We read with interest the review of shock by Rowe and Fletcher in the Acute Medicine Journal,1 and would like to make some comments regarding the contemporary definition of sepsis and the role of the Acute Medicine trainee in the management of severe sepsis and septic shock.
A 17 year old male was referred to the Accident and Emergency department (A&E) by his GP after he had experienced an episode of palpitations associated with dyspnoea whilst attempting exercise. He did not have any past cardiac history.
Picture Quiz: A young man with palpitations Read More
Balloon tamponade with compression tubes is used to stabilise life-threatening variceal bleeds when first-line endotherapy has failed and acts as a bridge to early definitive therapy.
Balloon Tamponade for Variceal Haemorrhage: A Practical Approach Read More
170,000 people present to Emergency Departments in the UK each year following an act of self-harm1 and this incidence is increasing. Deliberate overdose currently accounts for ≥10% of all acute medical admissions.2 The frequency and importance of this presentation to trainees in Acute Medicine is emphasised in the curriculum for Acute Internal Medicine 20093 which states that trainees must be able to perform a risk assessment following self-harm and formulate a management plan for care upon discharge from hospital. This article uses a common clinical case vignette to address these competencies.
Problem-Based Review: Self-Harm and Suicide Risk Read More
A 56-year-old female presents to the emergency department 6h after taking an overdose of verapamil MR 120mg x 28 capsules. She has a past medical history of hypertension and atrial flutter. On admission her GCS is 15, HR 50/min, BP 100/64, Capillary blood glucose (CBG) 10.2. ECG shows sinus bradycardia with prolongation of the PR interval. You estimate her weight to be 60kg.
Problem-Based Review: Calcium Channel Blocker (CCB) Poisoning Read More
The aim of this study was to look at the association between new onset atrial fibrillation (AF) and mortality as well as the influence of cardiovascular co-morbidities on risk in middle-aged women without cardiovascular disease at baseline. This large study demonstrated that those women who developed AF had an increased risk of all-cause, cardiovascular, and non-cardiovascular mortality compared with women who did not develop AF. Excess mortality associated with AF appears attributable to the occurrence of nonfatal cardiovascular events prior to death. It would seem that cardiovascular risk factors should be managed aggressively in patients with AF to try to reduce these deaths.
We have been aware for a while that there are disparities in specialist skill provision both between and within deaneries – and the SAC is working hard to identify problems in this area. More recently, the issue of funding for specialist skills has been raised. It seems that some deaneries are happy and able to contribute towards the cost of training in a particular skill, while others are not; in at least one deanery, part-funding has now been withdrawn, leaving trainees to cover the entire cost of their chosen skills training. As specialist skill training is now a mandatory part of the Acute Medicine curriculum, we need to find a way to eliminate disparity both between different deaneries and between different skills. However, there is no easy solution, and for the time being, trainees will have to factor in the potential financial implications of a particular skill when they are considering their options.
Acute Medicine Trainee Update Read More
Abstract
Diarrhoea is a common presenting complaint to the Acute Medical Unit. We report a case of acute fulminant necrotizing amebic colitis in a 73 year old man with no recent travel history preceding his admission. Such cases are often difficult to diagnose and hence associated with a high mortality, unless treated promptly and appropriately. This case report highlights the importance of early diagnosis and prompt initiation of treatment.
Abstract
Disseminated histoplasmosis is an opportunistic infection which is commonly associated with HIV. Haemophagocytic lymphohistiocytosis (HLH) has been described as a secondary phenomenon to infection, collagen – vascular disorders and malignancies. In patients with HIV, cases of reactive haemophagocytic syndrome associated with disseminated histoplasmosis have been reported with CD4 counts of less than 50 cells/μl (450-1660 cells/μl). We report a case of a 25 year old man with HIV who presented with a CD4 count of 153 cells/μl and would suggest that this diagnosis should be considered at higher CD4 counts than previously reported.
A case of haemophagocytic syndrome in HIV-associated disseminated histoplasmosis Read More
Abstract
Motor neurone disease (MND) is a chronic condition which presents mainly in the seventh and eighth decades. It classically presents with a mixture of upper and lower motor neurone features, with a predilection for the limb muscles as the presenting feature. The case report outlined below describes acute respiratory failure requiring non invasive ventilation (NIV), at the time of diagnosis of MND. It highlights the need for the acute physician to be vigilant in the differing forms of presentation of this condition and its subsequent diagnosis and management.
An ‘Acute’ Presentation of Motor Neuron Disease Read More