I read with interest the review article on the management of toxological emergencies , published in the last edition of the journal (E. Banham-Hall, R. Mallinson: Poisoning and toxological emergencies – acute trends and practice. Acute Medicine 2009 8(2) p17-21).
Gastrointestinal Emergencies describes itself as “the definitive reference guide for the management of gastrointestinal emergencies and endoscopic complications”, The book covers the huge topic of acute gastroenterology in a succinct and easy to read format. At just over 200 pages it covers a lot more than what you might expect and makes for easy and enjoyable reading.
Gastrointestinal Emergencies Read More
We are all responsible for maintaining our standards and improving the way in which we work. However, keeping up to date with the many guidelines/documents published and finding what is relevant to acute medicine can be difficult. This new section of Acute Medicine will hopefully bring together the relevant updates in the world of clinical governance.
Clinical Governance in Acute Medicine Read More
Abstract
Background: The utility of D-dimer in the diagnostic workup of pulmonary embolism has been established. Several D-dimer tests are available with different sensitivities and specificities. SimpliRED D-dimer is a rapid qualitative whole blood D-dimer assay suitable for bedside use.
Objective: To assess the utility of the SimpliRED D-dimer test in patients with suspected acute pulmonary embolism in the absence of formal ‘risk scoring’.
Design: A prospective study measuring SimpliRED D-dimer in unselected patients undergoing computed tomographic pulmonary angiography (CTPA) examination for suspected acute pulmonary embolism.
Main outcome measures: D-dimer and CTPA results were compared. Sensitivity, specificity, and positive and negative predictive values of SimpliRED D-dimer were calculated for the unselected patient group.
Results: Forty-seven patients underwent D-dimer testing and CTPA. SimpliRED D-dimer was positive in 23 and negative in 24 patients. D-dimer was positive in only 6 (50%) of the 12 patients with positive CTPA. Of the 35 with negative CTPA, 17 had positive D-dimer. The positive predictive value of the D-dimer was 26.1 % and the negative predictive value 75.0%.
Conclusion: SimpliRED D-dimer should not be used in the diagnosis of pulmonary embolism in the absence of risk scoring.
Abstract
Patients with complex needs are commonly admitted on the acute medical take and comprise a significant proportion of the workload for an acute physician. An innovative multi-professional approach to the assessment of this group of patients has been developed in Edinburgh; this paper summarises the results of a 4 week review of data collected on patients assessed by the multiprofessional team on the Medical Assessment Unit at Edinburgh Royal Infirmary.
Providing Better Care for Patients with Complex Needs in Acute Medicine Read More
Abstract
There are a number of cases reported in the literature which describe hyperglycaemia in patients following paracetamol overdose. The majority of these occur in conjunction with hepatic failure. Less well known is the occurrence of hyperglycaemia and acidosis following paracetamol overdose in the absence of hepatic failure. This report describes such a case which was initially misdiagnosed as diabetic ketoacidosis (DKA).
Abstract
We report two recent cases of tricyclic antidepressant (TCA) overdose complicated by the development of acute respiratory distress syndrome (ARDS). The previous literature documenting an association between TCAs and ARDS is reviewed. We propose that the respiratory complications of TCA overdose should be more widely publicised and included in national toxicology databases.
Tricyclic Antidepressant Overdose causing Acute Respiratory Distress Syndrome Read More
Abstract
A 62 year old female presented to the acute medical team with headache, fevers and enlarged axillary lymph nodes. Initial biochemical, microbiological and immunological investigations were normal. However, radiological imaging revealed that her silicone breast implants had ruptured, which may have been responsible for her presentation. A brief overview of the clinical features and management of silicone breast implant rupture is provided.
An Unusual Case of Fever and Lymphadenopathy Read More
Abstract
Abnormalities of the electrocardiogram are extremely useful for the diagnosis of heart disease, but they may also occur in non-cardiac conditions. The electrocardiographic abnormalities that have been described in neurological diseases are among the most striking deviations from normal. We describe a patient with an intracranial space occupying lesion (pilocytic astrocytoma) who exhibited electrocardiographic changes suggestive of acute coronary syndrome at the time of presentation with syncope.
A non-cardiac cause of an abnormal ECG Read More
Abstract
Lower extremity deep vein thrombosis (DVT) is a common disease associated with serious short term and long term complications. Its conventional treatment has been anticoagulation. Thrombolytic treatment has been used for DVT for over 40 years. More recently catheter directed thrombolysis has taken over systemic thrombolysis. This technique is useful to prevent post thrombotic syndrome (PTS) after DVT.
In this review article we present a case of DVT thrombolysis in our hospital, look at the pathophysiology of PTS, the mechanism of thrombolysis and the current status of thrombolysis in DVT.
Advances in Deep Vein Thrombosis Management with Thrombolysis Read More