In common with many parts of the United Kingdom the GPs in the Exeter area have formed a cooperative for out of hours cover. This means that 95 doctors have joined together to provide out of hours medical cover to a large population (over 200 000). This system has many advantages to its members, but I found another one while doing my shift recently.
I was asked to visit a man in a nearby town who was complaining of epigastric pain and vomiting. Having decided subconsciously that he probably had gastric flu that was doing the rounds in Exeter, I thought that a quick dose of prochlorperazine would rectify the situation.
He was aged 61 and suffered from polycythaemia and hypercholesterolaemia, but he seemed quite well. Examination was unremarkable apart from a bradycardia of 60, abdominal examination was completely normal, and in particular he had no epigastric tenderness. I was happy to explain the bradycardia as a vasovagal response to his vomiting, was reaching for my prescription pad for antiemetics and antacids when a sudden though crossed my mind—could this be a cardiac problem?
This is when the advantage of being in a cooperative comes into play; both cars are fully equipped with resuscitation facilities and a defibrillator. A relative was dispatched to ask the driver to bring in the equipment and in no time at all we had the standard limb leads attached to the patient and there were the tell tale signs of an acute inferior myocardial infarction. We administered aspirin and called for an ambulance to take him to hospital.
This could have been an easy diagnosis to miss and it made me feel good about myself, but without the defibrillators would I have just given him the antacids?
Footnotes
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