Dorset GP Centre

The Practical Management of Emergencies in Primary Care

Aims & Objectives of simulation based workshops

1. ABCDE approach to emergencies
2. Confidence and competence in practical management of emergency equipment and medication
3. BLS algorithm for adults and children. Discussion of causes of cardiac arrest.
4. Discussion of what emergency equipment/medication to carry in GP bag and to have in GP surgery
5. Discussion of organisation of resus trolley (e.g. grab and go boxes)

Emergencies to include:

1. Hypoglycaemia
2. Severe asthma
3. Meningitis
4. Anaphylaxis
5. Cardiac arrest
6. Seizures

Practical skills training to include:

1. Using BM machine
2. Oxygen cylinder & masks
3. Using a nebuliser
4. Drawing up & administering benzylpenicillin
5. Drawing up & administering adrenaline
6. Teach patient to use their epipen
7. Defibrillator

Confidence in administering medication to include:

1. Dextrogel, IM Glucagon
2. Oxygen
3. Salbutamol nebs
4. Benzylpenicillin
5. IM Adrenaline – epipens and adrenaline vials
6. PR Diazepam

Scenario based learning (e.g. 15 mins per scenario).

 GPs should use their own equipment and medication

Case 1: Hypoglycaemia

You are called to home of an elderly man with diabetes, hypertension and stage 3 CKD. His wife is worried as he has not been himself this morning. You note his medication is insulin, ramipril and aspirin.  When you arrive he is clearly very drowsy.

Learning points

• ABCDEFG approach to emergencies
• Using a BM machine
• Administer dextrogel or glucagon

Case 2: Severe asthma

20 year old known brittle asthmatic arrives in reception very short of breath, wheezy.

Learning points:

• Revise systematic ABC approach
• Find and set up oxygen in surgery
• Set up nebuliser and administer salbutamol

Case 3: Meningococcal septicaemia

The receptionist asks you to urgently see a child who has been carried into the practice treatment room. It is a 4 year old girl who had a headache, photophobia and fevers. Mum was worried when she had become more drowsy this afternoon and developed a widespread, non-blanching rash.

Learning points

• Administer benzylpenicillin to a child
• Management of sepsis in PRIMARY CARE

Case 4: Anaphylaxis – cases we have used:

• Practice nurse administering childhood imms and baby has anaphylactic reaction
• Adult with known peanut allergy stumbles into your surgery

Learning points

• Administer adrenaline in anaphylaxis (discussion re hydrocortisone, chlorphenamine)
• Revise administration of oxygen & nebuliser if needed

Case 5: cardiac arrest

60 year old woman returned from visiting family in New Zealand 3 days ago. She has noticed her left leg is swollen and this morning she felt short of breath and dizzy when getting dressed.

Patient starts feeling more unwell … then cardiac arrest.

Learning points

• BLS
• Use of GP surgery defibrillator

Case 6: Management seizures

You are called to the waiting room because a known epileptic has started fitting.

Learning points

• Recovery position
• Medical management seizures