All Journals from Sarbjit Clare
We read with interest to the article written by Kevin Fox 1 and wholly support the notion that acute medical trainees who wish to undertaken echocardiography within the medical admissions unit (MAU) should achieve British Society of Echocardiography (BSE) accreditation. I was one of the first trainees in acute medicine to undertake training in echocardiography; despite considerable competition from cardiology registrars as well as resistance from the physiology department I am now close to attaining the BSE Trans Thoracic Echocardiography accreditation.
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Abstract
Metformin Associated Lactic Acidoisis (MALA) has been reported to be a very rare but serious side effect of metformin treatment with a fatality rate of 50%. However, with the number of patients on metformin increasing the incidence of MALA is likely to increase. We aim to raise the awareness of MALA and prompt acute physicians to consider this diagnosis in the acutely unwell diabetic patient on metformin. We present 3 cases that presented with MALA in the course of 6 months, all of whom survived. We discuss metformin, its effects and lactic acidosis. We encourage effective prompt resuscitation of these individuals to increase survival.
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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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