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Introduction

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When Elisha arrived, he went alone into the room and saw the boy lying dead on the bed. He closed the door and prayed to the Lord. Then he lay down on the boy, placing his mouth, eyes and hands on the boy’s mouth, eyes and hands. As he lay stretched out over the boy, the boy’s body started to get warm—the boy sneezed seven times and then opened his eyes.

II Kings 4: 32–5 (A miracle or successful artificial resuscitation?)

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Definition of the emergency

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Emergency: ‘An event demanding immediate medical attention’.

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The GP must be available and organised to cope with the medically defined emergency when it comes. Emergency care outside the hospital represents one of the most interesting and rewarding areas of medical practice. City doctors will have to modify their degree of availability, equipment and skills according to paramedical emergency services, while others, especially remote doctors, will need total expertise and equipment to provide optimal circumstances to save their patients’ lives.

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In dealing with a specific emergency, the doctor adopts a different approach. Instead of taking a history and performing an examination in the usual way, he or she replaces this with a technique of rapid assessment and immediate management. In fact, the diagnosis may be possible on the information available over the telephone.

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An important yet obvious concept is that of ‘time criticality’, which implies that certain patients are at high risk of a critical outcome of deterioration if there is significant delay in appropriate management. This applies particularly to acute coronary syndromes.

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Refer also to childhood emergencies (see CHAPTER 96).

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Key facts and checkpoints

  • The commonest emergency calls in a survey of a typical community1 were accidents and violence (50.7%), abdominal pain (9.9%), dyspnoea (7.2%), chest pain (5.8%), syncope/blackout (5.2%), other acute pain (5.0%).

  • The prevalence of emergency calls was 2.6 per 1000 population per week.

  • The commonest specific conditions in this study1 were lacerations 19%, fractures 11%, injuries from transport accidents 11%, bronchial asthma 4%, ischaemic heart pain 3.5%, appendicitis 3%.

  • The commonest causes of sudden death were myocardial infarction 67%, accidents 10%, cerebrovascular accidents 7%, pulmonary embolism 6%, suicide 4%.

  • The main vital emergency procedures were cardiopulmonary resuscitation, intubation and ventilation, intravenous access including cutdown, intravenous (or rectal) dextrose and arrest of haemorrhage.

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Principles of management

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The important principles of management of the emergency call can be summarised as follows:

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  1. The practitioner must be aware of life-threatening conditions.

  2. The practitioner should be prepared mentally and physically:

    • PLAN, EQUIP and PRACTISE

  3. Chest pain/collapse/myocardial infarction (collectively) represents the premium emergency call.

  4. Beware of children with respiratory distress and traumatic injuries.

  5. The most saveable patients are those with blood loss. Hence IV fluids for intravascular volume expansion are essential.

  6. The necessary ...

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