EMERGENCYCARE

INFAMILYPRACTICE
RETNOASTIWERDHANI

EMERGENCY
Anemergencyisanunforeseenoccurrenceor
acombinaBonofcircumstancescallingfor
immediateacBonorremedy.
AninfrequentacuteeventinGeneralPrac1ce
Rapiddeteriora1oninpa1entscondi1on
Thelevelofrequiredemergencyresponseor
ac1onbyyoudependsonthebackup
servicesavailable,and..
The1medelaytoarrivalofbackup

ScopeofEmergencyCareseen
inGeneralPracBce

Pediatric
Cardiovascular
Respiratory
GastrointesBnal
Urogenital
BitesandsBngs,burns
andscalds

Obstetricand
gynecological
Neuromuscular
ENTandeye
Endocrine
Forensic
Psychologicalor
psychiatric

DeliveryofEmergencyCare
AppropriatepreparaBon:Equipmentand
clinicorganizaBon
BasicequipmentandessenBaldrugs.Housecall
bag
Clinicstatrainedtorecognizeemergency
situaBons.
PrioritytreatmentforsuchpaBents.
Requestforemergencyoutofocecallsshould
bescreenedrstbythedoctor,whowilldecideon
Bmeofvisit.

Skillsdevelopment
Doctortrainedinmanagementof
emergencies.ConBnuingselfreviewto
maintainskillsacquired.

ManagementProtocols
Workoutinadvancemanagementprotocols
fortheemergencieslikelytobeencountered.
Clinicstashouldbefamiliarwiththeirroles
intheseprotocols.

Acutepediatricproblems
Thebreathlesschildisacommonnight
emergency.
ThepaBentmaybeachildwithjustabadcold
orhemayhaveapotenBallyseriouscondiBon
suchasepigloXBs.
CarefulquesBoningonthetelephoneis
essenBalbeforemakingadecisionabout
whetherornottomakeanimmediatevisit.
Parentalanxietycanbetremendous

Lossofconsciousness
MaybepotenBallylifethreateningortrivial
Immediatetreatmentrequirede.g.hypoglycemic
coma(intravenousglucose50%).
Urgenthospitalreferralrequirede.g.head
injuries,poisoning.
Nonlifethreateningcausese.g.vasovagala_ack
('faint')andhystericalconversionpresenBngas
lossofconsciousness.
ManagementdependsontheparBcular
circumstances.Referralmayormaynotbe
necessary.

Acuterespiratorydistress
Usuallypresentsasdicultyinbreathing.Quick
historyandclinicalassessment.
UrgentstabilizaBonbeforereferrale.g.acute
laryngealedemasecondarytoanallergicreacBon
(subcutaneousadrenaline,intravenous
hydrocorBsone).
UrgentreferralrequiredwithoutintervenBone.g.
acuteepigloXBsinchildren.
NonurgentcondiBonse.g.hypervenBlaBon.
PaBentshouldbehandledwithtact,especiallyso
ifaccompanyingrelaBveswhoarehighlyanxious.

Chestpain
PaBentandrelaBvesusuallyveryanxious.
Trivialcausese.g.musculoskeletalcausesor
anxietymorecommonthanseriouscauses.
ThetaskofthegeneralpracBBoneristo
idenBfythosethataremedicalemergencies
(e.g.acutemyocardialinfarcBon),referthese
forfurthermanagement,andtreattheothers
asappropriateM.O.N.A

Severeabdominalpain
itisobendiculttodecidewhethertomakea
visitortogiveadviceoverthetelephone.
itisworthwhilespendingBmeonacareful
historyandexaminaBonandkeepingahighindex
ofsuspicionfortheunusual.
E.g.renal,biliaryorabdominalcolic,canbe
managedasoutpaBentiniBallyfollowedby
referralifindicated.
Gynecologicalemergenciessuchasectopic
pregnancyandtwistedovariancystmustbe
referredimmediatelyfollowinginiBalstabilizaBon
ifnecessary.

Bleedinginpregnancy
Ifectopicpregnancyissuspected,donotdoa
pelvicexaminaBonandarrangeforurgent
hospitaladmission.
WithholdanBbioBcsifbleedingfollows
therapeuBcaborBonorpreviousevacuaBonunBl
theuterushasbeenreevacuated.
PaBentswhobleedinthesecondhalfof
pregnancyrequireurgenthospitaladmission.
Usefuldrugstobringalongforhousecallinclude
ergometrine,oxytocin,diazepam,anopiate
analegesicandananBemeBc

Injuries
Rangefrommildtosevere
Causesincluderoadtracaccidents,accidentsat
homeoratwork,violentbehavior,etc.
Quicklyassesstheseverity,amountofbleedingif
any,decidewhethertoinsBtuterstaid
measuresandrefertothehospitalstraightaway,
orwhetherthepaBentcanbetreatedinthe
clinic.
RelaBvesshouldbereassured,andthetreatment
planexplainedtothem.

