1. Emergencies in General Practice Andrew Ashford

2. “Is it an emergency?...” • Patients’ viewpoint • HCP viewpoint

3. 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

4. Dealing with emergencies Requires • Personal competencies • Organisation competencies

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

6. Personal Competencies • Knowledge • Skills • Equipment

7. Knowledge = THE DIAGNOSES YOU NEVER WANT TO MISS! + How they present ATYPICALLY

8. What’s on that list? Brainstorming exercise

9. Meningitis Leaking AAA Dissecting AA Ectopic pregnancy Chronic subdural Appendicitis Acute glaucoma Retinal detachment Pneumothorax MI Septicaemia Placenta Praevia Cerebral Abscess Acute epiglottitis … tbc What’s on that list?

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

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

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

13. 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?

14. 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?

15. 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”

16. 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?

17. 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