Therapeutics and Medical Emergencies

Firstly, do no harm. This is held as the first law of clinical practice when considering any intervention to improve the health of our patients. This may at times be a difficult proposition, especially when the approach to treating a condition is fraught with risks and can carry the danger of adverse and unwanted side effects. Prescribing therapeutics is the time perhaps when this maxim should be most at the forefront of a clinician’s mind, as therapeutic interven­tions may not cause any immediately discernible danger or harm in the same way as operative interventions. It is therefore important for the prescriber to understand the relevant pharmacodynamics (the effects of the agent on the body) and pharmacokinetics (the effects of the body on the agent). To add a further layer of complexity, the reader should understand that pharmacological sciences are possibly the fastest evolving part of medicine. It would be a fair bet to say that, within the course of the reader’s undergraduate education, entire new classes of therapeutics will have emerged and established perceptions of other agents would have significantly changed. Practically speaking, this does not mean that it is necessary to mem­orize the nuances of all therapeutic agents (although you should have a good grasp of those you prescribe regularly); rather it is more important that a clinician understands how to recognize potential dangers and then be resourceful enough to mitigate against them, given the best know­ledge available at the time. Access to an up- to-date formulary and the will to use it are the surest way to navigate any prescribing pitfalls. ‘We don’t rise to the occasion, we fall to the most basic level of our training’. Thankfully, medical emergencies occur infrequently in the general practice setting. It is the rarity of such events that often leads to anxieties when dealing with them. This reaction is amplified by the caregiver’s nat­ural instinct to do something immediately, but often not knowing exactly what to do because the diagnosis is not immediately clear. The ABCDE approach, as advocated by the Resuscitation Council, is a safe and methodical way to approach any emergency. ABCDE is not only a hierarchy of importance for systems critical to life, but it also acts as an aide- memoire to undertake examinations and interventions when necessary. Most importantly, it buys time whilst the diagnosis is found or declares itself, without adversely affecting the outcome by inaction. Key topics include: ● Common drugs for common medical conditions ● Drug interactions ● Oral side effects of medications ● Basic life support ● Medical emergencies in dentistry (including the Resuscitation Council UK guidelines) ● ABCDE approach.