looking at the ma

?
koltunkaltı chest the
patient holding his chest) along your
had
How mave
pa!n
armpit --
back feet foot hand

?
r - -
8 there any other things you like talk about?Are there other th!ng any
hands
t leg neck -
shoulder
- -
arm you b ke the talk
- 9 What elseyou concern about?what else you
about about
are soncern

shoulder

?
I'vegot frozen I can'tget my arm up 10 the phlegm bronm, yellow or green? the phalegne brown yellow

?
was

,
orgren
veryfar. 2 Identify the type of question in I by using the
eğr! zarzor

I'vegotwry meck I can barely move my descriptions. More than one may be possible for each
head. answer.
kaynama
I've got what I think is a boil in my armp!t a aclosedquestion
b anopenquestion
can'tput any deodoranton.
c a leading question
I think I've pulled a muscle in my leg
to pallomah boyeonca
d apatient-centredquestion
can onlyhobble along. e a family- / work-related question
kabarcıklar avaç!ç!
I've got these blisters all over the palm of my f a prejudicial question or question suggesting the
hand answer
yırtık
-kopuk
6 I'm not surebut I think I'vetorn a ligamentin my In pairs,work out the questionsfor theseanswers.In
ş!şm!ş
fout It's swollenand I can'tget my shoe somecasesa prompt hasbeengiven.Theremay be
morethan oneanswerin eachcase.
on. hurt
nasır
1 It hurtsjust here.Where does !t
7 I'vegot a lot of calluseson the ballsof both
?
2 Well,I don't knowwhere to start really.I supposeit
feet dd
happenedjust afterI hadbeento... when thre

happen ?
parmake
Theknuckleson both
handst
elecanlar
alevlend!

have allflared 3 It'sgonecompletelyblack.How s

nc dent

!t now
?
up.I can'tgetmy ring off 4 No,not that I am awareof. (trauma:knock/ bang)
D d
you
m t someaetnere
?
5 Sittingat my
wher deskat work. (whenit's worst)
worsts the

9 I'vegotapain righthereinthe smallof my 6 Fora weeknow. How long have you had
?
back
7 No.Ican'tthinkof anything.
karıncalama

10 I've gottingling all the way down my Ieft

Aan you
th!nked about
anyth!ng
and leg
?
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 S oortsmedi cine23

standin for (v)replace

temporarily, bea locum

4 Useyour own words to completethe doctor'squestions Work in groups.Isthe conversationpatient centred?

in the conversation. What type of questionsdoesthe doctor ask?Couldyou
DocroR Goodmorning,my name is Dr Nesbitt.i'm lmprove the conversation?
standing in for Dr Ratanawhile he'son 6 Write out the conversationkeepingthe samepatient
holiday. You're Mr Finn? information, but changing the doctor'squestions
PATIXNT Yes. where youwould like to.
DO C T O R oK. 1 How oe you feel!ng D f-iotr: Grammar reference p 1.10
PATITNT Well,mmm, I'm not feeling too good.
2 what !s the problem
DO C T O R
Speaking
PATIENT Mmm.I havethis pain in myback.
3 s!nce when
has !t ex!sted Work ln pairs.Role-playDr Nesbitt (StudentA) and take
DO C T O R
the history from the patient (StudentB) inLanguage
PATIENT Acouple of weeks now. ???? spot 4 opposite.Rememberto be patient centredand
Have had before
DO C T O R 4
you ask open questions.
PATIXNT Yes.Off and on for a year or so.But never like StudentA, go to page 114.StudentB,take a history from
thls. StudentA. Write notes asyou listen and decidewhat
deta!ls
DO C T O R 5 can
you g!ve the patient'scomplaint is.
PATIENT Well, I could barely move at first. And now StudentB,go to page 116.StudentA, take a history from
it's like a dull ache.I just have to be careful StudentB.
getting up and it's not easyat all getting in
and out ofthe car either.
DO C T O R
where
6? exactly !s the pa!n
PATIENT Mmm, just here in the small of my back.
'7) Does !t hurt here
DO C T O R

PATIENT No.It staysjust here

8 when does !t hurt
DO C T O R

PATIENT Nothing really,but I can't stay in the one

position for long. And walking and lylng
down hurts too and,weli, I suppose...I
usually go to the gym quite a lot.
DO C T O R 9 D!d !t ex!st before that

PATIENT Not sincethis started.

