Ramanayake R P J C, Ranasingha Sudeshika, Lakmini Saumya
Department of Family Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka.
J Family Med Prim Care. 2014 Oct-Dec;3(4):305-8. doi: 10.4103/2249-4863.148089.
Management of emergencies is an integral part of primary care. Being first contact care providers general practitioners may encounter any type of emergency. Acute attacks of asthma, myocardial infarction, anaphylactic shock, hypoglycemic coma, convulsions, head injuries and trauma are some of the common emergencies encountered by GPs. Updated knowledge, communication and procedural skills, trained paramedical staff, necessary equipment and medications and appropriate practice organization are vital to provide optimum care which may even save lives of patients. The wide range of problems and the rarity of the problems make it difficult for primary care doctors to be updated and competent in providing emergency care.
Some of the emergencies can be managed completely at a general practice while others should be referred to hospital after initial management. The extent to which a patient should be managed may be determined by the degree of severity of the condition, expertise of the doctor and distance to the nearest hospital. Apart from pharmacological management, explanation about the condition and the need for admission and appropriate advice on care prior to admission are also vital components of management. Writing an appropriate referral, arranging transport facilities, informing the hospital about the referral are also important steps in the process as these measures could prevent crucial delays.
Emergency care is a responsibility of primary care doctors and they should be knowledgeable and skilled and organize their practices to provide prompt and effective management whenever the need arises.
急诊管理是初级医疗的重要组成部分。作为首诊医疗服务提供者,全科医生可能会遇到任何类型的紧急情况。哮喘急性发作、心肌梗死、过敏性休克、低血糖昏迷、惊厥、头部损伤和创伤是全科医生遇到的一些常见紧急情况。更新知识、沟通和操作技能、训练有素的辅助医疗人员、必要的设备和药物以及适当的执业组织对于提供甚至可能挽救患者生命的最佳护理至关重要。问题种类繁多且问题罕见,这使得初级医疗医生难以在提供紧急护理方面保持知识更新并具备相应能力。
一些紧急情况可在全科诊所完全得到处理,而其他情况则应在初步处理后转诊至医院。对患者进行处理的程度可能取决于病情的严重程度、医生的专业知识以及到最近医院的距离。除了药物治疗外,对病情的解释、入院的必要性以及入院前适当的护理建议也是处理的重要组成部分。开具适当的转诊单、安排交通设施、告知医院转诊情况也是该过程中的重要步骤,因为这些措施可以避免关键延误。
急诊护理是初级医疗医生的责任,他们应该知识渊博、技能娴熟,并组织好自己的业务,以便在需要时能够提供及时有效的处理。