InnovAiT: Education and inspiration for general practice

It's an emergency doc'. Managing emergency patient encounters in primary care can be both challenging and stressful for GPs. Many problems classified by patients as emergencies in primary care are not, in medical terms, true emergencies. Although this means that you do not always need to summon up your emergency care skills to manage GP emergencies, such cases present their own very special challenge.

As a doctor, at any stage of your training, you may in the course of your work, and sometimes outside it, be called upon to administer resuscitation to either a patient or another person. All general practitioner's (GP) practices should have a defibrillator, and defibrillators are often available in public places such as stations and supermarkets. The Quality and Outcomes Framework rewards practices for regularly updating cardiopulmonary resuscitation (CPR) skills of practice clinical and non-clinical staff (education indicators 1 and 5). In addition, all members of the public should be encouraged to consider taking the basic training as the earlier cardiopulmonary resuscitation is initiated after a collapse, the more likely it is to succeed.

Anaphylaxis is a severe, systemic allergic reaction that is life threatening. Although less than 1% of those that suffer an anaphylactic attack die as a result of that attack, in the UK, there are approximately 20 deaths each year from anaphylaxis (one death per 3 million population). Risk of death is increased in those with pre-existing asthma, particularly, if the asthma is poorly controlled. Half of all fatalities due to anaphylaxis result from circulatory collapse (shock) and the remainder from respiratory failure (asphyxia). Prompt recognition and appropriate management saves lives.

When a patient becomes very agitated or violent, threatens suicide or starts to behave oddly, the GP is usually called—by the patient, relatives or friends or police attending the disturbance. As a GP, it is important to know how to handle such situations and under what circumstances the Mental Health Act applies.

In 2005 in the UK, there were 153 491 deaths from cancer—one in four of all deaths (29% of male and 24% of female deaths). Seventy-six percent of these deaths occur in people aged over 65. Death rates rise with increasing age. However, cancer causes a greater proportion of deaths in younger people, with cancer being responsible for 37% of deaths in those under 65 (47% of deaths of women; 31% of deaths of men). Lung cancer is the most common cause of cancer death in both men and women (Fig. 1).

In the UK, 25% of adults smoke cigarettes, 1% smoke a pipe regularly and 4% of men smoke at least one cigar per month. Of the cigarette smokers, 34% hand-roll their cigarettes, 55% would find it hard to go a whole day without a cigarette and 17% (mostly heavy smokers) have their first cigarette within 5 min of waking up. Overall, a slightly higher percentage of men (26%) than women (23%) smoke. Prevalence is highest in those aged 20–34 and then declines with age (Fig. 1).

Influenza is a respiratory illness caused by the influenza virus. Most cases in the UK occur in a 6- to 8-week period during the winter. The exact timing of this period, number of people affected and severity of the illness varies from year to year.

We are what we eat. Although rather clichéd, the level of fat in the diet of a population does directly mirror the incidence of heart disease and there are many other dietary factors which have both direct and indirect links with disease. For example, excess ingestion of salt is associated with high blood pressure; low roughage diets are associated with bowel cancer; ingestion of infected beef causes Creutzfeldt—Jakob disease; eggs may carry salmonella and some food additives have been associated with hyperactivity.

A day in the life of a GP usually begins with the daily trawl through our email inbox to check the results of the blood tests. The assessment of renal function, with U + Es (i.e. urea, creatinine, sodium and potassium), will form a significant percentage of them. Severe hyperkalaemia is a life-threatening emergency as it may cause cardiac arrhythmias, leading to cardiac arrest. With these potentially catastrophic sequelae, urgent investigation and treatment of genuine hyperkalaemia is essential. Common causes of hyperkalaemia include renal failure, metabolic acidosis and drugs (e.g. potassium sparing diuretics, Angiotensin Converting Enzyme (ACE) inhibitors and excess potassium therapy). However, a well recognized cause of raised serum potassium is pseudohyperkalaemia.