1 0 Do dr!ve
DO C T O R you
PATIXNT Mmm.Well,I still drive,but getting down
into the car is not that easy.
DO C T O R Is it a sportscar,then?
PATIENT Yes.
24 Unit 3

ffiead**g
? Find adjectivesand nouns with similar meaning
that areusedto describenounsin the text.
1 relatedtocarryingheavyobjects
2 coveredmanypeoplescaba
3 carriedout over a period of time long!tud!nal
4 relatedto contests compet!t!ve
5 relatedto exploring and studying researche
6 worth noting s!gn!f!cart
7 relatedto questionsabout physicalactivity sports

Physicat
fitness muscle massandi mproved
femoralregionfor al[andsuggest
B MDi n the
that
A number of papers
moregeneral i ssue
address the
oftherel ati onship
andheatth if BMDis increased
reductions
at skeletalmaturity, between
mightbeachieved
sportsparticipation
in fracture behavi ours i nyoungpeopl e.
andhealth
Mi l tere t
riskin lateryears.Supporting this al (zooo)usedatafroma large-scale
A seriesof research findingsillustrates c o n c l u s i on N evi tlet
e al demonstrate the surveyofschootpupitsto illustrate that
thepositive relationships between i mp o rtance of sportsi nvol vi nghi ghpeak athleticparticipation hasbothpositive
p hy s ic al
ac t iv itay n db o n em i n e ra I strainfordetermining peakbonestatus, andnegative implications foradolescent
density(BMD)in a varietyof sub- e s p e c i a tli nyyoungmenandpossi bty for healthandrecommend waysto use
p opulat ions I n.t o n g i tu d i n a ts tu d i e s youngwomen(whoarelesslikelyto take sportfor healthpromotion. Pastor et al
u s ingv ar ious s am p l e s i z e sK, e m p e r partin suchsports). Greendale et a1, usesurveydataon fifteen-to eighteen-
et aIandPuntilta et al illustrate that in a studyof 4z-to 5z-year-old women, year-olds to conctude thatthehigherthe
regular(weight-bearin g) physicat explorefourdomains of physicalactivityl evel sofsportsparti ci pati on, thehigher
activityis significantty relatedto BMDat (sport,home,work,activeliving). They the perceived fitnessandconsequently
thelum bars pinea n dfe m o ranl e c kl.n illustrate thatbothsportandweight- enhanced perceived health,withlower
relat iont o t ot albo d ya n dl u mb asr p i n e bearing workin the homewerethebest, levelsof smokingandalcoholusealso
BMD,vanLangendonck et aI illustrate andequa[,predictors of greaterBMD enhancing healthperceptions. However,
thatthetypeof sportsparticipation is a t l u mb arsoi neandfemoral necksi tes. the relationships areonlyweakto
a significant factor,withhighimpact T h ew o rkof C heng et al rai sestheone moderate. Pyleet a['ssurveydataon
sports(ground forceshigherthanfour negative notein thisliterature, finding highschootstudents iltustratethat,for
timesbodyweight)mosteffective and thathighlevelsof physical activity malesandfemales, competitive sports
remaining beneficial fortheskeletat (running twentyor moremilesperweek) participation wasassociated witha
healthof malesaged4o.Ryanet al wereassociated withosteoarthritis lowerfrequency of mentalitt-heatth,
reportontheeffectsof sixmonths' (k n e ea n dhi pi oi nts)amongmenl ess eati nganddi etary probl ems, andtot al
wholebodyresistive trainingin both than5oyearsofage(although no risks(although therewasa higher
y oungandolderme na n dw o m e nT. h e y relationship wassuggested among frequency of sports-related iniuries).
reportthatthe programme increased w o me no r ol dermen).

In the text a number of researchers,e.g.Kemperet al, $ Work in groups.Answerthe questions.

and the focus of their researchare mentioned.Match
eachdescriptionto a researcher.
1 lookedonly at women
2 exploredinformation on older teenagersonly Pastor
3 mentioned findings relating to men and running chenf
4 made suggestions to improve health m!ller
5 researchedboth gendersovera wide agerange Ryan
,"' How can peoplebe encouragedto participate in
sport?Think, for example,of clubs,education,and
advertising.
e Is it difficult to dissuadepeoplefrom over-exercising
or exercisingwhen they areinjured?What strategies
can you use?Canyou orderor persuadethe patient?
Give an example of what you would say.
 52 R eading
bank

ng bank
Readi
t Triage
T Work in pairs. Explain what you
Triage
understand by the term triage.Compare Thenatureof triageof Emergency department workmeansthatsome
sıralarma
genahl! em nolemate
your answerwith other students. sortingsystemis requiredto ensurethatpatients withthemostimmediately
mayat tok l ke
stern aomor

areseenfirst.A triageprocessaimsto categorize

?
Readthe text. Completethe sentences life-threatening conditions
beiow using words from the text. You p a ti ents basedonthei rmedi calneedandtheavai l abldepartmental
tared
e
hanynaklar gaygonolarak
may have to change the form of the resources. Themostcommonly usedprocess intheUK is theNational
bek!rtrncl
ölçek ac!l!zet kolauylaştırmak
word. TriageScalewherethescaleof urgencyrsindicated by a colourforeaseof
1 Triageis a system where patients reference.
öncel!ll!

