Office Emergencies Are you really ready?

Office Emergencies Are you really ready? H. Mitchell Shulman MDCM FRCPC CSPQ Attending Physician, Emergency Dept, MUHC Assistant Professor, Dept of Surgery

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CME Faculty Disclosure Dr. Shulman has no affiliation with the manufacturer of any commercial product or provider of any commercial service discussed in this CME activity.

What We ll Explore What to do General principles How to set up your office What is an office emergency? Syncope; SOB; Anaphylaxis; Stroke; Haemorrhage; Hypoglycemia; Delivery; Burns; Breaks; Cuts; Urinary retention How to stock your office What about epidemics? Natural disasters?

General Principles Anticipate Emergencies Assign roles / responsibilities Post key phone numbers Stroke center, ER s you refer to, etc. Post your address to give to 911 Emergency supplies: Easy to find / clearly identified place Train / orient staff Triage Response to Emergency Where things are Call ahead warn receiving hospital Should you run a drill from time to time? Document, document, document!

Your Office Be prepared in advance Special code phrase to alert staff Staff trained (call 911, get you out of room) Rooms properly set up to protect you (exits, dangerous stuff out of sight, furniture and fixtures)

Your Office (2) Safety (you and your staff) 1 st Ensure way out Think of weapons leave the weapon leave the room If necessary escape Do not threaten or antagonize

What is an Emergency? A highly volatile, dangerous situation requiring immediate remedial action. An unexpected situation or sudden occurrence of a serious and urgent nature that demands immediate action. A physician can sometimes parry the scythe of death, but has no power over the sand in the hourglass. Hester Piozzi, Mrs. Thrale (1741-1821). English writer.

Key Principle At a Cardiac Arrest, the first procedure is: take your own pulse 3 rd law; Laws of the House of God Samuel Shem (Stephen Bergman), 1978

Most Commonly Encountered Office Emergencies Primary Care: Asthma exacerbation Psychiatric Seizure Hypoglycemia Anaphylaxis Impaired consciousness Shock Poisoning Drug overdose Cardiac arrest

Syncope / Pre-syncope Syncope could be vasovagal but. Stock: Adrenalin Atropine Nitroglycerin Aspirin Glucose / glucagon Lorazepam EKG machine? AED?

Shortness Of Breath CHF COPD / Asthma Pneumonia Stock: Salbutamol puffer (spacer) Furosemide (IV; PO) Nitroglycerin Steroid puffer

Anaphylaxis Stock: Anti-histamine (IM; PO) (diphenhydramine, hydroxyzine) Epipen vs adrenalin Salbutamol (spacer)

CVA / TIA Code Stroke Warn your staff how to prioritize if they: turn up at your office; call Activate 911

Haemorrhage Basics Direct pressure (when appropriate) Shock position Epistaxis Nasal packing vs balloon Stock: Gloves, dressings, cleaning solutions, IV, IV fluids, lidocaine with phenylephrine spray, cautery

Hypoglycemia Stock: Glucose oral solution Glucagon / D 50 Do you need a glucose meter? Another reason to have an IV set-up? (catheters, connector tubing, sterile solutions)

Child birth / Delivery Clean drapes Cleaning solution Cord clamp Bulb to suction baby Something to wrap baby in Container for placenta Suggestion: Store it all together Plastic sealed box Date last checked

Burns / Breaks / Cuts Stock: Cleaning solution Antibiotic cream Dressings / tape / wrapping Splinting material Sling Ice pack Glue vs sutures vs sterri-strips (butterflies) Topical / Injectable anaesthetic

Urinary Retention Stock: Foley Cleaning solution Urine bag Topical anaesthetic Suggestion: Store it all together Plastic sealed box Date last checked

Office Supplies Do you want to have: Sutures / staples / glue Local anaesthetic (topical, injectable) Airways (nasal, oral) Ambu-bag and masks

Epidemics Measles / Chickenpox / Swine flu / Avian Flu / Flu / SARS / MERS /??? Protect yourself and your staff Be aware Train your staff How to handle phone calls Referral / notify authorities Masks and isolation Ask the right questions Stock: Masks, gloves, hand sanitizers Designate an area or a specific room as isolation

Epidemics Script (phone and office triage) Symptoms? Fever, cough, SOB, vomiting, diarrhea, rash, stiff neck Travel? Contacts?

What We ll Explore What to do General principles How to set your office up What is an office emergency? Syncope; SOB; Anaphylaxis; Stroke; Haemorrhage; Hypoglycemia; Delivery; Burns; Breaks; Cuts; Urinary retention How to stock your office What about epidemics? Natural disasters?

Disaster Planning Think ahead (reverse plan) What do you need to get back in business? Who can help? What resources are available? Prepare for the worst - hope for the best Patient care delivery who, what, where Communications - telephone, fax, e-mail, etc. Supplies Information processing and medical records recovery Staff availability Financial resources Stress management

What We ve Explored Office emergencies : Syncope; SOB; Anaphylaxis; Stroke; Haemorrhage; Hypoglycemia; Delivery; Burns; Breaks; Cuts; Urinary retention What to do Stocking / Setting Up your office Epidemics; Natural disasters

P.E.A.R.L.S. Plan ahead Anticipate Emergencies Assign roles / responsibilities Post key phone numbers Stroke center, ER s, etc. Post your address to give to 911 Emergency supplies: Easy to find / clearly identified place Train / orient your staff Triage Response to an Emergency Where things are Call ahead (warn receiving hospital) Document