Emergencies in General

Practice
Andrew Ashford
 “Is it an emergency?...”

 Patients’ viewpoint

 HCP viewpoint
 Defining “emergency”?
A patient presenting with a medical problem
which
 Has the potential to pose a serious threat
to health or life
 And requires immediate or urgent action
(within 1/2hr) on behalf of the doctor to
reduce or remove this threat
 Dealing with emergencies
Requires

 Personal competencies

 Organisation competencies
 Personal Competencies

Group exercise

… what do YOU think you need?

 Personal Competencies
 Knowledge

 Skills

 Equipment
 Knowledge

= THE DIAGNOSES YOU NEVER WANT TO

MISS!

+ How they present ATYPICALLY

 What’s on that list?

Brainstorming exercise
 What’s on that list?
 Meningitis  Pneumothorax
 Leaking AAA  MI
 Dissecting AA  Septicaemia
 Ectopic pregnancy  Placenta Praevia
 Chronic subdural  Cerebral Abscess
 Appendicitis  Acute epiglottitis
 Acute glaucoma  … tbc
 Retinal detachment
 Where to learn about them?

 Standard text books

 Medical defence organisation case reports!
 Departmental Significant Event Reviews
 Confidential enquiries
– Eg Maternal Deaths
If you don’t think of a diagnosis,
you can’t make it.
 Skills
 Pattern recognition (knowledge)
 History taking
 Examination
 Procedural skills
 Interpersonal skills
 “NHS system skills”
 Equipment
Group Exercise
 What should the GP have available?
– Drugs + venous access
– Medical equipment
 Where should it be?
 Who should pay for it?
 Who should keep it up to date?
 Equipment

 If I unexpectedly come across a clapped-

out patient, have I got what I need with
me to do what accepted modern medical
practice expects?
 The Organisation
Patient:
“I can hardly breathe and there’s blood
everywhere…”

Receptionist:
“I’m sorry, I can’t give you an appointment
unless it’s an emergency”
 Triage and the “front line”
Group Exercise
How do you ensure:
 That emergencies are recognised for what
they are (or might be)
 That the right HCP is informed about them
 That appropriate action IS taken
 Within an appropriate timescale?
 Changing Times
 Visit?
 …or tell ‘em to call the ambulance
 …or ”take an aspirin and call me in the
morning”
 OOH and continuity
 Extended opening issues