juctn!s!n
are prioritized for treatment to make Timeto be seenby doctor
k ra n

surethose whose problems are most butabCo

l!fe are seenimmediatelv Within5-'1
0 minutes
-threat!n!ng
am ank
!
!
.
The purposeofthe triage processis Wtltn t how
to put patients into - categon!ze
accordingto their need medically W i thi n
4 hours
kaynarklar
and the resourcesavailablein the
As soonas a patjentarrivesintheemergency department he or sheshould
değerlend rmmeke özal bg narysel
kıdemel
department. be assessedby a dedicatedtriagenurse(a senio[experienced individual
öneml d ngn sağlamak
Patientswho needto be seen w i thconS i derabl e
common sense). Thi snurseshoul dprovi de anyi mmediat e
anında bel!rt!len araya g!rmele jükseltmek uzuv atel

instantly are indicated in i n terventi on needed(egel evati ng i nj ured l i mbs,appl yi ngi ce packs or splint s,
baslatmank sorustorma

red andgivinganalgesia) and initiate investigations to speedthepatient's journey

wygun
throughthedepartment (egorderingappropriate X-rays). Patients shouldnot
If patients do not needto be
haveto waitto be triaged.lt is a briefassessment whichshouldtakeno more
seenwithin two hours,they are thana fewminutes. k!sab!lg!
değentend!rme
categorizedas non on the
-ungent
Three points requireemphasis:
scalewiththe colour blue ac!l!get bandandolayı
Triageis a dynamicprocess. Theurgency(andhencethetriagecategory)
Answer the following questions. w i thw hi cha pati ent requikösteln
res to be seenmaychangew i thti me.Forexample,
oz tele ters sev rme

1 What qualities of atriage nurse are a m i ddl e-aged manw hohobbl esi nw i than i nversi on
ankl ei nj uryi s l i kely
to
adegecen
yerhadt!r!lm!s
mentioned? an be placedintriagecategory4 (green).lf in thewaitingroomhe becomes
2 What examplesof instant treatment pale,sweatyandcomplains he wouldrequireprompt
of chestdiscomfort,
ş lvenyert göğüs rehatsızlık
terl
çabuk
are mentioned for all patients? solgun
re{riageintocategory2 (orange).
3 How long doesbet triage normallytake? !maertmak
gertes t rame - ateraa
-kogma
nakemak
Placement in a triagecategorydoesnotimplya diagnosis, noreven
4 Why is triage describedas a dynamic öldürücülük şart yaşlı kol!k

process? thelethality of a condition (egan elderlypatientwithcolickyabdominal

mutlak kabızlık

5 Whatcategorychangeisquoted
alınfı
discomfort, vomiting, andabsoluteconstipation wouldnormally be placedin
bağ!rsale tıkkarn kl k

to illustrate the dynamic process, category3 (yellow) anda possiblediagnosis wouldbe bowelobstruction).
reder tümör

standardto very urgent or very Thecausemaybe a neoplasm whichhasalreadymetastasized and is hence

urgent to standard? l i k e l vto be ul trmal elfalv al .
ölüncül
özekl!kle
Triagehasitsownproblems. In particulaIpatientsin non
-urgent
Work in pairs.Completethe text in the ken

last paragraph,using the words below: caregones maywarr !nond!nantely l o n g p e r i o d so f t i m e ,w h i l s tp a t i e nts

algılaman
ş!kayet etmayen ac l farkandedrnck who haveoresentedlater.butwithconditions oerceived to be more
uncomplaining
sabırlı
urgent aware ungent areseenbeforethem.Patients needto be anáre
nnn - r r r o e n f in o r d in n ip lr r b!lg!l!
as!r!
derecede of this and to be informedof likelvwaitinotimes,uncompla!r!ng e l d e r l y
patients
canoftenbe poorlyservedby theprocess.
yeters!z serw s
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i

