By the time this is published, summer will be over, “Big Brother” will have evicted its final contestant and, no doubt, many of us will still be waiting for the elusive “lull” in emergency pressures. In practice, most acute medical emergencies occur year-round, and even acute asthma appears to be no exception. Whether it is the high pollen count, atmospheric pollution or ozone, our A&E has been literally ‘buzzing’ with nebulisers throughout recent months. Crighton Ramsay’s review of the ward m a n a gement of this condition is a timely sequel to the intensivist’s perspective published last year. This comprehensive paper includes a useful algorithm, based on the current British Thoracic Society guidelines, as well as an excellent pre-discharge checklist, which I can highly recommend. Chest pain remains at number one in our medical admissions countdown from year to year. The National Service Framework for coronary heart disease emphasised the importance of shortening “pain-to-needle” time for patients requiring thrombolysis, but it is the non-ST elevation patients who make up the majority of the workload. Raybould and Groves’ review summarises the management of the group of these who are determined to have acute coronary syndromes, emphasising the importance of risk stratification for these patients. Merrison and Scolding remind us that multiple sclerosis is a disease of affluent (and no doubt internet-browsing) societies. Armed with their excellent review of its emergency management you should stand a chance of knowing as much as the patient next time he or she presents on your acute medical intake. A shortage of suitable submissions means no “how-to-do-it” section, this time. However, Khakoo and Rosenburg have included a useful guide to Sengstaken tube insertion in their review of management of variceal haemorhage. Our “regular features” section includes a case of an important, but frequently forgotten cause of renal failure, while Andrew Crean presents some more of his controversial “thoughts from the dark room”. Once again, submissions along these lines, as well as original research or audits would be most welcome. I hope you find this edition continues to meet your personal CPD requirement for the coming few months.


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Acute exacerbation of asthma in adults

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