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EMERGENCY CARE IN

FAMILY MEDICINE
PRACTICE
PRITHA MAYA SAVITRI
EMERGENCY
An emergency is an unforeseen
occurrence or a combination of
circumstances calling for
immediate action or remedy.
An infrequent acute event in
general practice
Rapid deterioration in patients
condition
The level of required emergency
response or action by you
depends on the backup services
available, and..
The time delay to arrival of
backup
Scope of emergency care seen
in general practice
Pediatricemergencies
Cardiovascular emergencies
Gastrointestinal emergencies
Urogenital emergencies
Obsgyn emergencies
Contd....
Neuromuscular
ENT and eye
Endocrine
Forensic
Psychological or psychiatric
Delivery of Emergency Care
Appropriate preparation :
Equipment and clinic organization
Basic equipment and essential
drugs. House call bag
Clinic staff trained to recognize
emergency situations.
Contd
Priority treatment for such
patients.
Request for emergency
outofoffice calls should be
screened first by the doctor, who
will decide on time of visit.
Skills development
Doctor trained in management of
emergencies. Continuing
selfreview to maintain skills
acquired.
Clinic staff- trained in emergency
resuscitation and other
management procedures
Management Protocols
Work out in advance management
protocols for the emergencies
likely to be encountered.
Clinic staff should be familiar with
their roles in these protocols.
Acute pediatric problems
The breathless child is a common
night emergency.
The patient may be a child with
just a bad cold or he may have a
potentially serious condition such
as epiglottitis.
Careful questioning on the
telephone is essential before
making a decision about whether
or not to make an immediate visit.
Parental anxiety can be
tremendous
Loss of consciousness
May be potentially life threatening
or trivial
Immediate treatment required
e.g. hypoglycemic coma
(intravenous glucose 50%).
Urgent hospital referral required
e.g. head injuries, poisoning.
Contd......
Nonlife threatening causes e.g.
vasovagal attack ('faint') and
hysterical conversion presenting as
loss of consciousness.
Management depends on the
particular circumstances. Referral
may or may not be necessary.
Acute respiratory distress
Usually presents as difficulty in
breathing. Quick history and
clinical assessment.
Urgent stabilization before referral
e.g. acute laryngeal edema
secondary to an allergic reaction
(subcutaneous adrenaline,
intravenous hydrocortisone).
Contd.....

Urgent referral required without


intervention e.g. acute epiglottitis
in children.
Nonurgent conditions e.g
hyperventilation.
Patient should be handled with
tact, especially so if accompanying
relatives who are highly anxious
Chest pain
Patient and relatives usually very
anxious.
Trivial causes e.g. musculoskeletal
causes or anxiety more common
than serious causes.
The task of the general
practitioner is to identify those
that are medical emergencies (e.g.
acute myocardial infarction), refer
these for further management,
and treat the others as appropriate
M.O.N.A
Severe abdominal pain
It is often difficult to decide
whether to make a visit or to give
advice over the telephone.
It is worthwhile spending time on a
careful history and examination
and keeping a high index of
suspicion for the unusual.
E.g. renal, biliary or abdominal
colic, can be managed as
outpateint initially followed by
referral if indicated.
Gynecological emergencies such as
ectopic pregnancy and twisted
ovarian cyst must be referred
immediately following initial
stabilization if necessary.
Bleeding in pregnancy
Ifectopic pregnancy is suspected,
do not do a pelvic examination and
arrange for urgent hospital
admission.
Withhold antibiotics if bleeding
follows therapeutic abortion or
previous evacuation until the
uterus has been reevacuated.
Patients who bleed in the second half
of pregnancy require urgent hospital
admission.
Useful drugs to bring along for house
call include ergometrine, oxytocin,
diazepam, an opiate analgesic and an
antiemetic
Injuries
Range from mild to severe
Causes include road traffic
accidents, accidents at home or at
work, violent behavior, etc.
Quickly assess the severity,
amount of bleeding if any, decide
whether to institute first aid
measures and refer to the hospital
straight away, or whether the
patient can be treated in the
clinic.
Relatives should be reassured, and
the treatment plan explained to
them.
Allergic reactions
Range from mild skin rash to
urticaria, angioedema.
Treat those conditions that are :
life threatening e.g.
subcutaneous adrenaline in
generalized urticaria,
Arrange for hospital referral those
that are potentially severe e.g.
early StevenJohnson syndrome,
Treat those that are mild, and allay
anxiety in patient and relatives.
The disturbed patient/
forensic problems
The family physician oben has to
decide how to alleviate the crisis
over the next 24 hours, rather
than trying to find a definitive
solution to a long term problem
Supporting staff such as medical
social workers would be a great
help.
Severely disturbed patients may
need sedation with diazepam
before referral for admission.
Contd....
Psychiatric referral may be arranged
at a later date if the situation is not so
urgent.
Cases of alleged rape need to be
referred to the gynecologist for
further evaluation.
Inthe case of sudden death, a post
mortem is always prudent and the
general practitioner should so
advise the relatives.
PATIENT EDUCATION
Itis important that patients are
educated as to which situation
constitutes an emergency and which
doesn't.
This is so that the emergency services
of hospitals are not overloaded, and
that doctors are not called
outofhours for trivial complaints.
THANK YOU

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