Volume 16, Issue 3, Pages 101 – 152 (2017)

Measuring impact of telephone triage in Acute Medicine

Research Audit and Clinical Practice, Volume 16, Issue 3, Pages 101 – 152 (2017)

Abstract

The Society for Acute Medicine’s Benchmarking Audit (SAMBA) was undertaken for the 5th time in June 2016. For the first time, data on telephone triage calls prior to admission to Acute Medical Units were collected: 1238 patients were referred from Emergency Departments, 925 from General Practitioners (GPs), 52 from clinics and 147 from other sources.

Calls from Emergency Departments rarely resulted in admission avoidance.

Calls from Primary Care resulted in avoidance of an admission in 115 (12%) patients; the percentage of avoided admissions was highest if the call was taken by a Consultant.

Consultant triage might result in admission avoidance but the impact of local context on the effectiveness is not clear.

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Electronic Prompts Can Reduce The Number Of Unnecessary Clotting Screens Ordered For Patients

Research Audit and Clinical Practice, Volume 16, Issue 3, Pages 101 – 152 (2017)

Abstract

In an attempt to reduce the number of inappropriate clotting screens being performed in our Trust, an electronic prompt was introduced to our haematology requesting system. Over the six month period after introduction of this prompt the number of clotting screen requests reduced by 7001, representing a 21% reduction when compared to the same 6 month period one year earlier. This represented a cost saving of over £98,000 without any increase in adverse incidents being reported related to bleeding complications.

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Research Protocol: Intravenous Access during Resuscitation: the IVAR trial

Research Audit and Clinical Practice, Volume 16, Issue 3, Pages 101 – 152 (2017)

Summary

Objective: To compare the effects of central versus peripheral drug administration on the rate of return of organised electrical activity and/or spontaneous circulation during CPR.

Study design: Randomized clinical trial.

Study population: Hospitalized patients and patients presenting at the emergency department, older than 18 years, requiring CPR.

Intervention: Central venous access

Main study parameters/endpoints: Combined primary endpoint: rate of appearance of organised electrical activity or return of spontaneous circulation.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: All patients are treated according to the guidelines of the European Resuscitation Council, which are endorsed by the local VUMC CPR-committee. Central access will be obtained by cannulation of the external or internal jugular vein. To avoid interference with initial management, central venous access will be obtained after initiation of chest compressions, first attempt at defibrillation (if applicable), securing the airway and obtaining a peripheral access.

All resuscitated patients require vascular access and almost all successfully resuscitated patients require central venous access. Obtaining central access during CPR may be associated with a slightly higher complication rate, such as arterial puncture and pneumothorax. Possible benefits for study subjects are a higher success rate of CPR.

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Medical High Dependency Unit series, Article 3: Respiratory Support in the MHDU

Research Audit and Clinical Practice, Volume 16, Issue 3, Pages 101 – 152 (2017)

Abstract

Acute respiratory failure is a life threatening condition encountered by Acute Physicians; additional non-invasive support can be provided within the medical high dependency unit (MHDU). Acute Physicians should strive to be experts in the investigation, management and support of patients with acute severe respiratory failure. This article outlines key management principles in these areas and explores common pitfalls.

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Abstracts from Oral Presentations at the Society for Acute Medicine Autumn Conference

Research Audit and Clinical Practice, Volume 16, Issue 3, Pages 101 – 152 (2017)

Birmingham International Centre, 11-12th September 2017

As usual a large number of abstract submissions were received for the autumn meeting of the Society for Acute Medicine, which was held this year in the Birmingham International Centre on 11th-12th September. A large number of these were displayed as posters throughout the meeting, and twelve were selected for oral presentation. The abstracts from the oral presentation session are published here.

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Disseminated intravascular coagulation in an under-recognised zoonotic infection

Case Reports, Volume 16, Issue 3, Pages 101 – 152 (2017)

Abstract

A 51 year old man presented with severe sepsis, disseminated intravascular coagulation (DIC) and multiorgan dysfunction after a 24 hour history of diarrhoea and malaise. Despite fluid resuscitation and receiving a platelet transfusion, freshfrozen plasma and intravenous broad-spectrum antibiotics, he remained anuric with a worsening metabolic acidosis. He was transferred to critical care for organ support including renal replacement therapy. He subsequently developed purpura fulminans. Blood cultures were positive for Captocytophaga carnimorsis, a gram-negative canine zoonosis that is an underdiagnosed cause of severe sepsis, for which DIC at presentation is characteristic. Treatment is with penicillins and fluoroquinolones. Identification of risk factors for unusual organisms and recognition of DIC allowing prompt treatment is critical for the acute physician.

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Third cranial nerve palsy: an unusual manifestation of Mycoplasma pneumoniae

Case Reports, Volume 16, Issue 3, Pages 101 – 152 (2017)

Abstract

Mycoplasma Pneumoniae (M.pneumoniae) is a well-known cause of atypical pneumonia, however it is also associated with many extra pulmonary manifestations. This report highlights a patient with gastroenterological, haematological and neurological complications, including a third cranial nerve palsy which developed after her initial treatment and discharge from hospital.

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Not just a simple sore throat

Case Reports, Volume 16, Issue 3, Pages 101 – 152 (2017)

Abstract

The presentation of a ‘sore throat’ is common and often requires only symptomatic treatment. This is the case of a 20-year-old female who presented with persistent symptoms of a sore throat. On admission she had raised inflammatory markers and a subsequent blood culture demonstrated a fusobacterium necrophorum and arcanobacterium haemolyticum bacteraemia. Further investigations established an internal jugular vein thrombosis, confirming the diagnosis of Lemierre’s syndrome. This case highlights the importance of further investigation when a sore throat fails to improve, and to remember this often-forgotten syndrome.

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Society for Acute Medicine Trainee Update, Autumn 2017

Education and Training, Volume 16, Issue 3, Pages 101 – 152 (2017)

Tehmeena Khan has replaced Sanjay Krishnamoorthy as a Trainee Representative for SAM. We would like to thank Sanjay for all his hard work and contribution during his tenure as Rep. Tehmeena is a final year trainee from North East & Central London. Tehmeena’s specialist skills are Leadership, Management and Quality Improvement. She has previously been a Darzi Fellow and has undertaken a Winston Churchill Fellowship. She has recently joined the Health Foundation Q Community.

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