AllergicreacBons
RangefrommildskinrashtourBcaria,
angioedema.
TreatthosecondiBonsthatare:
lifethreateninge.g.subcutaneousadrenalinein
generalizedurBcaria,
arrangeforhospitalreferralthosethatare
potenBallyseveree.g.earlyStevenJohnson
syndrome,
treatthosethataremild,andallayanxietyin
paBentandrelaBves.

ThedisturbedpaBent/
forensicproblems
Thefamilyphysicianobenhastodecidehowtoalleviate
thecrisisoverthenext24hours,ratherthantryingtonda
deniBvesoluBontoalongtermproblem.
SupporBngstasuchasmedicalsocialworkerswouldbea
greathelp.
SeverelydisturbedpaBentsmayneedsedaBonwith
diazepambeforereferralforadmission.
Psychiatricreferralmaybearrangedatalaterdateifthe
situaBonisnotsourgent.
Casesofallegedrapeneedtobereferredtothe
gynecologistforfurtherevaluaBon.
Inthecaseofsuddendeath,apostmortemisalways
prudentandthegeneralpracBBonershouldsoadvisethe
relaBves.

PATIENTEDUCATION
ItisimportantthatpaBentsareeducatedasto
whichsituaBonconsBtutesanemergencyand
whichdoesn't.
Thisissothattheemergencyservicesof
hospitalsarenotoverloaded,andthatdoctors
arenotcalledoutofhoursfortrivial
complaints.

HOUSECALLS
Assessmentand/ormanagementofacute
illnesses
AssessmentandmanagementofpaBents
dischargedfromhospital
ManagementofpaBentswithchronicillness
ManagementofpaBentswithterminalillness
AssessmentofhomecondiBonsandfamily
funcBon
ToallaypaBentorcalleranxiety

DoingAHousecall:PreparaBon
PersonalpreparaBon:Thedoctor'sreadiness
Thedoctormustbepreparedpersonallytodo
housecalls.
Shouldbecontactable.Arrangementformessage
taking,e.g.viaapager.
AppropriatevocaBonaltraining.
Ensurethedoctor'ssafetyasfarasispossible.

DoingAHousecall:PreparaBon
ClinicorganizaBon:Stareadiness.
Clinicstatrainedtorecognizeanurgentcall.
Allsuchcallstobescreenedbythedoctorwho
willdecideontheBmeandmodeofmanagement.
Goodtodocumentdetailsofallrequestsfor
housecalls,anyadvicegiven,andwhetherornot
avisitwasmade.

Thehousecallbag
Themedicinecarriedinafamilydoctor'sbag
canplayalifesavingrole.Thedoctor'sbag
needstobestockedandreadyatallBmesand
itscontentsshouldbecheckedandupdated
regularly.
Finally,itmustberememberedthatthe
doctor'sbagmustbekeptlockedatallBmes,
asitcontainscontrolleddrugs.

Handlingarequestforhousecall
EstablishidenBtyofthecaller,contacttelephone
number,nameofthepaBent,andlocaBon.
CollectonlyenoughinformaBontodecidewhethera
visitisnecessaryandifnecessary,ambulanceatthe
sameBme.
IncaseswhereadviceistheonlyacBonneeded,make
itcleartothecallerthatiftheadviceisnothelpfulorif
symptomschange,anothercallwillresultinthe
paBentbeingseen.
Inthecasewhereavisitwillbemade,anyrstaid
advicenecessaryshouldbegiven,andthecaller
assuredofthedoctor'sintenBontovisitinan
esBmatedBmeframe.

Acutecases
Quickassessment.Firstaid,resuscitaBonand
emergencytreatmentifnecessary.Organize
admissiontohospitalifnecessary.
Iftotreatathome,orifpaBentorhisrelaBves
opposehospitaladmission,assessthe
paBent'sproblem,hisfamilyandhome
environmenttodecideifthisisfeasible.In
suchacase,arrangeforearlyfollowupvisit.

Acutecases
Importanttoa_endtothepaBentandhis
familymembers'anxieBes.InmanysituaBons,
itisthecallerratherthanthepaBentwho
needsreassuranceorexplanaBon.
VitaltorecognizethatadeniBvediagnosis
notalwayspossibleinemergencysituaBons.
PlanofacBonimportantinsuchcases.The
doctormustbepreparedtorevisitand
reconsiderhismanagementplan.

Chroniccases
NotmuchurgencyunlessanacuteexacerbaBon,
anurgentnewproblemoraterminalevent.
Managementdependsontheproblemathand.
A_endtopaBentandfamily'sanxieBes.Help
organizethefamily'sresourcestocopewith
problem,includingconsideringtheuseof
paramedicalandcommunityservices.Referralto
hospitalorspecialistarrangedwhenindicated.

FollowupacBon
Inanyproblemnotrequiringreferral,aberthe
iniBaltreatment,therelaBvesshouldbe
instructedtoreturntotheclinictocollect
furthermedicaBonsandtoensurethatthe
medicaladvicegivenarefollowed.
AppointmentsshouldbegivenforthepaBent
toa_endfollowupvisitsintheclinic,or,
alternaBvely,subsequenthomevisitsshould
bearrangedifindicated.