All Journals from Nicola Cooper
Abstract
We describe a case of postural orthostatic tachycardia syndrome (POTS) in a young female, presenting several weeks after neurosurgery, to the Medical Admissions Unit. The diagnosis is discussed with reference to differential diagnosis, diagnostic criteria, pathophysiology and treatment.
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Abstract
A retrospective case note analysis of 100 consecutive admissions to a Medical Assessment Unit to (a) review the current impact of alcohol, and (b) assess the quality of clinical management and adherence to local and national guidelines.
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Abstract
This article reviews the clinical and legal issues involved in dealing with patients who refuse medical treatment following an overdose. We first describe a real case that has been made anonymous, before discussing a general approach to management.
We then review the relevant legislation, including the Mental Capacity Act (2005), the Mental Health Act (1983) and legal issues surrounding the treatment of young people. We discuss how this legislation may be applied in practice and then conclude with the outcome of the case, sources of further information and some key learning points.
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Abstract
Cellulitis of the lower limb is a common presentation in patients with diabetes. We report a case illustrating how Charcot neuropathy can be overlooked because of its resemblance to cellulitis.
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Abstract
Some patients with COPD ‘retain CO2’ when given high concentration or uncontrolled oxygen therapy. The mechanism for this, and why it occurs in only some patients, is unclear. The pathogenesis of chronic hypercapnia in COPD involves multiple, poorly understood mechanisms. During acute exacerbations ‘CO2 retention’ is thought to occur due to redistribution in ventilation-perfusion with oxygen therapy, although some studies suggest reduced ventilation also contributes. Problems arise when inexperienced staff extrapolate this teaching to include all patients with hypercapnia. The most common cause of hypercapnia is ventilatory failure. Teachers need to emphasise how to recognise ventilatory failure and the dangers of hypoxaemia in critically ill patients.
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