Some areas are mentioned for information and awareness of surgery staff but the nurse would have a comprehensive list of emergency situations that may arise. More details can be obtained from web site given below.
Life threatening medical emergencies
- Cardiac arrest
Potentially life threatening emergencies
- Asthma and bronchospasm
- Severe upper airway obstruction
- Acute pulmonary oedema
- Convulsive status (convulsion for longer than 10 minutes)
- Meningitis and/or meningococcaemia (suspected)
- Septicaemia (suspected).
Nonlife threatening emergencies
- Nausea and vomiting
- Severe acute pain
- Migraine (adult)
- Painful wounds
- Palliative care emergencies
- Psychiatric emergencies (adults)
- Contaminated wounds.
Oxygen is essential for managing emergencies and its availability is a requirement for general practice accreditation. Oxygen cylinders can be hired and refilled from a medical gas supplier. A size C cylinder (490 L) will last for 55 minutes at 8 L/min.
The following are required to administer oxygen:
- Adult and paediatric Hudson masks and nebuliser masks,
- Nasal prongs,
- Airways, and
- A bag valve-mask breathing system (e.g. Air Viva 3).
Equipment for managing emergencies
Appropriate supplies of IV infusion sets, cannulas, syringes, and needles are required. General practitioners should consider the following items for their practices:
- An automated external defibrillator (AED) with monitor and manual override. Although a defibrillator is not a requirement for practice accreditation, its absence may put a practice at clinical and medico legal risk
- Pulse oximeter
- Portable packs to enable equipment to be taken for use offsite.
Equipment for the doctor’s bag
The doctor’s bag is very important and the contents of it vary according to the individual doctor and their pattern of work. GPs working in remote parts of the Highlands of Scotland will obviously have very different requirements from those working in the inner city.
Many GPs will no longer work out of hours but will still need to be able to assess and manage patients while out on home visits. Those working for out of hour’s organisations may have some, or all, of the necessary equipment and medications provided.
Most GPs will use a bag of some variety and the following should be considered:
- The bag must be lockable and not left unattended.
- Most medicines should be stored between 4° and 25°C. A silver-coloured bag or cool bag is more likely to keep drugs cooler than a traditional black bag.
- Consider keeping a maximum-minimum thermometer in the bag to record extremes of temperature.
- Bright lights may inactivate some drugs (e.g. injectable prochlorperazine) so keep the bag closed, when not in use.
- Lock the bag out of sight in the vehicle boot when not in use.
There are several key issues to be considered like:
- Basic and administrative equipment
- Diagnostic equipment
- Other equipment
- Administrative issues
Managing emergency drugs in general practice
Drugs must be stored in a locked cupboard or a locked bag at less than 25°C. ADT and syntometrine are stored in a refrigerator.
Schedule 8 drugs (opioids) must be stored in a locked, fixed, steel safe; although ampoules may be put in a locked bag for use away from the clinic.
All emergency drugs should be logged in a book or spreadsheet that includes, date received, date administered, recipient, and expiry date.
Systems should be in place for checking drug stocks and expiry dates, and for auditing the log.
A separate book is required to log Schedule 8 drugs received and used.