Volume 11, Issue 2, Pages 57 – 124 (2012)

Should systematic risk assessment and immediate intervention of the acutely ill patient replace the traditional management paradigm?

Viewpoint, Volume 11, Issue 2, Pages 57 - 124 (2012)

The outcome of the traditional diagnostic history and physical depends entirely on the availability, ability and diligence of an individual doctor. An alternative is a team-based approach that performs the following tasks: a focused assessment, monitoring of the response to initial treatment, and then determining what further management is appropriate (calling for urgent help if it is required). This concept is based on risk prediction rather than diagnosis, and is captured by the mnemonic FAITH3 (Focused Assessment, Initial Treatment, hAssessing response, calling for Help and Handing over care).

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Problem based review: The patient presenting with an acutely swollen arm

Trainee Section, Volume 11, Issue 2, Pages 57 - 124 (2012)

A 69 year old female presented to the Emergency Department with swelling of her right arm and elbow, one week following a fall which resulted in a fracture of the middle third of her right clavicle (Figure 1). The forearm was hot and tender and the arm and hand function were somewhat impaired by swelling, but sensation was intact. Initial bloods were unremarkable, apart from a mild neutrophilia.

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Problem based review: Alcohol-use disorders on the Acute Medical Unit

Trainee Section, Volume 11, Issue 2, Pages 57 - 124 (2012)

Abstract Alcohol-use disorders including acute intoxication and withdrawal are common in the acute medical setting. Acute physicians should be aware of the indications for inpatient detoxification, and be able to liase with specialist alcohol services in the hospital and in the community to determine those patients for whom community-based detoxification may be beneficial. Additionally, it

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Cardiac Tamponade: atypical presentations after cardiac surgery Ravikirti & R Karadi

Case Reports, Volume 11, Issue 2, Pages 57 - 124 (2012)

Abstract

We present two cases of cardiac tamponade presenting in the aftermath of cardiac surgery. We have briefly discussed the aetiology, presentation, diagnosis and management of the condition with emphasis on its atypical presentation in postoperative patients. A high index of suspicion and early access to echocardiography is necessary for prompt recognition and treatment of this life threatening emergency.

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An unusual cause of a recurrent painful rash

Case Reports, Volume 11, Issue 2, Pages 57 - 124 (2012)

Abstract

Churg-Strauss syndrome is an uncommon multisystem disease involving small and medium-sized arteries, capillaries, veins, and venules. It is characterised by the presence of asthma, hypereosinophilia, and evidence of vasculitis affecting a number of organs. It is important for acute physicians to recognise this condition as delayed diagnosis results in a higher morbidity and mortality. Here we describe a case of Churg-Strauss syndrome in a 41 year old woman presenting with a recurrent painful rash. The clinical manifestations and management of this condition are discussed.

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Actinomycosis masquerading as malignancy

Case Reports, Volume 11, Issue 2, Pages 57 - 124 (2012)

Abstract

We describe a patient who presented with neurological symptoms and radiological findings consistent with metastatic malignancy in several sites. However, no obvious primary site of tumour was identified and the patient later went on to develop clinical features of sepsis whilst using palliative dexamethasone therapy. A diagnosis of actinomycosis was eventually made on open lung biopsy and the patient recovered completely on penicillin V. This case serves to illustrate the need to obtain a formal tissue diagnosis whenever possible in all cases of suspected malignancy, in addition to exposing the weaknesses inherent in empiric diagnoses.

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Selected Abstracts from the Society for Acute Medicine Spring Meeting

Research Audit and Clinical Practice, Volume 11, Issue 2, Pages 57 - 124 (2012)

3-4th May 2012 Radisson Blu Hotel, Dublin

Over 170 abstracts were submitted for consideration of inclusion at the Spring 2012 meeting of the Society for Acute medicine, which was held this year in the Radisson Blu hotel in Dublin. After peer review, seventy were exhibited as posters, while eight were selected for oral presentation. The abstracts from those presented orally are published here.

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Patterns of admissions in an acute medical unit: priorities for service development and education

Research Audit and Clinical Practice, Volume 11, Issue 2, Pages 57 - 124 (2012)

Abstract

An Acute Medical Unit has recently been established at York Hospital. The present study sought to characterise the case mix of acutely unwell medical patients to allow identification of priorities for ongoing service development and to assess educational opportunities for trainees in the region. Data were collected for 16001 admission episodes between January 2010 and April 2011 inclusive. These allowed characterisation of the case mix, and identified key priorities where clinical pathway do not yet exist, namely heart failure, urinary tract infection, and acute diarrhoea. Good educational opportunities exist for most aspects of the Acute Medicine curriculum; several weaknesses were identified, and trainees might address these by undertaking a specific period of specialty training in endocrinology and neurology.

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