All Journals from Lorna Barton
Abstract
The Society for Acute Medicine has developed a number of clinical quality indicators by which all UK Acute Medicine Units can bench mark their activity. These will help to ensure high quality care for patients, inform the continuing development of acute medical services and demonstrate the positive impact of this new speciality. Prospective collection of these data may be a challenge for many busy units. This paper describes a local solution developed in house in a North East hospital. It demonstrates how the data collected can be analysed to assess the effect of changes in consultant presence on the unit and also time taken for patients to be seen by a doctor. The limitations of the system and potential for future development are considered.
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Abstract
Ischaemic stroke is a major cause of death and disability which costs the NHS £2.8 billion/year. Acute stroke care is developing rapidly in line with an increasing evidence base. Intravenous thrombolysis is now recommended by NICE. For this guidance to be effectively implemented stroke must be viewed as a medical emergency by both the public and professionals. Emergency medical services must work in partnership with stroke services to establish systems and protocols which offer high quality acute stroke care. This provides challenges, both in systems design and delivery of clinical care.
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Abstract We present the case of a patient who presented with evidence of pneumonia, sepsis and anaemia but no significant abdominal signs. A routine abdominal ultrasound scan revealed evidence of spontaneous splenic rupture. He underwent splenectomy but passed away subsequently from respiratory complications. The many associations of spontaneous splenic rupture are discussed. The diagnosis should be considered in any patient presenting with shock and non-specific abdominal signs and in those with pre-existing conditions known to cause splenomegaly. References Kumar S, et al. Spontaneous Rupture of Normal Spleen – An enigma recalled. Brit J Clin Pract. 1992; 46(1): 67-8 Paulvannan S, et al. Spontaneous Rupture of a Normal Spleen. Int J of Clinl Pract 2003; 57(3): 245-6 The New Aird’s Companion in Surgical Studies. 2nd edition. Churchill Livingstone. 1998pp. 969-996 Rothwell S, et al. Spontaneous Splenic Rupture in Infectious Mononucleosis. Emerg Med. 2004; 13(3): 364-6 Yagmur Y, et al. Spontaneous Rupture of the Malarial Spleen: Two case reports and a review of the literature. Critical Care 2000;. 4(5): 309-13 Domingo P, et al. Spontaneous Rupture of the spleen associated with Pneumonia. Eur J Clin Microbiol Infect Dis 1996; 15(9): 733-6 Rajagopal A, et al. Acute Myeloid Leukaemia presenting as Splenic Rupture. J Assoc Phys India 2002. 50: 1435-7 Lashley PM, et al. Spontaneous Rupture of the Spleen. West Indian Med J. 1998; 47(4): 172-3 Torricelli P, et al. Spontaneous Rupture of the Spleen: Report of two cases. Abdominal Imaging 2001; 26(3): 290-3. Sherwood P, et al. Spontaneous Splenic Rupture in uncomplicated Multiple Myeloma. Leukaemia and Lymphoma. 1996; 20(5): 577-9 Winslet MC, et al. Spontaneous Rupture of the Spleen in association with Idiopathic Thrombocytopaenia Purpura. Postgrad Med J. 1993; 69(815): 744-6 Shoemaker MT, et al. Acute Splenic Rupture in an adult with Homozygous Sickle Cell anaemia treated with chronic transfusions. Journal of Paediatric Haematology and Oncology 2004; 26(12): 849-51 Oran B, et al. Spontaneous Rupture of the Spleen in AL Amyloidosis. American Journal of Haematology 2003; 74(2): 131-5 Burg MD, et al. May 01 Rupture of a previously normal spleen in conjunction with enoxaparin: An unusual case of shock. Journal of Emergency Medicine. 2001; 20(4): 349-52 Blankenship JC, et al. Spontaneous Splenic Rupture complicating anticoagulant or thrombolytic therapy (Review). American Journal of Medicine. 1993; 94(4): 433-7 Full Text File size: 172 KB Downloads: 592...
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