All Journals from Charlotte Cannon
A 66 year old man who had been diagnosed with COPD 18 months earlier was readmitted with breathlessness unresponsive to bronchodilators and steroids. His symptoms were noticeably improved by lying on his left side. CTPA showed no evidence of pulmonary embolism but raised the possibility of tracheomalacia, which was later confirmed with bronchoscopy and lung function testing. The classification and treatment options for tracheomalacia are discussed.
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Case number 1
An eighty nine year old woman was admitted with a two day history of abdominal pain and vomiting. Two months previously she had undergone a Hartmann’s procedure following a sigmoid perforation secondary to diverticular disease. A hiatus hernia had been noted on a CT undertaken prior to her recent surgery (Figure 1).
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Abstract
Leptospirosis is a rare notifiable disease with three major clinical manifestations: subclinical disease, a self limiting illness (90% cases) and Weil’s disease, a fulminant, life-threatening condition with renal and hepatic failure, haemorrhagic pneumonitis and cardiovascular collapse. Diagnosis is by the detection of IgM antibodies to leptospira produced 7 to 14 days after the onset of illness. It is important for acute physicians to consider this condition in their initial differential diagnosis since early treatment reduces the severity and duration of symptoms and hospital stay. A history of environmental or occupational exposure to animals or potentially infected water should raise suspicions of leptospirosis.
This article aims to remind clinicians of the diagnosis and management of this condition. The typical symptoms and signs are illustrated by a recent case which presented to our department.
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The Great Western Hospital was opened in 2002. It was built as a PFI hospital, moving services from the old Princess Margaret Hospital situated in central Swindon. The Great Western Hospital is conveniently situated near junction 15 of the M4 and therefore has excellent transport links. The Acute Medical Unit (AMU) was purpose built adjacent to the Emergency Department and in close proximity to Emergency Department Radiology. Details of the Acute Medical Unit layout are summarised in Table 2.
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The long-awaited guideline from the National Institute for Health and Clinical Excellence (NICE) for the management of chest pain of recent onset has now been published. This provides detailed recommendations for the management of patients with chest pain of possible or likely cardiac origin. This clarity should be welcomed by Acute Physicians who have seen a significant increase in emergency referrals to hospital, of which up to 25% in our practice are patients with chest pain. The guidance aims to help and support healthcare professionals to direct their patients into the appropriate referral stream.
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