Emergencies in General Practice Andrew Ashford

“Is it an emergency?...” Patients’ viewpoint Patients’ viewpoint HCP 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 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 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 Personal competencies Organisation competencies Organisation competencies

Personal Competencies Group exercise … what do YOU think you need? … what do YOU think you need?

Personal Competencies Knowledge Knowledge Skills Skills Equipment 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 Meningitis Leaking AAA Leaking AAA Dissecting AA Dissecting AA Ectopic pregnancy Ectopic pregnancy Chronic subdural Chronic subdural Appendicitis Appendicitis Acute glaucoma Acute glaucoma Retinal detachment Retinal detachment Pneumothorax Pneumothorax MI MI Septicaemia Septicaemia Placenta Praevia Placenta Praevia Cerebral Abscess Cerebral Abscess Acute epiglottitis Acute epiglottitis … tbc … tbc

Where to learn about them? Standard text books Standard text books Medical defence organisation case reports! Medical defence organisation case reports! Departmental Significant Event Reviews Departmental Significant Event Reviews Confidential enquiries Confidential enquiries –Eg Maternal Deaths

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

Skills Pattern recognition (knowledge) Pattern recognition (knowledge) History taking History taking Examination Examination Procedural skills Procedural skills Interpersonal skills Interpersonal skills “NHS system skills” “NHS system skills”

Equipment Group Exercise What should the GP have available? What should the GP have available? –Drugs + venous access –Medical 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?

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? 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 emergencies are recognised for what they are (or might be) That the right HCP is informed about them That the right HCP is informed about them That appropriate action IS taken That appropriate action IS taken Within an appropriate timescale? Within an appropriate timescale?

Changing Times Visit? Visit? …or tell ‘em to call the ambulance …or tell ‘em to call the ambulance …or ”take an aspirin and call me in the morning” …or ”take an aspirin and call me in the morning” OOH and continuity OOH and continuity Extended opening issues Extended opening issues