Correspondence

Pardon My French

Correspondence, Volume 18, Issue 3, Pages 137 – 204 (2019)

Cama et al’s review of pneumothorax management was excellent, especially their elegant depiction of chest tube diameter in comparison to the intercostal space, as measured in French gauge. The use of gauge is medicine is confusing due to differing systems and seemingly random increments. This diagram neatly shows that French gauge (Fr) is directly proportional to diameter, as the external diameter of the tube in millimetres is the gauge multiplied by three. For example, a 15 Fr chest tube has an external diameter of 5mm.

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Predicting value of prehospital body temperature for ICU admission of septic shock patients

Correspondence, Volume 18, Issue 1, Pages 1 – 60 (2019)

To specify whether an association exists between pre-hospital body temperature collected by the emergency medical services (EMS) call centre, and intensive care unit (ICU) admission of patients with septic shock. An observational study based on data collected by the EMS of Paris. All septic shocks were included. Among, the 140 calls concerning septic shock, 22 patients (16%) were admitted to ICU. The mean core temperature was 37.4±1.6°C for ICU and 38.6±1.1°C (p<4.10^-5) for non-ICU patients. Using propensity score analysis, the relative risk for ICU admission of patients with pre-hospital fever or hypothermia was 0.31 and 2 respectively. The study highlights the potential usefulness of early temperature measurement in septic shock patients to allow early proper orientation.

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Response to: Assessment of Fluid responsiveness in the Acute Medical Patient and the Role of Echocardiography

Correspondence, Volume 17, Issue 4, Pages 173 – 240 (2018)

I read the article, ‘Assessment of Fluid responsiveness in the Acute Medical Patient and the Role of Echocardiography’ by Dr Parulekar and Dr Harris with interest. It rightly highlights the challenges posed when assessing for fluid resuscitation in a pressured setting with limited information. This scenario is a routine one for our speciality, which is why it is a concern that the evidence-base outside of intensive care remains limited. Of particular relevance to the Acute Medical specialist, the article acknowledges that performing a focussed-echocardiogram on all acutely-unwell patients is “impractical”. Developing a quick and straightforward approach to fluid resuscitation assessment should be a high research priority for Acute Medicine.

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Curriculum mapping for Focused Acute Medicine Ultrasound (FAMUS)

Correspondence, Volume 17, Issue 3, Pages 117 – 172 (2018)

Point of care ultrasound (POCUS) in the hands of the non-radiologist has seen a steady growth in popularity amongst emergency, intensive care and acute medical physicians. Increased accessibility to portable, purpose-built ultrasound machines has meant that clinicians often have access to a safe and non-invasive tool to enhance their management of the unwell.

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Is the AIM curriculum, for higher specialty training, fit for purpose? – response

Correspondence, Volume 17, Issue 2, Pages 57 – 116 (2018)

I read the article, ‘Is the AIM curriculum, for higher specialty training, fit for purpose’ with interest.
However, I disagree with the author on a number of points. First, a curriculum is ‘everything that happens in relation to an educational programme’, not a document setting out intentions and expectations.

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Shaping the future of Acute Medical training

Correspondence, Volume 17, Issue 2, Pages 57 – 116 (2018)

I read with interest the Viewpoint article by Dr Chadwick regarding the future of Acute Internal Medicine (AIM) training, particularly the development of Capabilities in Practice (CiPs) and their potential to promote a greater identity within the specialty training. Dr Chadwick highlights the struggle we face in asserting why our specialty is so vibrant and vital. In my experience, Acute Internal Medicine training suffers from an identity crisis whereby the specialty is seen as being permanently on call, with trainees working more shifts as the Duty Medical Registrar (DMR) than on other specialty training programs, without the variability of outpatient and skill-based training. Indeed, the recent Joint Royal Colleges of Physicians Training Board (JRCPTB) statement regarding quality criteria for GIM/AIM Registrars appears to regard the role of the AIM registrar as that of the DMR rather than a specialist in their own field.

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24 hour availability of echocardiography in Acute Medicine: time to get out of our ‘silos’!

Correspondence, Volume 11, Issue 3, Pages 129 - 185 (2012)

Dear Sir,

I read with interest the article by Ravikirti et al in the recent edition of Acute Medicine. The authors rightly highlight the potential for atypical presentations of tamponade following cardiac surgery, which has been reported previously. The investigation of any acutely unwell patient presenting after cardiac surgery should include some form of cardiac imaging. In the cases described the diagnosis was delayed, in part, due to the lack of an echocardiography service out-of-hours.

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