3 Presentinginjurfi*s
t Work in pairs.Are accidentsat work
easilypreventable?Givereasonsand
examplesfrom the field of medicine.
2 Readthetext.In pairs,findverbsthat
meanthe same asthe following. The
verbs in the text will be in different
forms.
1 put
2 avert
3 find / isolate
4 hit
5 suggest
6 disconnect
7 connect
8 get down
9 check
10 declare
* Work in pairs.AII of the statements
below are false.Find the evidencein
the text.
1 The Summary mentions the
recommendationsas regards
health and safety in allwork
situations.
2 Threemain causesof injury by
excavatorsor backhoeloadershave
been identified from the data.
3 Cave-insare the only other mdn
factors mentioned as Ieadingto
death.
4 In Casestudy 1,the victim was
rushed to hospital.
5 In Casestudy 2,the victim was
climbing a building when the
accidenthappened.
ban k 53
R eadi ng
Preventinginjuries
whenworking
with hydraulicexcavators
and
backhoeloaders
Summary
Workerswho operateor work near hydraulic excavatorsand backhoe
loadersareat risk of being struck by the machine or its componentsor
by excavatorbucketsthat detachfrom the excavatorstick. The National
Institute for OccupationalSafetyand Health (NIOSH) recommendsthat
injuries and deathsbe preventedthrough training, proper installationand
maintenance,work practices,and personalprotectiveequipment.
Description
of exposure
A NIOSH review of the Bureauof Labour Statistics(BLS)Censusof Fatal
OccupationalInjuries (CFOI) data identified 346 deathsassociatedwith
excavatorsor backhoeloadersduring 1992-2000INIOSH 2002].Review
of thesedata and of NIOSH FatalityAssessmentand Control Evaluation
(FACE) casesINIOSH 2000,2001]suggeststwo common causesof injury:
( 1) being struck by the moving machine,swinging booms, or other machine
components;or (2) being struck by quick-disconnectexcavatorbuckets
that unexpectedly detach from the excavator stick. Other leading causesof
fatalitiesare rollovers,electrocutions,and slidesinto trenchesafter cave-ins.
Casestudy1
A 28-year-oldlabourer died after he was struck by the bucket ofa
hydraulic excavator.The victim, a co-worker,and the operatorwere
using an excavatorequippedwith a quick-disconnectbucket to load
concretemanhole sectionsonto a truck. The victim was on the ground to
connectthe manhole sectionsto the excavatorwhile the co-worker was
on the truck to disconnectthe sectionsafter they had beenloadedon the
truck. The operatorhad positionedthe excavatorbucket near a manhole
sectionwhile the victim attacheda three-leggedbridle to the manhole
sectionfor lifting. The bucket disconnectedfrom the excavatorstick
(Figure l) and struck the victim. He was pronounceddeadat the scene
INrosH 2001].
Casestudy2
A32-year-old constructionlabourer died after being struck in the head
by a backhoebucket.The victim waspart of a two-man crew clearing
earth away from the foundation footing ofa house. The backhoe
operator began digging an approximately 60 cm-wide by 60 cm-deep
excavation around the foundation while the victim used a hand shovel to
remove extra earth after the backhoe had passedthrough. The amount of
footing protruding was decreasing.The operator lowered the backhoe's
bucket to rest on a pile of earth approximately 8 ft from the victim; he
then dismountedfrom the backhoeto inspectthe trench. When the
operatorreturned to the machineand steppedover the tyre to sit down,
he inadvertentlycontactedthe boom swing control, swinging the boom
toward the victim standingin the trench. The boom struck the victim,
pinning him againstthe house.He was pronounceddeadat the scene
fNIOSH 20001.
54 Reading
bank

S #4mwdmmgemmws
$s
etu€$re9? The Big Question: Is skiing now so
Work in groups.Readthe text, then dangerous that speedlimits should
match the paragraphheadingsbelow be imposed?
to the paragraphsA-E.
1 Are theretoo many peopleon the
A It'sallrelative. There arenooverall statisticsonskiing injuriesacrossthe
s lopes ? C
world, but individual studies suggest people's fears may beexaggerated.
2 Why are boardersand skiersin
TheAviemore-based sports injuryresearch facilityski-injury.comreports
conflict? E
thatonly1.74alpine skiers per1,000 willsustain aninjury,sostatistically
3 Sohas skiingbecomevery high-
it'ssafer thanagame offootball. Inaddition, onlytenpercentofskiing
risk? A
injuries are caused through collisions.Most are caused bytheskier either
4 Are helmets the answer?D
falling overorskiing intoatreeorother object.
5 How hard is it to avoid skiing into
someone?B Mostaccidents happen whenpeople gettired,sothelastrunoftheday
istraditionally quitebusy foremergency services. Even onthewidest of
Work in palrs.Useno more than three skiing motorways, it isverypossible tocollide withanother skier - spatial
words from the text to completeeach awareness isa keyelement to mastering alpine skiing.Certain resortshave
senrence. 'pinch points'where a lotoftraffic passes attheendofthedayaspeople
1 Accordingto research,
skiing is funnel downthemountain, andwhenboyracers losepatience anddecide
lessdangerousthan playing a t0queue-jump theorderly procession, people getknocked over.
game football
to theSki(lubofGreatBritain(SCGB),
on

According since2001thetotalsnow
2 Acruciaifactorinbecoming sports travel market hasincreased by23percent. That's nearlya quarter
proficient in mountain skiing is additional skiersusing, inmany cases, thesame acreage ofspace. Inmany
spat!al awameress
resorts, it issimply notpossible t0create more runs, asthelandisoften
Sometimesmore ski slopes privately owned, belongs toprotected national parks, ordoesn't have the
cannotbe createdbecausethe righttopography toallowforeasy ac(ess. Lastseason wasa bumper year
topographng
forskiers, withsuperb snow conditions across much ofEurope andNorth
of the land makesaccessto the ,l.35m
America; tothisend,some travellers headed fortheslopes.
cl nn cc di ffi rrrl t
D Atthemoment, there isnolawonwearing a'lid'on theslopes, butthe
4 Wearinga helmet increasesthe
S(GB recommends thatchildren under thirteen wearoneandleaves it
chanceof peopletaking more
r!sks upt0thediscretion oftheindividual fromthere onup.Thehelmet has
become afashion statement inrecent years andisused byallprofessional
5 Snowboardersare more exposedto
nn<cihle coll!s!ons freeriders andboarders, whospend theirentire timejumping 0utof
helicopters inthemostremote skifields intheworld. Bywearing oneyou
i -------

