A registrar survival guide - Emergencies

There are many ways a patient could present with a medical emergency.

I was recently asked to visit a gentleman at home who was 'unwell' and was presented with a young man with severe shock stuck on the toilet. It posed a few problems.

From my harrowing experience, here are some tips on how to manage these issues when they arise.

Keep calm
This is, without doubt, the best thing you can do. There will be enough panicking and wailing and sometimes dogs leaping about. Take a deep breath and remember you've done all this before.

Help
You're going to need some help. Liaise with emergency services and remember to state you need an ambulance, not a car.

Focus
It's only natural when there may be a lull in the proceedings for your mind to wander.

Afternoon surgery may start in 25 minutes and this is going to take ages. Deal with the problem in hand. Everything else is secondary.

Assess
ABCs and history are simple and important. If you're not sure what is going on, go back to basics. Nobody is expecting you to diagnose Shakhonovich's syndrome (Google it), but being able to spot a sick patient is imperative.

Referral
It is best to inform the admitting team that you're sending in a critically ill patient.

You might receive resistance but don't feel pressured into bending the truth, be honest.

Debrief
Discuss this with your trainer, be reflective about what went well and identify areas for improvement. Also remember to place an entry in your ePortfolio.

  • Contributed by Dr Syed Haque, a GPST3 in East Anglia.

Essentials Checklist

  • Zen-like state of calm.
  • Equipment: thermometer, sphygmomanometer, stethoscope, urine dipsticks and a phone.
  • Ability and insight to ask for help.
  • A debrief with your trainer for feedback.
  • A discussion with the admitting team to find out what happened to the patient.

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