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Acute Medicine

Caroline Lebus
I'm sitting at my desk, trying to concentrate. On anything. It's impossible. No, I should rephrase that, it's "challenging" is the term I've been taught to use. I can't focus. I have no motivation. And it's been like this for nine months.
2018: Acute Medicine
K F Alber, M Dachsel, A Gilmore, P Lawrenson, R Matsa, N Smallwood, J Stephens, E Tabiowo, A Walden
Point of care ultrasound (POCUS) in the hands of the non-radiologist has seen a steady growth in popularity amongst emergency, intensive care and acute medical physicians. Increased accessibility to portable, purpose-built ultrasound machines has meant that clinicians often have access to a safe and non-invasive tool to enhance their management of the unwell.
2018: Acute Medicine
K F Alber, M Dachsel, A Gilmore, P Lawrenson, R Matsa, N Smallwood, J Stephens, E Tabiowo, A Walden
Point of care ultrasound (POCUS) has seen steady growth in its use and applications in aiding clinicians in the management of acutely unwell patients. Focused Acute Medicine Ultrasound (FAMUS) is the standard created specifically for Acute Medicine physicians and is endorsed by the Society for Acute Medicine and recognised by the Acute Internal Medicine (AIM) training committee as a specialist skill. In this document we present a curriculum mapping exercise which utilises a 'knowledge, skills and behaviours' framework and incorporates the GMC's 'Good Medical Practice' (GMP) domains...
2018: Acute Medicine
S Mongolu
The Osmotic demyelination syndrome (ODS) primarily occurs with rapid correction of severe hyponatraemia that has been present for more than two or three days. Some patients are, however at risk and can develop ODS at higher sodium concentration and lower rates of correction. A case of Osmotic demyelination Syndrome which developed despite an 'optimal' rate of correction of serum Sodium with good clinical outcome is described. The risk factors that contribute to development of ODS and strategies to prevent this complication are discussed, along with recommendations on how to manage this condition in hospital inpatients...
2018: Acute Medicine
P Samudrala, M T Cruz-Carreras, M B Murphy, T Rice
No reported cases to date describe herpes simplex virus (HSV) myelitis in association with cancer and chemo-radiation. We report a case of sub-acute HSV myelitis in a 54-year-old man receiving chemo-radiation with 5-flourouracil for esophageal cancer who presented to the emergency department with increasing numbness in both lower limbs that gradually spread to waist level. Magnetic resonance imaging with gadobutrol contrast 1 week later showed transverse myelitis involving the dorsal columns. Radiation-induced myelitis was suspected, and the patient was initially treated with dexamethasone; however, CSF analysis revealed HSV myelitis...
2018: Acute Medicine
A Williamson, C Kelly
A 51-year-old lady, with a background of an arachnoid cyst and ventriculo-peritoneal shunt in situ, presented to the Acute Medical Unit with a 2-day history of neck pain. She awoke from sleep with the pain and it persisted since. She had not been involved in any trauma, had no previous history of neck or back pain and her pain was not controlled with simple analgesia. She also complained of new odynophagia and high dysphagia, particularly to solid foods. There was no history of upper respiratory tract infection...
2018: Acute Medicine
D S Lasserson, C Harris, Tne Elias, Jst Bowen, S Clare
Acute ambulatory care is a critical component of the emergency care pathway with national policy support and a dedicated NHS Improvement network. The evidence base for treating acute medical illness outside hospital is a diverse mix of randomised and observational studies with varying inclusion criteria, prognostic stratification, interventions and healthcare setting which limits synthesis of all available evidence and translation to the UK context. There is little consensus on the level of risk for home-based treatment for acute medical illness...
2018: Acute Medicine
N Denny, S Musale, H Edlin, F Serracino-Inglott, J Thachil
Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Although acute DVT is often well managed, there is uncertainty in the management of chronic DVT which is increasingly being noted among patients presenting with similar symptoms to their initial DVT. The presence of a residual venous clot can be a problem for both physicians and patients fearing the risk of emboli to the same extent as the acute DVT. There are also issues in the accurate diagnosis and appropriate management of chronic DVT, which is the focus of the second part of this review...
2018: Acute Medicine
P Patel, N King
Studies demonstrate 67% of elderly patients can have dermatoses, which could result in functional and psychological consequences. Elderly presentations are further complicated by comorbidities and polypharmacy. This combined with limited dermatology training at undergraduate and postgraduate levels creates diagnostic challenges. This project investigated dermatology assessments by trainees using the Trust's acute medical admissions proforma. 100 proforma were reviewed for skin assessments alongside nursing skin care bundles...
2018: Acute Medicine
D Byrne, J G Browne, R Conway, S Cournane, D O'Riordan, B Silke
BACKGROUND: There is concern that undue ED wait times may result in adverse outcomes. METHODS: We studied 30-day in-hospital mortality (2002-2017) for all medical admissions (106,586 episodes; 54,928 patients) focusing on clinical risk profile. RESULTS: Comparing 2002-09 vs. 2010-17, median ED waits > 6 hours (hr) increased 10h (95% CI: 8,13) to 15h (95% CI: 9,19). 30-day mortality declined 6.2% to 4.9%- (RRR- 20.8%/ NNT- 78). 30-day-mortality by ED wait: - < 4hr 6...