than skiers.
canassociate withthisromanticism, evenif youneverstrayfromthepiste,
Work in groups.Shouldgreater sothisisaforce forgood. Having saidthat,thehelmet does leadsome
controlsbe introduced into sports people tothinkthattheycantakemore risks astheyareprotected, soit
to reducethe risk of injuries ?Give leads toafalse sense ofsecurity.
reasons.Do controlsfor children Whyareboarders andskiers such acombustible mix? Thiscould bethe
reducethe enjoymentof sports? subject ofitsownBigQuestion, butgenerally thetwoapproach the
Doessuch risk aversecontrol reduce mountain intwoentirely different ways. Askier hasto haveattained a
children'sdevelopment) levelofproficiency inorder totackle theslopes thata snowboarder will
nothave hadto.Inshort, there aremore'bad'amateur snowboarders
whotaketotheslopes thanthere are'bad'amateur skiers.
Snowboards
- which attract theyounger andpossibly more recklessthrill-seeker
- simply don'thave thesame control andgripastwoindependently
controlled skis,
andwithout asetof poles, a boarder whowants a rest
simply sitsdown, whichmakes themless visible andtherefore more
vulnerable topotential collisions.
1 18Cr am m arr ef e re n c e

ar reference
Gramm
Unit 1
Rapidtensechange
Whendescribinga seriesof actions,it is very
importantto conveyaccuratelythe sequence of
events.It is helpfulto rememberthat the Past
Continuousand PastPerfectContinuousprovidea
backgroundto otheractions.
PastContinuous:.Iwaslifting a box...
= Subject+ PastSimpleof be+ -ing form
PastPerfectContinuous:My motherhad beenfeeling
dizzyfor afew days.
= Subject+ PastSimple of have+ been+ -ingf.orm
Weoftenusethe PastSimplefor eventsthat interrupt
otheractionsor which areconnectedto a contextthat
hasbeenprovided.
?
Wecanusetime markerssuchaswhenot afterto link
actions.Bevery carefulaboutthe tenseyou use.
I wascleaningthewindowswhenI slippedand broke
my leg.or WhenI wascleaningthewindows,Islipped
andbrokemyleg.
Nor I eleenedthewiftdewswh
ffiy-lefr
After I had rested,Ifeltbetter.
Hedoesn'trememberanythingafter theambulance
arrived.
Notethe useof the commawhen afteror whencome
at the beginningofthe sentence.
Comparativeand superlativeadjectives
and adverbs
Comparative and superlative adjectives

PastSimple:I waslifting a boxwhenI feII over. Adjective Comparative

5 uperlative
My motherf ainted this morning.She had beenf eeling Short + -er / -est short shorter th e
dizzyfor afew days. adjective shortest
It is commonto usethe PastSimpleto describea Adjective +-r/-st rarge larger t he
seriesof consecutive
events.Weoftenusewordssuch endi ngi n largest
assuddenlyandthenlo providecontinuity. -e
I got onthebusandthenlsatdown.Suildenly,Ifelt Short doubl ethe wet wetter t ne
sick. adjective consonant + wettest
endi ngi n -er / -est
Weusethe PastPerfectto referbackto an earlier vowel+
actionthat is finished. conS 0na nI,
PastPerfect:Myfather hailfallen earlierthat day. excepr-w
= Subject+ PastSimpleof have+pastpartlciple Adjective more/most mooern more the most
of two + adjective modern m oder n
Weusethe PresentPerfectto talk aboutsomething or more
that happenedat anytime in the pastup to the expensivemore the most
syl l abl es
presentmoment. expensive expensive
Adjective change-yto lively livelier the
PresentPerfect:Shehasn'teatenanything today. endi ngi n -i+-er / -est liveliest
= Subject+ PresentSimpleof have+ pastparticiple con50nanI
Weusethe PresentPerfectContinuousto talk about + -y
somethingthat hashappenedcontinuouslyor l rregul ar good better best
repetitivelyfrom a point in the pastright up to the adjective bad worSe worst
present.Sometimes, we canuseeithera Present far farther/ farthest
/
Perfector a PresentPerfectContinuousform.The further furthest
importantthing to rememberis that the latter
emphasizes the continuousaspectof the action. Comparative adjectives

PresentPerfectContinuous:She'sbeenhavingdizzy We use than after the adjectivewhen directly

spells comparing two things.
for sometime now.
= Subject+ PresentSimpleof have+ been+ -ing form In the UK, this treatment is more expensivethan in the
USA.

