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Acute Medicine

Tim Cooksley, Ben Lovell
Acute Medicine remains a specialty in its infancy and, as such, faces many challenges associated with developing new ways of working. As the Society for Acute Medicine celebrates its 18th birthday the extraordinary role of Acute Medicine in both maintaining and indeed enhancing the care and welfare of patients is increasingly evident. However, scepticism still persists among some colleagues with regards to its effectiveness - a perception heightened by the difficult environment that currently pervades in acute and emergency care in the UK which mirrors the experience of many countries internationally...
2018: Acute Medicine
Zay Myo Htet, Mahzuz Karim
Quinine has long been used for the treatment of conditions such as malaria and leg cramps, and is also present at low levels in some beverages; however, it can cause serious side effects. We describe a patient who developed severe haemolysis, thrombocytopaenia, and acute kidney injury following the ingestion of a single dose of quinine. This case demonstrates the importance of awareness of such potentially life-threatening consequences of exposure to this agent.
2018: Acute Medicine
Adam Williamson, Dan Beckett, Nik Arestis
A 34-year-old gentleman, with a background of osteoarthritis, presented to the Acute Medical Unit with a short history of breathlessness. He had returned from holiday to the United States five days previously. Since return, he had complained of myalgia, sore throat, a non-productive cough, mild anorexia and fevers at home. More acutely, prompting his presentation to hospital, was acute dyspnoea, which was sudden onset, with some central anterior chest discomfort and worse lying flat.
2018: Acute Medicine
C Napier
Thyrotoxicosis is common and can present in numerous ways with patients exhibiting a myriad of symptoms and signs. It affects around 1 in 2000 people annually in Europe1. The thyroid gland produces two thyroid hormones - thyroxine (T4) and triiodothyronine (T3). Thyroxine is inactive and is converted by the tissues and organs that need it into tri-iodothyronine. In health, the production of these thyroid hormones is tightly regulated by the secretion of thyroid stimulating hormone (TSH; thyrotropin) from the pituitary gland...
2018: Acute Medicine
Viyaasan Mahalingasivam, John Booth, Michael Sheaff, Magdi Yaqoob
Nephrotic syndrome is an important presentation of glomerular disease characterised by heavy proteinuria, hypoalbuminaemia and oedema. The differential diagnosis of the underlying condition is wide including primary renal disorders and secondary diseases such as malignancy, infection, diabetes and amyloid. Presentations to acute medicine may be with hypervolaemia, complications of the nephrotic state (such as venous thromboembolism), or complications of therapy (such as infection). Early recognition of nephrotic syndrome is possible through simple urinalysis for protein and testing serum albumin, although a high index of suspicion is sometimes required in patients with comorbidities including potentially distracting cardiac or hepatic diseases...
2018: Acute Medicine
C Dudreuilh, R Aguiar, M Ostermann
Managing kidney transplant patients in an acute medical unit can be challenging, as patients have a single functioning kidney, underlying chronic kidney disease, and are immunosuppressed. Transplant patients develop AKI for all usual reasons but the differential diagnosis is wider and includes specific problems, such as obstruction of a single functioning kidney, vascular thrombosis, rejection, drug toxicity and drug-induced thrombotic microangiopathy. Septic AKI is common but again, the differential diagnosis of sepsis is wider...
2018: Acute Medicine
Matilde Røgilds Soltau, Mikkel Brabrand
OBJECTIVE: To clarify if leucocyte count progression can predict one-week mortality in unselected medical patients admitted to the emergency department. Additionally, we investigated the importance of leucocyte count progression for admission to the intensive care unit and length of stay. METHOD: This retrospective cohort study uses data collected in two phases from patients admitted through the emergency department at Hospital of South West Jutland. Upon admission, a nurse recorded the primary complaint and vital signs and registered these along with demographic information...
2018: Acute Medicine
Declan Byrne, Richard Conway, Seán Cournane, Deirdre O'Riordan, Bernard Silke
BACKGROUND: An Illness Severity and Co-morbidity composite score can predict 30-day mortality outcome. METHODS: We computed a summary risk score (RS) for emergency medical admissions and used cluster analysis to define four subsets Results: Four cluster groups were defined. Cluster 1 - RS 7 points (IQR 5, 8) Cluster 2 - 9 (IQR 8, 11), Cluster 3 - 12 (IQR 11, 13) and Cluster 4 - 14 (IQR 13, 15). Clusters predicted 30-day in hospital mortality OR 1.86 (95%CI: 1.82, 1...
2018: Acute Medicine
James N F Murphy, Ivan Le Jeune
Physical inactivity causes morbidity, mortality and healthcare expenditure. A minority of people undertake sufficient physical activity to meet the DoH recommendations. NICE has determined that brief advice in primary care is costeffective in increasing physical activity levels but there is no current recommendation for secondary care. Acute medical admissions represent "teachable moments" where patients might be receptive to advice. Qualitative methodology was used to determine the perspectives of acute medical in-patients on their willingness to receive physical activity advice and on its format and delivery...
2018: Acute Medicine
C P Subbe, B Duller
A high respiratory rate is a significant predictor of deterioration. The accuracy of measurements has been questioned. We performed a prospective observational study of automated electronic respiratory rate measurements and compared measurements with electronic counts obtained in the 10 minutes prior to the manual measurement. For 182 patients 1331 matching measurements could be compared. The mean age of these patients was 68 (SD 14) years. 96 (53%) of patients were female. While mean and median measurements were similar frequency distributions were significantly different...
2018: 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
N Alam, R S Nannan Panday, J R Heijnen, L S van Galen, M H H Kramer, P W B Nanayakkara
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
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