(A Evans & M Taylor) · Diabetic Ketoacidosis 1. Only occurs in patients with a history of Insulin-treated Diabetes 2. Can be precipitated by Acute Pancreatitis 3. The diagnosis is excluded by a blood glucose less than 14 mmol/l 4. Has a higher mortality than Hyper-Osmolar Non-Ketotic coma 5. Patients with newly diagnosed Diabetes Mellitus […]
Self-Assessment MCQ Questions Vol.1 No.2 Read More
2002 Volume 1: 2 Cellulitis Diabetic Ketoacidosis Ventilation of the Asthmatic Pulmonary Embolism Anaphylaxis Volume 1: 3 Medical Emergencies in Pregnancy Non-Variceal Gastrointestinal Bleeding Atrial Fibrillation Chronic Obstructive Airway Disease Myaesthenia Gravis
Provisional Cycle of Reviews Read More
The fifth meeting of the Society for Acute Medicine took place on the 15th and 16th April of this year, hosted by Dr Paul Jenkins and Dr Rob Mallinson in Norwich. The education centre of the new Norfolk and Norwich hospital provided an excellent venue for the conference, which was attended by around eighty delegates
Society for Acute Medicine Spring Meeting 15th-16th April 2002 Read More
The pressure of acute admissions continues to place a great strain on those staff fighting on the front line. I stand in awe of those with enthusiasm for the battle but am occasionally aware of grumbles directed at compatriots with more comfortable lives, in the shelter of the Radiology department.
How many of you have approached your friendly radiologist with a request slip in hand to be greeted with “no”, “I’m busy”, “it’s a waste of time anyway”, “is that all you can tell me about the patient”; or worse, not greeted at all, but ignored for the next ten minutes whilst Dr Grumpy FRCR finishes his ultrasound scan/report/cup of coffee? Isn’t it sad that, as intelligent professionals, with the patients’ wellbeing as our common goal, we sometimes interact so poorly.
Pleuritic chest pain: infection, infarction or musculoskeletal? Read More
Abstract
Direct ophthalmoscopy is an essential part of the full systemic examination. However, the technique is challenging and time-consuming. In the acute medical setting therefore, it is advisable for the physician to identify the subgroup of patients in whom examination of the fundus is most likely to be helpful.
Ophthalmoscopy should be performed where papilloedema is suspected, in those with an altered level of consciousness or other focal neurology, those with an unknown systemic disorder, and those complaining of visual disturbance.
Abstract
Pulmonary embolism is common, treatable and often overlooked. Genetic factors such as factor V Leiden and acquired factors such as immobility, pregnancy, surgery and malignancy increase the risk. The clinical features are nonspecific, but dyspnoea and tachypnoea are almost universal. Traditional tests such as electrocardiography, blood gases and chest X ray lack sensitivity and specificity and recently ventilation perfusion scanning and leg ultrasound have been shown to be unhelpful in many cases. Central venous pressure measurement and echocardiography, especially of the right ventricle, are helpful in a collapsed patient. D-Dimer testing is useful in excluding pulmonary embolism provided it is part of a diagnostic pathway that includes clinical risk. Spiral CT scanning is sensitive and specific for proximal pulmonary embolism. Immediate treatment with low molecular weight heparin is indicated, except for the hypotensive patient, when thrombolysis with alteplase should be considered. Warfarin should be started and continued for six months or longer if justified by genetic or acquired factors.
Pulmonary thromboembolism Read More
Abstract
Ventilation of the asthmatic is a major challenge with a potential for catastrophic problems that can and should be anticipated. Therapy should be tailored to the individual’s needs. If managed appropriately mortality in these patients is low (less than 1%). Much of the reported morbidity relates to cerebral hypoxia at or immediately before ventilatory intervention. Early use of CPAP in asthmatics that fail or are slow to respond to conventional therapy has been shown to significantly reduce the need for intermittent positive pressure ventilation.
Ventilation for the Asthmatic Patient Read More
Abstract
Cellulitis is a common medical emergency. Investigations often fail to establish the specific microbial aetiology and there are few data to support common choices of antibiotic therapy used to treat cellulitis. Potentially unusual pathogens can be predicted from the epidemiological circumstances at presentation, while empirical treatment choices must be based on an understanding of the underlying pharmacokinetic and pharmacodynamic principles that govern antibiotic-microbe interactions. Animal models have established conditions that predict treatment success, taking into account confounding factors such as bacterial inoculum size. Synergistic combinations of antibiotics can improve outcome in difficult cases.
Principles and Practice of Antibiotic Therapy for Cellulitis Read More
Abstract
Anaphylaxis is a severe, potentially life threatening allergic reaction which occurs in adults and children. Prompt diagnosis and appropriate acute medical management will prevent fatal anaphylactic episodes. Anaphylactic reactions are IgE mediated responses to foreign antigens to which there has been previous exposure. The foreign antigens commonly implicated in anaphylaxis are foods (particularly nuts), drugs and venoms. Long term management should involve liaison with an immunologist/allergist to identify an underlying cause, provide education for further prevention and where possible offer immunotherapy.
Anaphylaxis – A guide to diagnosis, management and follow up Read More