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.
Management of Atrial Fibrillation with Preexcitation Syndrome Read More
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.
Training in Intensive Care Medicine Read More
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 pressures in the visceral and parietal pleural vessels maintains this environment; any disorder affecting this balance will result in a pleural effusion.
Investigation of Pleural Effusions Read More
A 29-year old male presents to the emergency department 1h after an overdose of cocodamol. He admits to taking approximately 60 x 8/500mg tablets, with alcohol, over a 20 minute period. He has a past history of depression, treated by his GP with citalopram 20mg OD. He has no previous history of deliberate self-harm. His past medical history is otherwise unremarkable and he is not on any additional medications. He drinks approximately 40 units of alcohol per week. Physical examination is unremarkable, his pupils are normal diameter and his Glasgow Coma Scale is 15. He weighs 82kg.
Problem-Based Review: Paracetamol Overdose Read More
In the recent SAM elections, there were three nominations for trainee representative, and we are pleased to announce that Kirk Freeman was the successful candidate. Kirk is an ST6 trainee in the Wales Deanery, and will be taking over from Alice when her term ends in May 2012. He will also be helping out over the next few months while Amy is on maternity leave.
Acute Medicine Trainee Update Read More
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 in the appearance of her eyes. The headache was not associated with symptoms of meningism, vomiting, seizures, syncope or loss of consciousness. She did not report any weakness in her extremities. There was no recent history of neck trauma or neck pain and no other systemic symptoms.
Picture Quiz: A young patient with a severe headache Read More
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.
Serotonin Syndrome: An unusual cause of acute confusion and fever in the elderly Read More
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.
Dyspnoeic dysphasia: A series of unfortunate events Read More
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.
Periodic Paralysis: An Unusual Presentation of Thyrotoxicosis Read More
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
Cytomegalovirus Pneumonia in an Immunocompetent Adult: A Case Report Read More