It was great to see so many of you at SAM Glasgow back in October and we hope you enjoyed the conference and found it worthwhile. There were so many excellent sessions together with the opportunity to mix with acute medicine colleagues it’s hard to imagine anyone leaving without feeling positive.
Trainee Update December 2012 Read More
Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disease characterized by bradykinesia, tremor and/ or rigidity, often with gait disturbance and postural instability.
Problem based review: A patient with Parkinson’s disease Read More
Pulmonary embolism (PE) in pregnancy carries a significant mortality. Pregnant patients often present via the acute medical take with symptoms of possible PE and require timely assessment and investigation. The symptoms of PE are sometimes very difficult to differentiate from those of normal pregnancy and the vast majority of patients will require imaging. The radiation risks to mother and foetus from imaging may cause considerable anxiety (to both patients and healthcare providers) and need to be explained to patients in the context of a potentially life-threatening condition so they can be actively involved in decision-making on how best to proceed. When PE is diagnosed in pregnancy, there are obstetric considerations around the time of delivery and women should receive specialist follow-up.
Problem based review: pulmonary embolism in pregnancy Read More
The rates of liver disease in the UK are rising and hence more patients than ever are presenting to acute medical units with potentially life threatening sequelae. Early recognition and treatment of sepsis, kidney injury, bleeding and alcoholic hepatitis can significantly improve outcomes, but requires a comprehensive approach to assessment. This patient cohort often suffers from a perceived uniform poor prognosis, especially in alcohol related disease, but evidence for this is changing and reassessment of prognosis after 48 hours of organ support may be more accurate than that made ‘at the front door’. This article summarises the most important complications of decompensated cirrhosis, their early management, and presents a targeted system of care: ‘RING Liver’ – Renal failure, Infection, Nutrition, Gastrointestinal bleeding and transit, Liver dysfunction/transplantation. Factors favouring transfer to tertiary units are also explored.
The patient presenting with decompensated cirrhosis Read More
Abstract
Patients with suspected acute coronary syndrome are commonly assessed by acute physicians on arrival in hospital. Although most will recognise the typical ECG features of ST elevation myocardial infarction, the significance of ST elevation in lead aVR may not always be appreciated. This case series describes 6 cases in which this ECG abnormality was the predominant feature in patients whose subsequent angiogram revealed severe acute left main coronary artery disease. The importance of early referral of such patients to a centre in which percutaneous coronary intervention can be performed, is discussed.
ST elevation in ECG lead aVR signals severe acute left main coronary artery disease Read More
Abstract
Chest pain is a common symptom amongst patients presenting to the acute medical unit, and presents a diagnostic challenge. We present the case of a previously healthy 65 year old year old gentleman with chest pain and subsequent vomiting, treated initially as an acute coronary syndrome, despite normal ECG and troponin. Chest radiograph revealed left basal consolidation with an effusion, suggesting pneumonia. The absence of symptoms of respiratory infection along with a normal C-reactive protein level led to further investigation with CT. This revealed evidence of oesophageal rupture (Boerhaave’s syndrome). Despite early surgical intervention our patient suffered a number of complications and continues his recovery in hospital three months post presentation.
Chest pain and an abnormal chest X-ray – a case report Read More
Abstract
Although uncommon, lead poisoning should be considered as a differential diagnosis in cases of unexplained acute abdominal pain in both adults and children. We present the case of a 35-year-old Asian male who presented with abdominal pain and constipation secondary to lead poisoning. Initially, the source of lead exposure was not apparent; this was later found to be due to ingestion of an Ayurvedic herbal medicine for the treatment of infertility. Lead poisoning due to the ingestion of Ayurvedic remedies is well described. We discuss the diagnosis, pathophysiology and treatment of lead poisoning. This case illustrates one of the rarer medical causes of acute abdominal pain and emphasizes the need to take a thorough history (including specific questioning regarding the use of over-the-counter and traditional/ herbal remedies) in cases of suspected poisoning or drug toxicity.
Acute abdominal pain and constipation due to lead poisoning Read More
Abstract
Background: Benchmarking is important to improve quality of care.
Aim: To audit the performance of Acute Medical Units (AMUs) against the clinical quality indicators published by the Society for Acute Medicine (SAM).
Methods: 24-hour data collection on the 20th of June 2013 with follow-up data at 72 hours.
Results: 43 units submitted data on 1425 patients. 76% of patients had early warning scores recorded within 30 minutes of admission, 95% of patients had been seen by a competent decision maker within four hours. 79% of patients were seen by a consultant physicians within the appropriate period of time.
Conclusion: The difference in compliance with quality standards between UK units opens opportunities for learning. The reasons why some units perform better than others require further investigation.
Abstract
The purpose of clinical training is to develop doctors capable of delivering professional, personal, effective, high quality, safe clinical care with Intelligent Kindness. The processes supporting training must promote development towards excellence. In 2004 a formative assessment process for use on medical post take ward rounds was introduced based on a model of a Driving Instructor and Learner Driver. This process has been evaluated in comparison with the Case based Discussion (CbD) and mini-Cex by 140 of 369 trainees, using online surveys. Ten trainees were interviewed in depth. The majority of trainees reported that this process had helped them more in their development as doctors than the CbD or mini-CEX. Trainees were able to describe positive effects in areas such as diagnosis, prescribing and confidence in their work. In the NHS the assessments are meant to be “trainee driven”, however all but one of the trainees stated that they preferred the routine provision of an assessment to having to ask for an assessment. This evaluation of a truly formative assessment process shows that the trainees benefit in their progression towards clinical excellence. Effective formative feedback can be provided on an Acute Medical Unit even within the constraints of busy post take ward rounds. Within a team of Consultants one should be allowed time to develop an extended Clinical Supervisor role.
An Evaluation of a Formative Assessment Process used on Post Take Ward Rounds Read More
Abstract
Aim: Survival of Acute Medicine (AM) depends on successful recruitment. Local juniors were unaware of training requirements and opportunities in AM. We conducted a survey to establish whether this was a nationwide issue.
Methods: A survey was distributed nationally with participants responding to statements on a Likert Scale.
Results: 397 responses from four deaneries were received. 50% of respondents were unaware of AM training opportunities. 20% of juniors did not know of entry requirements for training. Juniors felt that becoming a medical registrar would discourage them from careers in AM.
Discussion: This study reveals poor awareness of training opportunities in AM and reluctance to pursue the medical registrar role, which is unrelated to confidence in dealing with acute medical emergencies. Promotional work will be invaluable in future workforce planning.