Emergencies in Emergencies in General PracticeGeneral Practice

Andrew AshfordAndrew Ashford

““Is it an emergency?...”Is it an emergency?...”

Patients’ viewpointPatients’ viewpoint

HCP viewpointHCP viewpoint

Defining “emergency”?Defining “emergency”?

A patient presenting with a medical A patient presenting with a medical problem which problem which

Has the potential to pose a serious Has the potential to pose a serious threat to health or lifethreat to health or life

And requires immediate or urgent And requires immediate or urgent action (within 1/2hr) on behalf of the action (within 1/2hr) on behalf of the doctor to reduce or remove this doctor to reduce or remove this threatthreat

Dealing with emergenciesDealing with emergencies

RequiresRequires

Personal competenciesPersonal competencies

Organisation competenciesOrganisation competencies

Personal CompetenciesPersonal Competencies

Group exerciseGroup exercise

… … what do YOU think you need?what do YOU think you need?

Personal CompetenciesPersonal Competencies

KnowledgeKnowledge

SkillsSkills

EquipmentEquipment

KnowledgeKnowledge

= THE DIAGNOSES YOU NEVER WANT = THE DIAGNOSES YOU NEVER WANT TO MISS!TO MISS!

+ How they present ATYPICALLY+ How they present ATYPICALLY

What’s on that list?What’s on that list?

Brainstorming exerciseBrainstorming exercise

What’s on that list?What’s on that list?

MeningitisMeningitis Leaking AAALeaking AAA Dissecting AADissecting AA Ectopic pregnancyEctopic pregnancy Chronic subduralChronic subdural AppendicitisAppendicitis Acute glaucomaAcute glaucoma Retinal detachmentRetinal detachment

PneumothoraxPneumothorax MIMI SepticaemiaSepticaemia Placenta PraeviaPlacenta Praevia Cerebral AbscessCerebral Abscess Acute epiglottitisAcute epiglottitis … … tbctbc

Where to learn about them?Where to learn about them?

Standard text booksStandard text books Medical defence organisation case Medical defence organisation case

reports!reports! Departmental Significant Event Departmental Significant Event

ReviewsReviews Confidential enquiries Confidential enquiries

– Eg Maternal DeathsEg Maternal Deaths

If you don’t think of a If you don’t think of a diagnosis, you can’t make it.diagnosis, you can’t make it.

SkillsSkills

Pattern recognition (knowledge)Pattern recognition (knowledge) History takingHistory taking ExaminationExamination Procedural skillsProcedural skills Interpersonal skillsInterpersonal skills ““NHS system skills” NHS system skills”

EquipmentEquipment

Group ExerciseGroup Exercise What should the GP have available?What should the GP have available?

– Drugs + venous accessDrugs + venous access– Medical equipmentMedical equipment

Where should it be?Where should it be? Who should pay for it?Who should pay for it? Who should keep it up to date?Who should keep it up to date?

EquipmentEquipment

If I unexpectedly come across a If I unexpectedly come across a clapped-out patient, have I got what I clapped-out patient, have I got what I need with me to do what accepted need with me to do what accepted modern medical practice expects?modern medical practice expects?

The OrganisationThe Organisation

Patient:Patient:

““I can hardly breathe and there’s blood I can hardly breathe and there’s blood everywhere…”everywhere…”

Receptionist:Receptionist:

““I’m sorry, I can’t give you an I’m sorry, I can’t give you an appointment unless it’s an appointment unless it’s an emergency”emergency”

Triage and the “front line”Triage and the “front line”

Group ExerciseGroup Exercise

How do you ensure:How do you ensure: That emergencies are recognised for That emergencies are recognised for

what they are (or might be)what they are (or might be) That the right HCP is informed about That the right HCP is informed about

themthem That appropriate action IS takenThat appropriate action IS taken Within an appropriate timescale? Within an appropriate timescale?

Changing TimesChanging Times

Visit?Visit? ……or tell ‘em to call the ambulanceor tell ‘em to call the ambulance ……or ”take an aspirin and call me in or ”take an aspirin and call me in

the morning”the morning” OOH and continuityOOH and continuity Extended opening issuesExtended opening issues