2018: Acute Medicine
C S van Dam, N Moss, S A Schaper, M C Trappenburg, M M Ter Wee, K Scheerman, M Muller, Pwb Nanayakkara, Mjl Peters
BACKGROUND: Early detection of vulnerable older adults at the emergency department (ED) and implementation of targeted interventions to prevent functional decline may lead to better patient outcomes. OBJECTIVE: To assess the level of agreement between four frequently used screening instruments: ISAR-HP, VMS, InterRAI ED Screener and APOP. METHODS: Observational prospective cohort study in patients ≥ 70 years attending Dutch ED. RESULTS: The prevalence of vulnerability ranged from 19% (APOP) to 45% (ISAR-HP)...
2018: Acute Medicine
A Dobbe, J G Zijlstra, J C Ter Maaten, Jjm Ligtenberg
INTRODUCTION: We noticed that fewer patients with self-poisoning were transferred from the ED to the Intensive Care Unit (ICU) than previously. To objectify this, we evaluated ED and ICU admissions in two time periods. METHODS: The number of admissions was collected during 1994-1998 and 2010-2014. As a sample survey, full records of patients with an intoxication from January 2010 till December 2010 were studied. RESULTS: From 2010-2014 26 patients/year were admitted from the ED to the ICU; from 1994-1998 51 patients/year (p=0...
2018: Acute Medicine
Mnt Kremers, Pwb Nanayakkara
In recent years we indeed have witnessed an increasing demand on healthcare services coupled with spiraling healthcare costs forcing us towards identifying factors and interventions leading to greater healthcare efficiency.
2018: Acute Medicine
Tim Cooksley, Ben Lovell
There is a myth that Acute Physicians only work in Acute Medical Units (AMUs). In fact, they tread a constant path between the AMU, the Emergency Department (ED), ambulatory care, Intensive Care Units (ITUs) and various specialty wards within the hospital. Just as our focus is not tied to a single organ or body system, is it not solely linked to a certain geographical place. As a result, those working in Acute Medicine are invested in the pathways, problems, processes and positive attributes of departments and units outside of the AMU, because they affect our patients...
2018: Acute Medicine
Mark Lander
I read with interest the Viewpoint article by Dr Chadwick regarding the future of Acute Internal Medicine (AIM) training, particularly the development of Capabilities in Practice (CiPs( and their potential to promote a greater identity within the specialty training. Dr Chadwick highlights the struggle we face in asserting why our specialty is so vibrant and vital. In my experience, Acute Internal Medicine training suffers from an identity crisis whereby the specialty is seen as being permanently on call, with trainees working more shifts as the Duty Medical Registrar (DMR) than on other specialty training programs, without the variability of outpatient and skill-based training...
2018: Acute Medicine
Nicola Cooper
I read the article, 'Is the AIM curriculum, for higher specialty training, fit for purpose' with interest. However, I disagree with the author on a number of points. First, a curriculum is 'everything that happens in relation to an educational programme', not a document setting out intentions and expectations. Issues with the quality of training in medical specialties are often addressed by re-writing documents. But the root causes of problems are often to do with the quality of posts 'on the ground' (e.g. timetable, experience and learning opportunities) and the quality of supervision and feedback (nonexistent in some cases)...
2018: Acute Medicine
P Parulekar, T Harris
Both hyper and hypovolaemia have been associated with poor outcomes. Assessment of fluid responsiveness is challenging in the acute medical patient, due to time constraints, limited evidence and quite often the lack of accurate assessment tools on the Acute Medicine Unit (AMU). This article explains how focused echo assessment is quick and easy to use for this purpose on the acute medical take and highlights key principles to bear in mind when assessing for hypovolaemia and whether to administer fluid therapy...
2018: Acute Medicine
N Denny, S Musale, H Edlin, F Serracino-Inglott, J Thachil
Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Among the different presentations of DVT, thrombus in the iliofemoral veins may be considered the severest form. Although anticoagulation is the mainstay of the management of iliofemoral thrombosis, despite adequate anticoagulant treatment, complications including post-thrombotic syndrome is not uncommon. The latter is often overlooked but can cause considerable morbidity to the affected individuals. Preventing this condition remains a challenge but recent clinical trials of catheter directed thrombolysis and elasticated compression stockings provide some advance in this context...
2018: Acute Medicine
M Jackson, K Balasubramaniam
A 64-year-old male presents to the emergency department in acute respiratory distress. He gives a limited history of progressive shortness of breath of one week's duration and several episodes of sudden unexplained syncope. There was no history of chest pain, palpitations or localising symptoms of infection. He takes no regular medications.
2018: Acute Medicine
S Yeniocak, A Kalkan, D D Metin, A Demirel, R Sut, I Akkoc
Olanzapine is an antipsychotic drug used in psychiatric diseases. At high doses it exhibits cardiovascular and neurological sideeffects in particular. Lipid emulsion therapy for the removal of medication from plasma in high-dose lipophilic drug use has recently become very widespread. In the light of current literature, this report discusses the successful treatment of a patient within 4 hrs of olanzapine overdose as an attempted suicide, who presented with agitation and clouded consciousness.
2018: Acute Medicine
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