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Acute Medicine

Andrew Brereton
This review will critically appraise the AIM curriculum from a trainee,s perspective. The author will focus on the curriculum,s aims and objectives, availability of learning opportunities, adopted assessment and evaluation strategies and finally make recommendations to aid curriculum development.
2017: Acute Medicine
Tehmeena Khan, Neil Patel
The Specialist Advisory Committee (SAC) of June 2017 discussed the sign off of procedural competences relating to Sengstaken-Blakemore tube insertion and transvenous cardiac pacing and the application for chief registrar roles.
2017: Acute Medicine
Ben Chadwick
Acute medicine training has come a long way in a relatively short period of time. Acute Medicine was recognised as a speciality by the Royal College of Physicians in 2003, initially as a subspeciality of General Internal Medicine. Acute Medicine was formally recognised as a speciality in its own right in 2009.
2017: Acute Medicine
Louise Mundy, Purav Desai
Chest pain is an extremely common presenting complaint on the acute medical unit. It is important to distinguish between patients who have serious pathology and those without. Often, the focus is on ruling out an acute coronary syndrome and inadequate consideration is given to other possible causes. This case highlights the importance of performing relevant investigations in a timely manner, in order to ensure that a correct diagnosis is made.
2017: Acute Medicine
Raj Kumar Bhatnagar, Isuri Kurera, Robert Perry, Jennifer Tringham
Diabetic ketoacidosis (DKA) is a state of hyperglycaemia, ketosis and metabolic acidosis. This carries a significant morbidity and mortality particularly if left untreated or if the diagnosis is delayed. We present a case of euglycaemic DKA in a 48 year old female with non-insulin treated T2DM who had good glycaemic control. Initial investigations revealed moderate metabolic acidosis, persistent ketonuria and blood glucose levels < 11 mmol/l. There was a significant delay in diagnosing DKA following admission with multiple consultant reviews...
2017: Acute Medicine
Anastasia A Theodosiou, Rebecca Houghton, Nicholas Shepherd, Patrick Lillie
A 25-year-old Caucasian flight attendant with an extensive travel history presented with night sweats, fevers, weight loss and axillary and supraclavicular lymphadenopathy. Apart from surgical breast augmentation, she had no past medical or surgical history. She was anaemic, leucopenic and lymphopenic, and a broad infection screen was negative. Cross-sectional imaging revealed ipsilateral silicone breast implant rupture, with leaking of implant contents into the surrounding tissue. Histological examination of an axillary lymph node core biopsy confirmed the diagnosis of silicone lymphadenopathy...
2017: Acute Medicine
Euan Black, Russell Allan
The number of patients with tracheostomies managed within high dependency units is increasing. National audits have suggested that the care of these patients could have been improved upon with a significant minority of cases resulting in death or serious adverse events. Because of this, it is crucial that staff working within medical high dependency units have a good understanding of the indications for and techniques of insertion of tracheostomies. In addition, knowledge of the various tube types and ancillary equipment is mandatory...
2017: Acute Medicine
Thomas Edwards
A Delphi study approach was used to develop a national standard of competencies for Occupational Therapists and Physiotherapists working in acute medicine. Nineteen expert therapists participated in the Delphi study, which consisted of four rounds. A total of two hundred and seventy one competencies were developed and agreed for inclusion in a single document. This paper describes the methodology and challenges presented in developing such a diverse range of competencies.
2017: Acute Medicine
Tharmmambal Balakrishnan, P S E Teo, Wan Tin Lim, Xiao Hui Xin, Bi Huan Yuen, Kok Seng Wong
Coordination and consolidation of care provided in acute care hospitals need reconfiguration and reorganization to meet the demand of large number of acute admissions. We report on the effectiveness of an Acute Medical Ward AMW (AMW) receiving cases that were suspected to have infection related diagnosis on admission by Emergency Department (ED), addressing this in a large tertiary hospital in South East Asia. Mean Length of Stay (LOS) was compared using Gamma Generalized Linear Models with Log-link while odds of readmissions and mortality were compared using logistic regression models...
2017: Acute Medicine
P W B Nanayakkara, N Alam, R S Nannan Panday, J R Heijnen, L S van Galen, M H H Kramer
Sepsis is a major health care issue and sepsis survivors are often confronted with long-term complications after admission to the intensive care unit (ICU) which may negatively influence their health related quality of life (HRQOL). This study aimed to systematically evaluate the outcome in terms of HRQOL in patients with sepsis after ICU discharge. A literature search was conducted in the bibliographic databases PubMed, EMBASE, and CINAHL, including reference lists of published guidelines, reviews and associated articles...
2017: Acute Medicine
D A W A Joosen, N Anne Zwietering, Milou Bosch, Patricia M Stassen
Hyponatremia is a common finding in hospitalized patients. In this retrospective cohort study we assessed the characteristics and outcome of acute medical admissions with hyponatremia. Compared to the normal sodium group, those with hyponatremia were significantly older and the Charlson Comorbidity Index (CCI) was higher. The number of admissions to MCU/ICU between both groups was similar, but hyponatremic patients had a longer length of stay and both 28-day and one-year mortality were higher, even in patients with mild hyponatremia...
