All Journals from Nigel J Langford
Abstract
Suspected deep vein thrombosis (DVT) is a common reason for medical referral to hospital. We evaluated our new approach to assessment of DVT using combined automated strain gauge plethysmography and pretest probability score in comparison with venous ultrasonography in 100 consecutive patients with suspected DVT referred to the nurse-led clinic. The combined plethysmography and pretest probability score produced a negative predictive value of 99%, positive predictive value 53%, sensitivity 94% and specificity 83% for detection of a DVT. We conclude that our new working practice for DVT assessment is both safe and cost effective and can lead to a reduction in venous ultrasonography of approximately 70%.
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Transdermal fentanyl is a well-used and highly effective form of opioid analgesia for patients suffering with severe chronic pain. It is also an opioid that is widely abused. Acute clinicians need to be aware of the methods by which fentanyl patches may be used both therapeutically and illicitly as well as the impact this can have in managing a patient’s period of intoxication.
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A key component of training in Acute Medicine is the assessment and initial resuscitation of severely ill medical patients. The curriculum for General Internal Medicine (Acute Medicine) states that all specialists in Acute Medicine should attain Level 3 competencies in all emergency presentations.1 Different training programmes have variable exposure to the emergency department, to which the majority of these patients present. One module, currently being developed at City Hospital, Birmingham, is for the Acute Medicine Specialist Registrars (SpRs) to attend all medical alerts in Accident and Emergency (A&E) Department. This means that the SpR works as part of the receiving team, seeing patients first hand, rather than taking secondary referrals. At our hospital over 80% of alerts brought in the resuscitation room are medical emergencies.
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Venous thromboembolic disease (VTE) is a common presentation in acute medicine and ensuring fast, accurate diagnosis and appropriate management is important. Getting it right not only reduces mortality but can also reduce the long-term complications associated with the disease such as post-thrombotic syndrome (PTS) and chronic thromboembolic pulmonary hypertension.
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