Emergency in Primary Care (PHC) - Family Medicine ASU PDF

Family Medicine Fifth Year Emergency in Primary Care ILOS - Identify the meaning of medical emergencies. - Identify the responsibilities of family physicians in emergency situations. - Enumerate the essential items of emergency case r...

Family Medicine Fifth Year Emergency in Primary Care ILOS - Identify the meaning of medical emergencies. - Identify the responsibilities of family physicians in emergency situations. - Enumerate the essential items of emergency case referral letter. - Discuss the competencies required to manage an emergency case. What is the Medical Emergency? A Medical Emergency is an injury or illness that is acute and poses an immediate risk to a patient’s life. Early identification of a Medical Emergency and subsequent management will be helpful to save the patient’s life and prevent irreversible consequences. Acute attacks of asthma, myocardial infarction, anaphylactic shock, hypoglycemic coma, convulsions, head injuries and trauma are some of the common emergencies encountered by Family Physicians and Primary Care Doctors. The airway, breathing, circulation, disability, exposure approach which is widely accepted by experts in Emergency Medicine is applicable in Primary Care settings as well for immediate assessment and treatment of critically ill patients. Responsibility of Family Physicians in Emergency Situations Being first contact care providers, Family Physicians could come across any type of emergency at any time. The provision of timely, effective and proper care require knowledge, proper training, confidence, experience, trained supportive staff, equipment and medications. Even though conditions such as acute attacks of asthma, febrile convulsions and hypoglycemia could be managed entirely in a general practice, most of the emergencies such as acute myocardial infarction, ectopic pregnancy and torsion of the testis need to be transferred following initial management. The extent to which the emergency should be managed may depend on the condition of the patient, expertise of the doctor and distance to the nearest Emergency Department. Primary Care Medical Services could help to minimize the delay in transferring a patient to the hospital. Primary Care Physicians can co-ordinate care by informing the hospital about the condition of the patient. Then the hospital would be ready to receive the patient and crucial delays could be avoided. Advising patients not to take anything orally in surgical situations such as torsion of the testis, ectopic pregnancy and to minimize physical exertion such as walking in patients having myocardial infarction are also important part of Pre-Hospital Care. It is important to write a referral letter mentioning the essential items of information such as:  The probable diagnosis (myocardial infarction).  Present status (blood pressure, pulse rate and rhythm).  Investigation findings (ECG changes).  Treatment administered (aspirin).  Co-morbidities (asthma, diabetes mellitus).  Treatment for co-morbidities, drug allergies and other relevant information which would be vital for the assessment, diagnosis and the management of the patient. Family Physicians can carry out opportunistic health promotion by displaying posters regarding symptoms of medical emergencies, features of early recognition and first aid measures that should be practiced. Physicians should educate patients who are susceptible to emergencies such as hypoglycemic and hyperglycemic attacks about prevention, early detection of impending attacks and measures to be adopted in such situations. Competencies required managing an emergency case: 1. Knowledge and skills: The top most requirements for emergency management are the updated knowledge of the Family Physician that aids in the early diagnosis and management. They should be able to: - Suspect or diagnose that a patient is having a serious problem. - Be able to carry out at least initial pre-hospital management. - Family Physicians should also know the indications to admit patients having conditions which can be managed in an outpatient set up such as acute attack of asthma and febrile convulsion. - They should be competent in therapeutic and diagnostic procedures such as nebulization and ECG. - Algorithms for the management of different medical emergencies can be displayed in the emergency management room for quick reference. 2. Communication skills: Family Physicians should be skilled to gather accurate and essential information from all sources including history, physical examination, family members, witnesses to the incident and medical records. They need to have excellent interpersonal skills and communication skills that result in information exchange as well as teaming with patients, family members and paramedical staff. 3. Trained paramedical staff: The presence of trained paramedical staff is essential. They should be advised to give priority to patients who present with Medical Emergencies. They also should be competent in basic procedures such as obtaining intravenous access, stabilizing and maintaining the airway, breathing and circulation and nebulization. 4. Practice organization: The location and the layout of the medical center play a major role in providing Emergency Care. It should ideally be situated in the center of the community. There should be an emergency care room accessible from the consultation room of the doctor. This kind  of arrangement will help the doctor to attend to the patient immediately and review the patient while attending to other patients. 5. Equipment and medications: Emergency room should be equipped with equipment and a suitable range of medications which reflect the anticipated emergencies in the patient populations, the practitioners’ skills and the distance to the nearest Emergency Department. Medications, intravenous fluids and equipment which are essential for emergency management should be stored in a separate place and labeled properly for easy access. The availability of stocks and expiry dates of the medications and intravenous fluids should be checked regularly by an appointed person. Training of Family Medicine Residents in Spain Rotation in all Medical Specialities: Internal Medicine Cardiology - Chest Diseases Neurology - Psychiatry Dermatology - ICU Medical Oncology - Radiology General and GIT Surgery Obstetrics and Gynaecology Paediatrics Every week, Family Medicine Residents have a 24-hour Doctor Duty in the Emergency Room. Work of Family Medicine Specialists in Spain: 1. Public Family Medicine Centres. 2. Private Family Medicine Centres/Hospitals. 3. Extra-Hospital Emergency Medicine. Special Courses like ALS. 4. Hospital Emergency Medicine. Master in Accident and Emergency Medicine.