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General Medicine


If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Anaemia

  • Severe anaemia (Hb <70g/L) with risk of cardiovascular and/or syncopal collapse
  • Anaemia associated with definite clinical features of overt gastrointestinal bleeding e.g. haematemesis or melena
  • Severe cytopaenias if patient is unwell (i.e. infection, symptomatic anaemia, active bleeding)
    • Neutrophils < 0.5x109/L
    • Haemoglobin < 70g/L
    • Platelets < 20x109/L

Hypertension

  • Severe hypertension (systolic BP >180) with no known ischaemic heart disease, cardiomyopathy, or chronic kidney disease AND any of the following concerning features:
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilloedema
    • signs of heart failure
    • chest pain
    • headache
  • If suspected gestational hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible
  • If hypertension service available refer to hypertension service.

Complex or undifferentiated medical problems

  • Any sudden decompensation in clinical condition that carries risk of serious adverse events or death
  • Pyrexia of unknown origin with temp ≥ 39ºC
  • Pyrexia with neutropaenia
  • Delirium
  • Suspected systemic vasculitis associated with symptoms, signs or investigation results suggestive of vital organ involvement
  • Suspected temporal arteritis (giant cell arteritis) with markedly elevated ESR (>100) and/or jaw claudication and/or visual disturbance

Complex paediatric patients transitioning to adult services

  • Any sudden decompensation in clinical condition that carries risk of serious adverse events or death

Falls

  • Any fall occasioning serious trauma (including fractures, major soft tissue injury, head strike or concussion) that cannot be managed in primary care
  • Frequent falls (more than one every few days)

Medication review / polypharmacy

  • Anaphylactic or other serious adverse drug event
  • Markedly prolonged heart rate adjusted QT interval which may herald pro-arrhythmic event
  • Marked drug induced electrolyte abnormality (Na <120, K <3.0 or >6.0, corrected Ca >3.0, Mg <0.4)

Osteoarthritis, gout and joint pain

  • Acute non-traumatic monoarthritis causing severe pain and/or incapacitating loss of function and/or marked constitutional symptoms
  • Suspected septic arthritis

States of altered neurological function

  • Witnessed tonic-clonic (grand mal) seizures
  • Suspected transient ischaemic attack or stroke based on focal neurological deficits
  • Delirium or acute confusional state
  • Severe headache or altered level of consciousness of sudden onset

Syncope / pre-syncope

  • Syncope / pre-syncope with any of the following concerning features
    • exertional onset
    • chest pain
    • persistent symptomatic hypotension (systolic BP < 90mmHg)
    • severe persistent headache
    • focal neurological deficits
    • preceded by palpitations
    • associated significant physical injury (e.g. fractures, extreme soft tissue trauma, intracranial bleeds) or causing motor vehicle accident
    • family history of sudden cardiac death

Unintentional weight loss

  • Uncontrolled hyperthyroidism with risk of thyroid storm
  • Vomiting, dysphagia or odynophagia suggesting oesophageal or gastric outlet obstruction
  • Associated severe electrolyte abnormalities (K+ <3.0 mmol/L, corrected Ca+ <1.6 or >3.0 mmol/L, Mg+ <0.4 mmol/L, PO4- <0.4mmol/L)

Wounds of uncertain cause or non-healing ulcers

  • Severe cellulitis with ongoing or worsening systemic symptoms or fevers despite oral antibiotics for 48 hours
  • Foot ulcer in diabetic patient that is not responding to oral antibiotics and regular wound cleaning
  • Any infected ulcer associated with systemic inflammatory response symptoms (SIRS) or excessive pain or features suggestive of abscess formation, osteomyelitis or deep tissue infection (necrotising fasciitis)
  • Acute Charcot arthropathy
  • Ulcers or wounds in a limb with markedly compromised circulation

Chronic Deep vein thrombosis (DVT)

  • Patient severely symptomatic e.g., severe swelling or pain.
  • Pregnant or given birth within the past 6 weeks 
  • Present, or suspected, acute iliofemoral or supra-inguinal deep vein thrombosis
  • Present or suspected acute laxiliary or subclavian vein thrombosis

Other

  • Any condition defined by other CPCs as requiring referral to emergency

The following are not routinely provided in a public General Medicine service.

  • Clearly evident mental health disorders requiring psychiatric consultation
  • Genetic testing / counselling
  • Requests for respite care, ACAT assessments or other forms of assessment or supportive care in the presence of established diagnoses and management plans, or where patients with established mental capacity to make decisions refuse such  assessments or care
  • Reviews relating to workers’ compensation claims, NDIS eligibility, disability pensions, driving license renewals, or other legal and administrative procedures
  • Reviews relating to drug withdrawal or detoxification