Volume 10, Issue 2, Pages 65 – 120 (2011)

Acute Medicine Trainee Update

Trainee Section, Volume 10, Issue 2, Pages 65 - 120 (2011)

New SAM trainee representative

Amy Daniel replaces Tim Bonnici as one of the SAM trainee representatives. Tim’s term of office came to an end in May 2011, and Amy took over just after the Spring meeting in Bristol. Amy is an ST5 in the Oxford Deanery, and brings lots of enthusiasm and new ideas. Media and Communications updates SAM is working hard to keep us all updated on relevant stories from the national and international media. In addition…

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Meeting the challenges of Acute Care Quality Indicators

Research Audit and Clinical Practice, Volume 10, Issue 2, Pages 65 - 120 (2011)

Abstract

The Royal College of Physicians and Society of Acute Medicine have proposed the introduction of Acute Care Quality Indicators. These include the need for rapid initial patient assessment and instigation of a management plan.1 Reductions in junior doctor working hours may impact on our ability to meet these standards. We present the result of a service review of 297 consecutive admissions to a large acute medical unit. This has identified a marked dichotomy between waiting times during daytime and out-of-hours, despite appropriate response to initial triage. We conclude that further service redevelopment is required to reach the standards proposed in the current Acute Care Quality Indicators.

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The Acute Medicine – Speciality Interface: Experience in a District General Hospital

Research Audit and Clinical Practice, Volume 10, Issue 2, Pages 65 - 120 (2011)

The Great Western Hospital was opened in 2002. It was built as a PFI hospital, moving services from the old Princess Margaret Hospital situated in central Swindon. The Great Western Hospital is conveniently situated near junction 15 of the M4 and therefore has excellent transport links. The Acute Medical Unit (AMU) was purpose built adjacent to the Emergency Department and in close proximity to Emergency Department Radiology. Details of the Acute Medical Unit layout are summarised in Table 2.

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The Acute Medicine – Speciality Interface: Experience in a large teaching hospital

Research Audit and Clinical Practice, Volume 10, Issue 2, Pages 65 - 120 (2011)

The Norfolk and Norwich University Hospital opened at its present site in 2001. The purpose built Acute Medicine Unit (AMU) is on the ground level, co-located with Emergency Radiology and the Emergency Department (ED). There are, on average, 220 ED attendances and 70 AMU admissions each day, with a split of approximately 30% General Practice referrals and 70% ED referrals. (see table 1) There is no observation ward in the ED, although there is an arrangement for the Emergency Physicians to manage patients with uncomplicated head injury for up to 48 hours.

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Preventing deaths in Ambulatory Care from Isolated Pelvic Vein Deep Vein Thrombosis: Mortality and Mortality Meetings have a key role

Research Audit and Clinical Practice, Volume 10, Issue 2, Pages 65 - 120 (2011)

Abstract

Isolated Pelvic vein Deep Venous Thrombosis (DVT) is a relatively rare phenomenon, but is usually not identified by conventional lower limb duplex Ultrasound scanning. We present two cases of isolated iliac vein thrombosis; the first resulting in the patient’s death from Pulmonary Embolism (PE) after normal lower limb duplex scan. The second case was identified and successfully treated after introduction of a revised investigation algorithm following the first case. The literature supports the use of magnetic resonance imaging, CT venography, or ascending venography, to diagnose this condition.

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Mucositis, Conjunctivitis but no rash – The “Atypical Stevens –Johnson syndrome”

Case Reports, Volume 10, Issue 2, Pages 65 - 120 (2011)

Abstract

The Stevens-Johnson syndrome (SJS) classically involves a rash, conjunctivitis and mucositis. We describe the case of a young adult male with isolated mucositis and conjunctivitis . Previous rare reports of severe SJS like syndromes without a rash are confined to children, usually with mycoplasma pnemoniae infection.1 Terminology for this syndrome includes - “Stevens-Johnson Syndrome without skin lesions”, or “Atypical Stevens – Johnson Syndrome”.2 This case highlights the importance of maintaining an open mind when a “full house” of clinical features is absent. It also illustrates the use of a rapid electronic literature review as a clinical tool. The importance of updating records when a drug has been cleared of causing harm is highlighted.

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Isolated Syncope – an Uncommon Presenting Feature of Pulmonary Embolism

Case Reports, Volume 10, Issue 2, Pages 65 - 120 (2011)

Abstract

We describe a case of a 62 year old man who presented with transient loss of consciousness following exertion. On presentation to hospital, he was haemodynamically stable and was not breathless, tachycardic or hypoxic at rest. The finding of exercise-induced desaturation on pulse oximetry triggered further investigations which confirmed the presence of PE.

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Acute Angle closure glaucoma (AACG): an important differential diagnosis for acute severe headache

Case Reports, Volume 10, Issue 2, Pages 65 - 120 (2011)

Abstract

Acute headache is a common presenting symptom in the acute medical unit. We present a case of Acute Angle Closure Glaucoma (AACG) presenting with acute severe headache. It highlights the importance of remembering this ophthalmologic emergency and reminds us of its clinical presentation. The rapid assessment and diagnosis of AACG allowed prompt treatment and likely prevented the patient from losing her vision.

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Complications of Emergency Refeeding in Anorexia Nervosa: Case series and review

Clinical Reviews, Volume 10, Issue 2, Pages 65 - 120 (2011)

Abstract

The refeeding syndrome is common among patients with anorexia nervosa. It may be lethal and has many manifestations. We report a case series of 14 anorexic patients admitted for feeding to a single British centre. There was a high prevalence of the refeeding syndrome, with three cases requiring higher dependency unit support and one death. We present a review of the refeeding syndrome in anorectics and highlight our impression that infection among such patients may be serious and under-recognised.

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Acute and General Medicine on Opposite Sides of the World

Guest Editorial, Volume 10, Issue 2, Pages 65 - 120 (2011)

The environments in which General, Acute and Emergency Medicine have evolved in Australia, New Zealand and the United Kingdom have differed significantly. As a result of this, the development and the role of Acute Medicine have also had significant contrasts but there are also many similarities and opportunities for shared learning. We are now in a position to look maturely at our services and allow a little constructive ‘compare and contrast’. Confidence in our own models means now we can each embrace diversity rather than believe one size fits all – not just across the world but also in our own backyards.

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