The Practical Management of Emergencies in Primary Care
Aims & Objectives of simulation based workshops
- ABCDE approach to emergencies
- Confidence and competence in practical management of emergency equipment and medication
- BLS algorithm for adults and children. Discussion of causes of cardiac arrest.
- Discussion of what emergency equipment/medication to carry in GP bag and to have in GP surgery
- Discussion of organisation of resus trolley (e.g. grab and go boxes)
Emergencies to include:
- Severe asthma
- Cardiac arrest
Practical skills training to include:
- Using BM machine
- Oxygen cylinder & masks
- Using a nebuliser
- Drawing up & administering benzylpenicillin
- Drawing up & administering adrenaline
- Teach patient to use their epipen
Confidence in administering medication to include:
- Dextrogel, IM Glucagon
- Salbutamol nebs
- IM Adrenaline – epipens and adrenaline vials
- 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.
- 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.
- 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.
- 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
- 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.
- Use of GP surgery defibrillator
Case 6: Management seizures
You are called to the waiting room because a known epileptic has started fitting.
- Recovery position
- Medical management seizures