Please click link below to view the PDF. References Ghosh Dastidar A, Garg P, West JN, et al. ST elevation in ECG lead aVR signals severe acute left main coronary artery disease. Acute Medicine 2013;12(4):220-223. Engelen DJ, Gorgels AP, Cheriex EC, et al. Value of the electrocardiogram in localizing the occlusion site in the left...
Abstract
In this article we look at the causes of ataxia, and how the patient presenting with ataxia should be managed. One of the difficulties in managing the patient with ataxia is that acute ataxia has many causes, but usually these can be teased out by means of a careful history and examination. Investigations can then be targeted at confirming or disproving the differential diagnosis. Some patients with ataxia need to be managed in hospital, but many can be investigated, and receive therapy, as an outpatient.
The Patient with Ataxia Read More
Abstract
Proximal muscle weakness can present acutely or subacutely to the Acute Medical Unit. Early diagnosis of the underlying pathology is essential due to life threatening complications such as respiratory failure and cardiac disturbances as well as causing significant levels of disability. The diagnosis requires thorough history-taking and examination to discern evidence of true weakness, assess its onset, distribution and severity followed by extensive investigations including a CK level, which if high should raise suspicion of rhabdomyolysis. Assessment of respiratory function should be done promptly to identify patients with associated respiratory muscle weakness and treatment should not be delayed waiting for definitive and confirmatory investigations. Poor response to treatment is unusual when diagnosis is correct; this raises the possibility of an alternative diagnosis.
The patient with Acute Muscular Weakness Read More
Risk of first venous thromboembolism in pregnant women in hospital: population based cohort study from England.
Journal Watch November 2013 – February 2014 Read More
We hope you all had a lovely Christmas and New Year. Apart from making all the usual resolutions, New Year is always a time to think about our careers, look at our CV’s and strive to improve ourselves towards our ARCP or CCT. Our spring conference will take place in Amsterdam this May on 1st-2nd May and there is plenty of opportunity for you to get involved! This year we will be joined by the Dutch Medical Society (DAM). The SAM conferences always provides us with an opportunity for networking, presenting our hard work and meeting other trainees throughout the UK (and in this case Holland). It will be interesting to hear what the Dutch trainees think about their training and how it is structured. There is a dedicated session on acute medical education and training. It will be useful to certainly combine and share ideas with our Dutch colleagues. We certainly could learn a lot from each other and therefore improve our training.
Our acute awareness week will take place on 14th-20th July. This is a huge chance for us to raise awareness of our speciality to the public and other hospital workers. You often find that people don’t understand what acute medicine actually is or what an acute medical registrar or consultant actually does. This is an opportunity for us to ‘celebrate’ our speciality and enjoy team bonding. The junior doctors enjoy getting involved and this often encourages them to think about a career in acute medicine. Full details and information packs will be available via our website shortly. We will be interested to hear what you are all planning as we both have a huge part to play in this year’s acute awareness week. Perhaps one day we could have a training awareness day? It would be great if you got in touch with us to let us know your plans or suggestions! We hope to see as many of you in Amsterdam. Please feel free to contact us with any suggestions, ideas or concerns
Trainee Update January 2014 Read More
Abstract
Pain is a common symptom amongst patients presenting to the Acute Medical Unit, with an extensive differential diagnosis. We present the case of a patient with back and lower limb pain where the diagnosis of an atypical form of Guillain-Barre Syndrome (GBS) was made. Acute physicians must be vigilant to the less common presentations of GBS and the variations from the “classical” presentation of ascending flaccid paralysis.
An atypical presentation of an acute neurological illness: Acute Motor Axonal Neuropathy Read More
Abstract
We present a case report of young man with Type 1 diabetes who developed acute visual loss after initially presenting with diabetic ketoacidosis. The diagnosis of invasive paranasal sinusoidal aspergillosis was made following CT and biopsy. Although uncommon, visual loss is a recognised complication of disseminated aspergillosis and is more likely in immunecompromised patients and those with diabetes. Early investigation with appropriate sinus imaging and involvement of the Ear Nose and Throat team in recommended when patients with diabetes develop acute visual loss in the context of a non-specific infective illness.
Sudden loss of vision in an Acute Medical Unit Read More
Abstract
We report the case of a 75-year old woman who presented with shortness of breath and haemoptysis. She had been treated for presumed essential hypertension for many years. On admission she was found to be severely hypertensive. Chest X-ray showed pulmonary oedema. However, an echocardiogram reported good systolic ventricular function. Her hypertension and pulmonary oedema did not respond to medical treatment necessitating intubation. A CT angiogram identified the cause – undiagnosed bilateral severe renal artery stenosis. We discuss this increasingly common condition that is difficult to manage and easily missed.
Scottish Exhibition and Conference Centre, Glasgow; 3-4th October 2013
A number of posters at the 7th International Conference of the Society for Acute Medicine were awarded ‘highly commended’ certificates by a panel of judges. The abstract text from these posters published here. The posters themselves can be accessed via the Society for Acute Medicine website: www.acutemedicine.org.uk
Abstract
Introduction: Early and appropriate recognition of patients requiring palliative care is essential to delivering high quality management and Acute Medical Units have a pivotal role to play in ensuring its implementation.
Aim: To identify the prevalence of patients admitted to Acute Medical Unit (AMU) who met palliative criteria, the overall prevalence of terminal diagnoses and the frequency of appropriate referrals to the units Palliative Care in reach team.
Methods: An audit was performed at a University Hospital AMU to examine these issues. The NHS Supportive and Palliative Care Tool (SPCIT) was used to identify palliative patients. 409 patients were admitted to the AMU during the study period.
Results: 66 (16.1%) of patients were identified as palliative. Two-thirds of these patients had a non-malignant diagnosis. 30% of palliative patients were referred to the palliative care team of which 85.4% had a diagnosis of cancer. 88% of patients that received ongoing palliative care review had a diagnosis of cancer.
Conclusion: There is a high prevalence of patients with a terminal diagnosis presenting to the AMU reflecting an aging population and increasingly complex co-morbidities. Palliative patients with a non-cancer diagnosis are less likely to be referred to the palliative care team, which has the potential to disadvantage their care.
Palliative and end of life care on the Acute Medical Unit Read More