7.
We can also use less+ adjectiveto mean the opposite
of more.
Theinjury islessseriousthanwethought.
Nor Twesffierioeseh
We use more and/essbefore nouns. Note that it is
more correcttousefewer rather than lessbefore
countable nouns.
Thereis more information available now,and more
people expectafull explanation.
In the past, there was lessinformation available,and
fewer people expectedafuII explanation.
We use (not)as...asto describetwothings or
situations that are (not) the same as each other.
The outcome is as good as it possiblycan be.
The medication isn't as strong as the oneyou were
taking before.
Superlative adjectives
We don't usethan after a superlative adjective.
Restis the best treatment we can offer him.
The superlative forms of more and lessare the most
andthe least.
This is the most serious caseI've seen.
That hospital has the least up-to-datefacilities in the
region.
Comparative adverbs
We can use more,lessand(not)as...as inthe same
wayfor adverbsas for adjectives.
Sheis shaking more violently now.
He is bleeding lessprofusely than before.
Mr Janssen'sheart isn't beating asfast as it was thirty
minutesago.
We generally don't use adverbsin the superlative
form.
Unit 2
Talkingabout the present
There are severalways to talk about actions in the
present or recent past.
C rammarreference1 19
PresentPerfect
Weusethe PresentPerfectto talk aboutsomething
that hashappenedrecently.Wesometimesusejustto
emphasizea very recentevent.
Thepatienthas(just)itischarged himself.
Youhaven'tbrokenyour arm.
= have/ has(+ not)+ pastparticiple
Wealsousethe PresentPerfectto referto a time span
from anytime in the pastup to the present.
He'sbrokenhisarm severaltimes.
= during his life
fallen overtwicethismonth.
She's
PresentContinuous
Weusethe PresentContinuousto describean
actionor situationthat is happeningnow.Wedon't
generallyusethe PresentContinuouswith verbs
of perceptionsuchasthink,know,sound or look+
adjective.
My head'sthrobbing.
I'mgettingpainsinmy shoulder.
Hisarm isn't achingasmuchasit wasbefore.
= am / is/ are/ (+ not)+ -ingf orm
PresentSimple
Weusethe PresentSimpleto describea state.Wecan
usethe verbbeor a verbofperception,orverbssuch
asneedor havegot.
Thewoundis verysore.
Itlooksserious.
Thatdoesn'tsoundgood.
He needsstrongerpainkillers.
Wecanalsousethe PresentSimpleto talk abouta
habit or repeatedaction.Thisis sometimescombined
with an adverbof frequencysuchasolftenor regularly.
Shefalls oververyeasily.
He doesn'ttakehismedicationeveryday.
Doyougetpainsinyourback?
With someverbs,we canuseeitherthe Present
Continuousor PresentSimplewith no realchangein
meaning,e.g.hurt,show,or work.
120 Cr am m arr ef e re n c e

?
It hurtsjust here. Unit3
= It'shurting just here.
Typesof questions
TheX-ray showsa hairlinefracture. Weusedifferenttypesof questionsaccordingto the
= TheX-ray'sshowinga hairlinefracture. kind of informationwewant.
Yes/ no questions
Thetabletsdon'twork.
--Thetabletsaren'tworking. Theseareclosedquestions.Theydon't beginwith
a questionword,and generallyrequirea'yes'or'no'
answer.With yes/noquestions, we invertthe subject
Sayingwhat's necessary
politelybut firmly andverb.
Togivea politeinstruction,we oftenuseYouneedto + Haveyou got the medicationwithyou?
infinitive.Thisis lessdirect,andthereforemorepolite, Isyourkneepainful?
than usingthe imperativeon its own. Doyou takeyour medicationeveryday?
Youneedto takea courseof tablets. Canyoubendyour arm?
Nor@ lVh-questions
Wecanusethe negativeforrr.rofneedtosaythat Whenwe needto havemoreinformation,we ask
somethingisn't necessary. openquestions, oftenbeginningwith a question
Youdon't needto maketheappointmentyourself. word such aswhere,what, when, how,why.Theword
orderis the sameasfor yes/noquestions.
However,we do usethe affirmative and negative
imperativeaspart of an instruction,for example What'stheproblem?
combinedwith an r/-clause. Wheredoesithurt?
Howlong hasyourlegbeeninfected?
Askyour GPif you.'reconcerned.or If you're
concerned,askyour GP However,we canmodify thesequestionsto make
Don't waitfor thepain to get worsebeforecontacting them evenmoreopen.Wecaninvite someoneto talk
your doctoragain. aboutor describesomethingby usingCanyoutellme
...?or Whatdoyouthink...?
Theexpressi on Don't hesitateto + infrnitivewithout
Canyoutellmehowithappened?
to is a fixedphraseandindicatesa desireto be helpful.
What doyou think theproblem is?
Don't hesitateto caII me.
above,the questionform is
Notethat in the sentences
Otherstructureswe usewith an r/-clause or other indirect.
contextareYouhaveto / Youmust+ infinitive without to.
Ontheir own,they aremuchtoo direct. N OT

