Drug-Induced Methaemoglobinaemia
I read the case report of cocaine induced methemoglobinemia¹ in the recent edition of the acute medicine journal with interest.
Drug-Induced Methaemoglobinaemia Read More
Summary Care Records in Urgent and Emergency Care in England
Abstract
Summary Care Records (SCRs) have been created for more than 50% of the population of England. The number is increasing at about 100,000 records a week. Fewer than 1.5% of people have elected not to have a SCR. SCRs contain updated details of patient medication, allergies and adverse reactions, electronically extracted from the GP record. A patient and their GP can also agree to have additional information included. SCRs are being viewed by authorised healthcare staff in urgent and emergency care settings all over England. Benefits are being reported in relation to increased patient safety, improved clinical decision making, improved efficiency and improved quality of care. NHS England strongly supports the uptake and adoption of SCRs by Trusts in England.
Please subscribe to see more.
Subscribe
Subscribe
Already a member? Log in here
Summary Care Records in Urgent and Emergency Care in England Read More
The patient presenting with ‘Acopia’
Patients may be referred to Acute Medical Units (AMUs) with a diagnosis of ‘acopia’. This term is offensive and lazy, implying fault on the part of the patient and allowing the assessing doctor to erroneously label the patient as a ‘social admission’ when, in fact, such patients are likely to be frail with co-morbidities and have an acute (potentially reversible) illness. Frail older patients should be assessed using the principles of Comprehensive Geriatric Assessment, informed by an understanding of the concept of frailty and of geriatric syndromes such as falls and delirium.
Please subscribe to see more.
Subscribe
Subscribe
Already a member? Log in here
The patient presenting with ‘Acopia’ Read More
Problem Based Review: The patient who has taken an overdose of long-acting insulin analogue
Insulin overdose can cause harm due to hypoglycaemia, effects on electrolytes and acute hepatic injury. The established long-acting insulin analogue preparations (detemir and glargine) can present specific management problems because, in overdose, their effects are extremely prolonged, often lasting 48-96 hours. The primary treatment is continuous intravenous 10% or 20% glucose infusion with frequent capillary blood glucose monitoring. Surgical excision of the insulin injection site has been used successfully, even days after the overdose occurred. Once the effects of overdose have receded, diabetes treatment must be restarted with care, especially in patients with type 1 diabetes. Monitoring serum insulin concentration has been successfully used to predict when the effects of the overdose will cease.
Please subscribe to see more.
Subscribe
Subscribe
Already a member? Log in here
Trainee Update September 2013
We hope you all enjoyed this summer’s hot spell and that those who moved jobs in August have now settled in. We would like to extend a very warm welcome to all the new acute medicine trainees, and look forward to representing your interests in this ‘new and vibrant’ speciality over the coming years.
Trainee Update September 2013 Read More
Abdominal pain and a raised amylase? It’s not always pancreatitis…
Abstract
We report the case of a 72 year old man with a history of COPD and heavy alcohol consumption who was initially diagnosed with acute pancreatitis based on a presentation with epigastric pain and elevated serum amylase. Review of his notes revealed several previous similar admissions and extensive normal investigations apart from persistently elevated amylase. Further analysis showed evidence of macroamylasaemia which accounted for the apparently high serum amylase level.
Please subscribe to see more.
Subscribe
Subscribe
Already a member? Log in here
Abdominal pain and a raised amylase? It’s not always pancreatitis… Read More
The vanishing lung: an important cause of hyperlucency on chest radiograph
Abstract
Giant bullous emphysema is an uncommon condition characterised by large asymmetric bullae with upper lobe predominance. This condition is most frequent in young male smokers. Patients usually present with progressive breathlessness which is secondary to enlargement of the bullae leading to compression of the lung parenchyma. Large asymmetrical bullae may appear as a unilateral hyperlucency on a plain chest radiograph, and may mimic the appearances of pneumothorax. A computed tomography scan is needed to delineate the lung pathology. We describe two cases with this condition that presented acutely and discuss the management of bullous emphysema.
Please subscribe to see more.
Subscribe
Subscribe
Already a member? Log in here
The vanishing lung: an important cause of hyperlucency on chest radiograph Read More
Acute care simulation training for foundation doctors: The perceived impact on practice in the workplace
Abstract
High fidelity simulation allows training of foundation doctors in a safe, structured environment. We explored the perceived impact of such training on subsequent clinical practice. 82 doctors attended and 52% responded to a follow up questionnaire sent two months after their training. 88% felt better able to manage the acutely ill patient than they did before their training. All cited simulation training as a reason for this and 44% felt simulation training was the main contributor. The remainder cited clinical experience as the main contributor. 53% gave real clinical examples where they applied skills attributed to simulation training. Doctors reflected positively on simulation training sometime after the experience, demonstrated transference of learnt skills and felt more confident at work.
Please subscribe to see more.
Subscribe
Subscribe
Already a member? Log in here
Exercise Stress Test Utility in Patients with Chest Pain Presumed to be of Cardiac Origin
Abstract
Introduction: NICE stated exercise stress tests (EST) should not be used to diagnose obstructive coronary artery disease in patients presenting with chest pain presumed to be of cardiac origin.
Methods: A retrospective review of 209 patients with presumed cardiac chest pain was done. EST results, GRACE scores and need for invasive coronary angiogram (ICA) were analysed to predict the need for readmission, intervention and future events.
Results: The sensitivity of the EST in identifying obstructive coronary artery disease was 70%. The EST, ICA and the GRACE 6-month mortality had a 77%, 70% and 81% negative predictive value (NPV) for readmission respectively.
Conclusion: EST, GRACE scores and ICA are useful in providing prognostic information but are poor predictors of readmission. Follow up and education programmes are needed to reduce this burden.
Please subscribe to see more.
Subscribe
Subscribe
Already a member? Log in here
Exercise Stress Test Utility in Patients with Chest Pain Presumed to be of Cardiac Origin Read More
No substitute for experience: do consultants that have been practising for longer lead faster post-take medical ward rounds?
Abstract
Aim: To ascertain whether consultants that have been practising for longer lead faster post-take medical ward rounds.
Method: Single-centre observational study of nine consultant physicians at morning post-take medical ward rounds at a district general hospital in the North West of London.
Results: Data were gathered from 25 post-take medical ward rounds. Multivariate regression analysis revealed that less time is spent per patient when consultants have been practising for longer (p<0.01), or have spent more time on the specialist register (p<0.01), with no discernible relation to the outcomes for the patients seen. This time is further reduced when a greater number of patients are seen on the ward round. Conclusion: More experienced consultant physicians conduct faster post-take medical ward rounds.
Please subscribe to see more.
Subscribe
Subscribe
Already a member? Log in here