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Background: Data are scarce about the possible role for the general practitioner (GP) in patients with decreased consciousness (DC) or coma. We wanted to investigate how often a GP is confronted with DC or coma during out-of-hours service in an urban region and to compare the patients presented to primary care to those who were immediately treated by the emergency medical services (EMS)., Method: In a prospective observational study during 2 weekends in the city of Ghent, Belgium, which has 232 500 inhabitants, 724 patients were seeking emergency care, and DC or coma was the reason for encounter in 27 patients (3.8%). Eight patients initially seen by a GP had more heterogeneous diagnoses than the 19 patients immediately transferred to the emergency department without intervention by a GP., Results and Conclusion: This study shows that about one-third (N=8) of emergencies involving patients with DC or coma were initially evaluated by a GP; five out of these eight patients were subsequently transported by the EMS. We conclude that telephone triage guidelines providing simultaneous alerts of the GP and the EMS for DC or coma patients, tailored training of GPs with skills maintenance, adequate equipment and close collaboration with the EMS are recommended for GP out-of-hours services.

This case report describes an acute overdose in a female patient with the serotonin mixed agonist-antagonist m-chlorophenylpiperazine (mCPP), a new synthetic drug that is also a metabolite of the antidepressant trazodone. Following ingestion of three multi-coloured tablets, she developed anxiety, agitation, drowsiness, flushing, visual disturbances and tachycardia. The mCPP concentration was 320 ng/mL in plasma and 2300 ng/mL in urine. Amphetamine (40 ng/mL), benzoylecgonine (47 ng/mL) and alcohol (0.7 g/L) were also detected in plasma. The concentration of mCPP in plasma was approximately six times higher than the usual concentration measured in patients under trazodone treatment (26-108 ng/mL, average 56 ng/mL). However, one should be careful to link the observed symptoms to the use of mCPP only as the other drugs that have also been taken or an interaction between the drugs could also have played a role.