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INTRODUCTION

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?)

DEFINITION OF THE EMERGENCY

Emergency: ‘An event demanding immediate medical attention’.

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 the availability of paramedical emergency services, while others, especially remote doctors, will need total expertise and comprehensive equipment to provide optimal circumstances to save their patients’ lives.

The immediate approach to a specific emergency differs from normal, less urgent medical practice. The usual method of history and examination is replaced with a technique of rapid assessment and immediate management. In fact, the primary diagnosis is sometimes possible on the information available over the telephone, or during the first few seconds of surveying the patient.

An obvious yet important 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. A classic example in general practice would be acute coronary syndromes.

Refer also to childhood emergencies (see CHAPTER 96).

Key facts and checkpoints

  • The most common emergency calls in a survey of a typical rural general practice1 were accidents and violence (51%), abdominal pain (10%), dyspnoea (7%), chest pain (6%), syncope/blackout (5%), other acute pain (5%).

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

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

  • The most common 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 venous cutdown), intravenous (or rectal) dextrose and arrest of haemorrhage.

PRINCIPLES OF MANAGEMENT

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

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

  2. The practitioner should be prepared mentally and physically.

  3. PLAN, EQUIP and PRACTISE.

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

  5. Beware of children with respiratory distress and ...

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