If thepain getsworse,
you must/ haveto let usknow
immediately.
Alternativeways of making a direct instruction sound
more polite,or of making unwelcomeinformation
soundmoreacceptable, are You'regoingto haveto /
You'II have to / You'II need to + infrnitivewithout to.
You'regoingto haveto beadmitted,l'm afraid.
He'IIhavetowait sometimefor abed.
Wecanusea word suchaselsein yes/noor wh-
questionsto elicita longerrepiyfrom a patient.Note
the positionof.else.
Doesithurt anywhereelse?
Whereelsedoesit hurt?
Is thereanythingelseyou'd liketo talk about?
128 Lis t ening
s c r ip ts
Listening
scripts
Unit T
listening t
D = Doctor,P=Patie nt
D Hi, Mr Stone,I'm Dr Tariq,one of the
doctors in A&E. How are you?
P I'm OK,but I'm a bit worried about my
wife.
D Your wife's OK.
P That's good.
D Amir, one of the paramedics,saysyou
were walking along the street when
your wife coliapsed.Can you tell me
a bit more about what vou actuallv
saw?
P Mmm. Yes,sure.We were shopping
in Cambridge Street in town, when
suddenly Barbara,my wife, just
fainted. Mmm, we tried to get her
upright and she started twitching
quite violently. it was quite scary.
D Yes,it certainly can be, but it can
happen when people faint like thls.
Did anything else happen?
P No. Nothing at all. She came round
very rapidly. But we dialled 999 and a
paramedic appeared almost instantly
and then the ambulance almost
immediateiy afterwards. Do you think
she had a seizureor something like
epilepsy?
D We don't think so.But can I ask
you a few more questions?Did she
complain of anything before that?
P Mmm. Shehad been complaining of
feeling a bit unwell, and had almost
fainted and she felt a bit woozy? She
...yes,er...she was abrt dizzy and she
was yawning repeatedly and then all
of a sudden,there she was, lying on
+ha nr nr r nz ]
D Anything else?Was she ill or anything
before she fell?
P No. lust tired.
D What about her eyesight?
P Nothing, but she said her hearing
was a bit funny - she wasn't hearing
clearly.
D Anyvomiting?
P No.
D When she fell, how did she fall?
P Shejust crumpled to the ground
slowly. In fact, it all happened so
abruptly and silently I didn't realize it
had happened.
D So she didn't cry out or anything?
P No, there was no warning sign at all.
D Just a few more questions.
P OK.
D Has she ever had anything like this
before?
P When I come to think of it, she passed
out once before about a month ago.
Shehasn't been feeling well off and
on over the summer. We thoueht it
was the heat.
D At the moment it looks like ...
Listening 2
Gary Edwards,a Brltish Airways
customerservicearrivalsagent,had
been sitting with hls work colleagues
ln a rest room at Heathrow Airport's
Terminal One when he suffered severe
pain in his chest and arms. Within
seconds,he Iost consciousnessand
stopped breathing. His British Airways
colleaguesimmediately dialled 999 for
an ambulance and began attempts to
resuscitatehim.
All he can remember is that he had
got up from the sofa and said to his
coileaguesthat his chest and arm hurt.
After that, everything went blank.
Within secondsof the 999 call being
made, cycle paramedic Dave Parks
reachedMr Edwards.Dave was able to
continue resuscitation and re-start Mr
Edwards'sheart after three attempts
using the portable deflbrillator that is
carried on ambulance bicycles.
Paramedics,dispatched in an ambulance
at the same time as the bicycle
ambulance, arrived a few minutes later
to continue treatment and took Mr
Edwardsto hospitai. This resuscitation
shows how well-suited bikes are to
reaching patients quickly inside the
airport. As they are based at the airport
and were able to get to him so quickly,
it most probably made the difference
between life and death.
Dave emphasizedthe importance of
quick intervention when someone
suffers a cardiac arrest and took the
opportunity to remind members
of the public that they can Iearn
cardiopulmonary resuscltation - or CPR
- at free'Heartstart' classesgiven across
the capital by the London Ambulance
Serviceand supported by the British
Heart Foundation. Effective CPRbuys
time for a patient and doubles a person's
chancesof survival.
Unit 2
listening 1
D =D o c t o r , P =P a t i e n t
D You look as if you are in quite a lot of
pain.
P Yes,I thlnk I've hurt my hip badly. it's
giving me a lot of pain.
D I think we need to get you some
painkillers. So ...can you tell me a bit
more?
P Oh, I slipped on the kitchen floor. I
must have spilled some water and I
was coming into the living room with
a cup of tea and I just went down on
my bottom and twisted my leg.
D Oh, dear.That sounds bad.
P It was. I couldn't move. Fortunately,
I had my mobiie in my apron pocket
and I phoned my neighbour who
had the key to come in. Shecalied an
ambulance.
D Fallslike this happen so easily.You
may just have pulled a joint out of
place rather than breaking anything.
2
D What's brought you here today?
P My wrist is really hurting. I think I've
broken it.
D OK.How did it happen?
P Weil, I was coming out of a shop and
I was trying to avoid someone and I
didn't notice the paving stone was

