Emergencies in General Practice Andrew Ashford

Emergencies in General Practice Andrew Ashford

“Is it an emergency?.” Patients’ HCP viewpoint 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 Leaking AAA Dissecting AA Ectopic pregnancy Chronic subdural Appendicitis Acute glaucoma Retinal detachment Pneumothorax MI Septicaemia Placenta Praevia Cerebral Abscess Acute epiglottitis tbc

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