Erythroderma (or ‘red man syndrome’) is a diffuse inf lammation of the skin, affecting at least 90% of the skin surface. It can be the clinical manifestation of a variety of dermatological, systemic, malignant and haematological diseases. It can be also the result of a hypersensitivity reaction to drugs.
Picture Quiz: A Red Man on the AMU – Answers Read More
Making Sense of Acute Medicine: a guide to diagnosis details a symptomatic approach to acute medicine. It begins with a preface that states that many junior doctors seem to employ a ‘scattergun approach to diagnosis’, and often ‘multiple tests’ are requested when a more thoughtful p r o b l e m – b a s e d approach might be better employed. The authors, both Professors of Medicine, are clearly experienced physicians with a wealth of clinical and teaching expertise.
Making Sense of Acute Medicine: a guide to diagnosis Read More
A fifty-eight year old man was referred to the Acute Medical Unit by his general practitioner with a generalised erythematous rash. The rash had appeared 3 weeks earlier, initially affecting his back, but had not responded to topical emollient treatment, nor the subsequent addition of an antibiotic.
Picture Quiz: A Red Man on the AMU Read More
Journals were reviewed between August and December 2010. The journals reviewed include: The lancet, Lancet Neurology, New England Journal of Medicine, British Medical Journal, Heart, Gut, Thorax, Circulation, Journal of the American Medical Association (JAMA), American Journal of Medicine, Archives of Internal Medicine, and Annals of Internal Medicine. The articles chosen are those which have particular relevance to Acute Physicians.
Bleeding from the upper gastrointestinal (GI) tract is a common medical emergency, with an incidence of between 50-150 cases per 100,000 per year.1 A recent audit by the British Society of Gastroenterology showed the mortality rate from upper GI bleeds has fallen from 14%2 in 1993 to 10% in 2007.3 However, despite the use of proton pump inhibitors (ppis), admission rates for peptic ulcer haemorrhage have increased in older age groups,4 probably related to increased use of antiplatelet agents such as aspirin and clopidogrel and anticoagulants in acute coronary syndromes, stroke and atrial fibrillation. The rising age of the population may also have offset further reductions in mortality and morbidity that may have otherwise come about through improved supportive and endoscopic care.
The patient with haematemesis and melaena Read More
Acute paraplegia is an emergency requiring immediate assessment by the acute medical team because of the need to rule out compressive lesions of the cord for which intervention may preserve neurological function and limit persistent disability. In addition acute paraplegia could be complicated by life-threatening problems. These require prompt recognition and treatment to prevent further deterioration.
The following clinical scenario, based on a real case of acute paraplegia seen by the authors is aimed at providing a problem-based approach to the management of patients presenting with acute paraplegic weakness.
The Patient with Acute Paraplegia: A Problem-Based Review Read More
The new trainee section of the Acute Medicine journal gives us an excellent opportunity to keep trainees up-to-date with the latest news. We will provide you with a summary of relevant information coming directly from both the Society for Acute Medicine and the Acute Medicine Specialty Advisory Committee (SAC).
This edition of the journal sees the launch of a new regular trainee-orientated section. Over the course of a rolling five-year cycle we will be publishing a series of articles which will cover the ‘Emergency Presentations’, ‘The Top 20 Common Medical Presentations’, ‘Other Important Presentations’ and ‘Practical Procedures’ outlined in the curriculum for Acute Internal Medicine 2009. Articles will take the form of a problem-based review that uses a brief clinical case (real or fictional) and its development to illustrate the assessment, differential diagnosis and management of the common presentations to Acute Medicine. We hope these reviews will highlight recent evidence-based guidelines and provide readers with clinically useful ‘pearls and pitfalls’ from specialist experience that can be easily applied to future practice. Although many of these reviews will be commissioned directly by the editors of the journal, if you do have a particular interest in producing a review relating to a specific curriculum topic, please contact me at tomheaps@hotmail.co.uk. Similarly, I would welcome any early feedback relating to the content and format of this new journal section. This edition features reviews of the management of GI bleeding and paraplegia which I hope will be of interest to readers of various levels of seniority. Dr Joe Wileman has also produced a ‘Journal Watch’ section, which we plan to repeat in future editions (again contact me directly if you are interested in undertaking this for a future edition) and there is a ‘trainee update’ from Alice Miller.
Trainee Section: Introduction Read More
Abstract
A 51-year-old man presenting with left arm weakness and slurred speech was referred to the acute medical team. Admission chest X-ray showed a cavitating lesion, which had not been present 2 weeks earlier. Systemic enquiry elicited a 2 month prodromal illness and back pain. Urgent CT of his head and chest revealed evidence of thoracic discitis spreading anteriorly into a pleural-based lung abscess and an intracerebral abscess causing his neurological deficit. He was transferred for urgent craniotomy and evacuation of a Streptococcus milleri abscess. Following several weeks of neurosurgical care and antibiotics he made a near full recovery.
Not just a ‘simple stroke’ Read More
Abstract
Severe hypoglycaemia is a diagnostic challenge.1 It is often explained by mismatch between insulin doses, food ingestion and exercise. Recurrent hypoglycaemia can indicate underlying medical problems. Drug related events usually concern insulin or sulphonylureas. However, withdrawal of drugs which can cause insulin resistance can be causative if insulin or sulphonylureas continue.2We report the case of an insulin-treated patient who presented with severe recurrent hypoglycaemia. After exclusion of secondary causes of hypoglycaemia it was established that at the time of diagnosis of diabetes he had been taking olanzapine. This had subsequently been discontinued. Olanzapine is recognised to cause diabetes and diabetic ketoacidosis. Our patient was able to discontinue insulin therapy.
Severe recurrent hypoglycaemia following discontinuation of olanzapine Read More