2017: Acute Medicine
Jennie McNaught
This is a pocket sized book (if your pockets are 20×18×2 cm big, that is) and it weighs less than two decent stethoscopes. Its small physical size belies the comprehensive coverage given to the subject. It is a really a compact textbook covering all aspects of stroke care.
2017: Acute Medicine
Neil Patel, Tehmeena Khan
Tehmeena Khan has replaced Sanjay Krishnamoorthy as a Trainee Representative for SAM. We would like to thank Sanjay for all his hard work and contribution during his tenure as Rep. Tehmeena is a final year trainee from North East & Central London. Tehmeena's specialist skills are Leadership, Management and Quality Improvement. She has previously been a Darzi Fellow and has undertaken a Winston Churchill Fellowship. She has recently joined the Health Foundation Q Community.
2017: Acute Medicine
Olivia Jones, Aram Salehi
The presentation of a 'sore throat' is common and often requires only symptomatic treatment. This is the case of a 20-year-old female who presented with persistent symptoms of a sore throat. On admission she had raised inflammatory markers and a subsequent blood culture demonstrated a fusobacterium necrophorum and arcanobacterium haemolyticum bacteraemia. Further investigations established an internal jugular vein thrombosis, confirming the diagnosis of Lemierre's syndrome. This case highlights the importance of further investigation when a sore throat fails to improve, and to remember this often-forgotten syndrome...
2017: Acute Medicine
Dalia Nelson, Heather Angus-Leppan, Phillip Jacobs
Mycoplasma Pneumoniae (M.pneumoniae) is a well-known cause of atypical pneumonia, however it is also associated with many extra pulmonary manifestations. This report highlights a patient with gastroenterological, haematological and neurological complications, including a third cranial nerve palsy which developed after her initial treatment and discharge from hospital.
2017: Acute Medicine
Sarah Lawrence, Andrew Claxton, Mark Holland, Jack Hodd
A 51 year old man presented with severe sepsis, disseminated intravascular coagulation (DIC) and multiorgan dysfunction after a 24 hour history of diarrhoea and malaise. Despite fluid resuscitation and receiving a platelet transfusion, freshfrozen plasma and intravenous broad-spectrum antibiotics, he remained anuric with a worsening metabolic acidosis. He was transferred to critical care for organ support including renal replacement therapy. He subsequently developed purpura fulminans. Blood cultures were positive for Captocytophaga carnimorsis, a gram-negative canine zoonosis that is an underdiagnosed cause of severe sepsis, for which DIC at presentation is characteristic...
2017: Acute Medicine
Christopher J Wright, Russell M Allan, Stuart A Gillon
Acute respiratory failure is a life threatening condition encountered by Acute Physicians; additional non-invasive support can be provided within the medical high dependency unit (MHDU). Acute Physicians should strive to be experts in the investigation, management and support of patients with acute severe respiratory failure. This article outlines key management principles in these areas and explores common pitfalls.
2017: Acute Medicine
Pwb Nanayakkara, Y M Smulder
OBJECTIVE: To compare the effects of central versus peripheral drug administration on the rate of return of organised electrical activity and/or spontaneous circulation during CPR. STUDY DESIGN: Randomized clinical trial. STUDY POPULATION: Hospitalized patients and patients presenting at the emergency department, older than 18 years, requiring CPR. INTERVENTION: Central venous access Main study parameters/endpoints: Combined primary endpoint: rate of appearance of organised electrical activity or return of spontaneous circulation...
2017: Acute Medicine
P J Johnson, T Dutt, B J Renton
In an attempt to reduce the number of inappropriate clotting screens being performed in our Trust, an electronic prompt was introduced to our haematology requesting system. Over the six month period after introduction of this prompt the number of clotting screen requests reduced by 7001, representing a 21% reduction when compared to the same 6 month period one year earlier. This represented a cost saving of over £98,000 without any increase in adverse incidents being reported related to bleeding complications...
2017: Acute Medicine
Huma Asmat, Shah Khalid Shinwari, Tim Cooksley, Roger Duckitt, Ivan Le Jeune, Christian P Subbe
The Society for Acute Medicine's Benchmarking Audit (SAMBA) was undertaken for the 5th time in June 2016. For the first time, data on telephone triage calls prior to admission to Acute Medical Units were collected: 1238 patients were referred from Emergency Departments, 925 from General Practitioners (GPs), 52 from clinics and 147 from other sources. Calls from Emergency Departments rarely resulted in admission avoidance. Calls from Primary Care resulted in avoidance of an admission in 115 (12%) patients; the percentage of avoided admissions was highest if the call was taken by a Consultant...
2017: Acute Medicine
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