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?
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Meningitis
Leaking AAA
Dissecting AA
Ectopic pregnancy
Chronic subdural
Appendicitis
Acute glaucoma
Retinal detachment

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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 clappedout 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
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