Volume 14, Issue 4, Pages 145 – 196 (2015)

Legal Highs, Lethal Lows

Problem Based Reviews, Volume 14, Issue 4, Pages 145 - 196 (2015)

Abstract

Novel Psychoactive Substances (NPS), sometimes referred to as Legal Highs, are newly available drugs with psychoactive properties that are not currently prohibited by United Nations Drug Conventions. Despite many of these compounds still being ‘legal’ and readily available via online mail-order companies and high-street ‘headshops’, their rapid emergence in the UK has been associated with increasing hospital admissions, enquiries on TOXBASE® and fatalities. It is therefore vital that Acute Physicians have a good understanding of the issues in recognizing, investigating and managing patients presenting to the AMU with toxicity due to legal highs. This article outlines the classification and effects of various novel psychoactive substances and presents a strategy for management according to the prevailing toxidrome.

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‘Non Surgical’ jaundice- how to manage on the medical take

Trainee Section, Volume 14, Issue 4, Pages 145 - 196 (2015)

Malignancy and alcoholic hepatitis are cited as the most common causes of jaundice seen in secondary care. A patient with non-alcohol related jaundice, however, may require extensive investigations and early involvement of specialists. This article utilises a case presenting to the Acute Medical Unit, (AMU) to illustrate the importance of a careful and systematic assessment of non-alcoholic related jaundice.

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Ambulatory Outpatient Management of patients with low risk febrile neutropaenia

Trainee Section, Volume 14, Issue 4, Pages 145 - 196 (2015)

Patients with febrile neutropenia are a heterogeneous group with only a minority developing significant medical complications. Scoring systems, such as the Multinational Association for Supportive Care in Cancer (MASCC) score, have been developed and validated to identify low risk patients. Caring for patients with low risk febrile neutropenia in an ambulatory setting is proven to be safe and effective. Benefits include admission avoidance, cost savings and reduced risk of nosocomial infections, as well as improved patient experience and satisfaction. Implementation of an ambulatory pathway for low risk febrile neutropenia provides an excellent opportunity for Acute Physicians and Oncologists to collaborate in delivering care for this group of patients.

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Trainee Report Winter 2015

Trainee Section, Volume 14, Issue 4, Pages 145 - 196 (2015)

You will hopefully be aware that the first national takeAIM conference was run in Manchester on Saturday November 14th. It was attended by around 150 Foundation and Core trainees who had a morning of lectures followed by an afternoon of small group workshops, all for only £50. Feedback was very positive and will be used to shape future takeAIM events. These are likely to include regional and/or national conferences, alongside teaching workshops and possibly simulation events. For further information or to contact the fellows, please tweet (@take__AIM – remember there’s two underscores), or e-mail takeaim@acutemedicine.org.uk.

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Bad presentations

Viewpoint, Volume 14, Issue 4, Pages 145 - 196 (2015)

Which is more painful: an unsolicited PPI telephone call during clinic? Your hospital email on returning from two weeks annual leave? The strong realisation on waking at 3am that you have contracted norovirus like the rest of the team? Or a 10 minute powerpoint presentation? It’s the powerpoint. That is the most painful. And, painful as it might be and unlike the others, it is all your fault.

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A rare cause of secondary hypertension

Case Reports, Volume 14, Issue 4, Pages 145 - 196 (2015)

Abstract

Severe hypertension is a well-recognised cause for acute medical admission, and can have serious consequences if untreated. We present a 48 year old patient in whom coarctation of the aorta was identified following the finding of severe hypertension at the time of routine preoperative assessment, and subsequent finding of absent lower limb pulses. The patient had a past history of Apert syndrome, a rare autosomal dominant inherited condition characterised by craniosynostosis, facial dysmorphia, syndactyly of the hands and feet and cardiac abnormalities. This case report highlights the importance of a careful clinical examination in adults with severe hypertension, without which coarctation of the aorta may go undiagnosed.

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Abstracts from Highly Commended Posters Society for Acute Medicine Autumn Meeting 2015 Manchester

Research Audit and Clinical Practice, Volume 14, Issue 4, Pages 145 - 196 (2015)

Over 120 posters were presented at the Society for Acute Medicine autumn meeting which was held in the Manchester Central Conference Centre in September 2015. The judging panel identified a small number from each category which were deemed to be of particularly high standard; the abstracts for these posters are published here.

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A UK wide survey on attitudes to point of care ultrasound training amongst clinicians working on the Acute Medical Unit

Research Audit and Clinical Practice, Volume 14, Issue 4, Pages 145 - 196 (2015)

Abstract

The use of point of care ultrasound (POCU) is increasing across a number of specialties, becoming mandatory within some specialist training programmes (for example respiratory and emergency medicine). Despite this, there are few data looking at the prevalence of use or the training clinicians have undertaken; this survey sought to address this. It shows that the majority of POCU undertaken on the Acute Medical Unit (AMU) is without formal accreditation, with significant barriers to training highlighted including a lack of supervision, time and equipment. For those who undertook POCU, it was shown to regularly speed up clinical decision making, while 76.3% respondents believed a lack of access to POCU out of hours may affect patient safety. The data provide support to the concept of developing AMU specific POCU accreditation, to ensure robust and safe use of this modality on the AMU.

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The prediction of death up to 100 days after admission to hospital for acute medical illness – the comparison of two ECG interpretation methods with ECG-dispersion mapping

Research Audit and Clinical Practice, Volume 14, Issue 4, Pages 145 - 196 (2015)

Abstract

Background: the prognostic performances of different ECG interpretation methods have not been compared.

Methods: the 100 day mortality of 513 patients predicted by Marquette proprietary ECG software, Tan et al’s scoring system and the myocardial micro-alternation index (MMI) were compared.

Results: 33 patients (6.4%) died within 100 days of hospital admission. The c statistics for Mar

Abstract

quette and Tan ECG interpretation and MMI were not statistically different (i.e. 0.64, 0.68 and 0.73, respectively). Only MMI was independent from age as a predictor of mortality. The c statistic for MMI plus age of 0.81 was significantly higher than that of Marquette ECG interpretation (p 0.015).

Conclusion: predictions of 100 day mortality by of all three ECG interpretation methods are equivalent.

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