raised and I just tripped and of course
I put out my hands to protect myself
and break my fall. My wrist took the
full force of my fall.
D It certainly looks quite bad, yes.I think
we need to do an X-ray.
3 that halls and stairways are well lit.
D = Doctor, ! = Patient's father
D What's happened here?
F She fell down from a tree at school
and they called me and I came here
from work as the ambulance was
bringing her here.
D Oh,I see.
F She'scrying a lot and Ithink she's
fractured something in her leg.
D She may not have broken anything,
but let's have a look at her.
[anguagespot
1 Soyou'vetakensomepainkillers,but
they don't work, and your arm'sstill
hurting you just here.
2 Mytoe is throbbingwith pain.I don't
know what I'vedone.It looksasif it's
broken.
3 He'shad severalfalls recentlyand
he hasseveralfractures.but he'snot
c n r i _n_'b
-_ j
q *a _-
l n t_'
Listening 2
As health professionals, we give advice
about healthy lifestyles, which should
inciude accident prevention. When
we use tfre word accident,it seemsto
lmply that accidents are unavoidable. It
is true that we do not live a life free of
risk, but the danger of accidentscan be
minimized by simple precautions ...and
thinking ahead.
We can,for exampie, make patients
aware of the potential for risk. All risk
situations including those in the home
or garden,in the workplace, on the
road, or during leisure activities such
as hillwalking or mountain climbing
should be treated with due respect.
Peopleneed to be reminded to think
of others, especiallychildren and the
elderly.Once an accident has happened
scri pts1 29
Li steni ng
it is too late to go back and take P I d o n 't k n o w . I t m a y b e t h e w o r k . I
precautions. type a Iot.
D OK. So you sit at a desk a1lday.
There are many simple piecesof advice
P Yes.
that can be given to prevent accidents
D Mm. Now the pain, doesit ...?
in the home like fitting stairs with
banisters or rails and making sure Conversation B
D Sowhat has happened to you, Mrs
Encouraging people to climb up only
Skinner?
on something firm and strong can help
P Well, I've hurt my hand.
reduce the risk of falls. Another thing to
D Tell me a bit more about it.
avoid is loose rugs and flooring in order
P I've had it since the week before last
to reduce the rlsk of slipping or tripping
here on the heel of my hand, and I'm
especiallywhen old people or children
flnding it difflcult to work and also
are around. And if small children are
to go to the gym. I've tried painkillers
about, ponds and swimming pools in
and that, but they haven't worked.
the garden need to be covered.
When the tablets wear off, it's still
DIY at home or home improvements there. I don't have a touch of arthritis,
is another area with potential for do you think?
accidents.When using power tools, D At this stage it's difflcult to say.It's
people need to be encouragedto use something we have to try and rule
adequate protection including sturdy out. But can I just ask you what you
shoes,gloves,and goggles. think causedit?
P I don't really know. It may be the
work.
U n i t3
D Can you tell me when it is worst?
Jm
[istening 1
P Mmm. When I'm at the gym, when
I'm typing, and when the boss is
?
D= Doc t or , P= P a t i e n t
around!
Conversation A D Yes,I can imagine the boss making it
worse. You mentioned the gym.
D So what has happened to you, Mrs
P Yes.
Skinner?
D Doyougoalot?
P Well,l've hurt my hand
P Yes,I do.
D Right. When did it happen?
D Id just like you to put your arm ...
P I've had it since the week before last.
D Hm, where do you get the pain? listening 2
P Here on the heel of my hand.
D =D o c t o r , P =P a t i e n t
D I s t hat bot hh a n d s ?
D Alexander, you've had quite a bang on
D l\ln irrcl thi< nnp
your head.
D And have you taken anything for it?
P Yeah,and I'm surprised I feel OK.I
P I've tried painkillers and that, but they
thought it might give me a really bad
haven't worked. When the tablets
headacheor something, but I really
wear off, it's still there. I don't have a
feel fine. I'm just a bit shaken,really.
touch of arthritis, do you think?
D Yes.Thesethings can knock you quite
D At this stage it's difficult to say.It's
a bit. You still need to be careful over
something we have to try and rule
the next twenty-four hours, even
out. But can I just ask you what you
though you feel flne.
think causedit? P What? You mean I have to stay inthe
P I don't really know.
hospital?
D Anything at work?