Management of Atrial Fibrillation with Preexcitation Syndrome

Dear Editor: We read with interest the picture quiz ‘’A young man with palpitation’’ by Shaukat and Grey in Acute Medicine Journal, and we would like to make some comments regarding the management of pre-excited atrial fibrillation.   References T. Heaps:Calcium Channel Blcoker Poisoning. Acute Medicine 2011; 10(3): 153-155 Sirianni AJ, Osterhoudt KC, Calello DP …

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Training in Intensive Care Medicine

Abstract Training in Intensive Care Medicine is currently undergoing extensive changes, with the introduction of a new curriculum and new examinations. This article explains the new pathways for training in Intensive Care, with specific reference to trainees in Acute Medicine. References Intensive care society. Update on current training plans 2012. Available at www.ics.ac.uk/education/update_on_current_training_plans_2012. Accessed o …

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Investigation of Pleural Effusions

Introduction Pleural effusion is a common medical condition which often presents on the AMU. There are more than 50 recognised causes of pleural effusion which include diseases local to the pleura or underlying lung, systemic conditions, organ dysfunction and drugs.1 The normal pleural space contains approximately 1mL of fluid. The balance between hydrostatic and oncotic …

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Picture Quiz: A young patient with a severe headache

Case history A 38 year old woman presented with one day history of acute onset frontal headache which progressively generalised over a few hours. The headache was dull in nature and did not respond to analgesics. A day prior to the onset of headache her family members and the patient had noticed a distinct change …

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Serotonin Syndrome: An unusual cause of acute confusion and fever in the elderly

Abstract

Delirium is a common cause for hospital admission among elderly patients. Although infection is the most common explanation, there is a large number of other potential causes. We present a case of acute delirium due to serotonin syndrome, precipitated by concomitant prescription of clarithromycin and fluoxetine. The symptoms improved following treatment with a benzodiazepine and discontinuation of the fluoxetine. The diagnosis and management of serotonin syndrome is discussed.

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Dyspnoeic dysphasia: A series of unfortunate events

Abstract

We describe a case of a 56 year old man with no previous medical history who presented with sudden onset dyspnoea, expressive dysphasia, and right arm sensory loss and paresis. A diagnosis of bilateral pulmonary embolism and transient cerebral ischaemic attack was confirmed by CT pulmonary angiogram and MRI. Paradoxical embolism through an occult patent foramen ovale (PFO) was subsequently proven by contrast echocardiography. This case highlights a number of short and long-term management conundrums, that to date are incompletely addressed by clinical trials. These include timing of anticoagulation in patients with both venous thromboembolism and cerebral infarction, and the risk:benefit ratio of surgical closure of patent foramen ovale.

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Periodic Paralysis: An Unusual Presentation of Thyrotoxicosis

Abstract

Thyrotoxic Periodic Paralysis (TPP) is a rare complication of thyrotoxicosis and is up to 20 times more common in males. Cases usually present with painless muscle weakness precipitated by heavy exercise, fasting, an alcohol binge or large carbohydrate meal. Serum potassium is low in the majority, but normokalaemic (or even hyperkalaemic) TPP is recognised. Acute treatment of any electrolyte disorder, administration of a beta-blocker and treatment of the thyrotoxicosis leads to complete resolution. This rare diagnosis should be considered by the Acute Physician when confronted with any case of muscle weakness.

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Cytomegalovirus Pneumonia in an Immunocompetent Adult: A Case Report

Abstract

A 38 year-old woman, who was previously fit and well, presented with a 10 day history of fever and non-specific symptoms. Initial chest X-ray demonstrated patchy nodular infiltrates bilaterally. She became increasingly hypoxaemic. Cultures to this point were all negative.

A high-resolution CT thorax showed diffuse multilobular ground glass appearance with peripheral nodular shadowing, consistent with a viral pneumonia. CMV IgM antibody was positive and CMV PCR was positive on two subsequent occasions. She was commenced on oral valganciclovir. She made a full recovery and was discharged seven days later

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