Volume 21, Issue 3, Pages 121-164 (2022)

Evaluation of a basic point-of-care ultrasound course for residents in internal medicine

Correspondence, Volume 21, Issue 3, Pages 121-164 (2022)

Point-of-care ultrasound (POCUS) integrates imaging into the physical examination at the bedside. This offers the advantage of instant clinical information and has shown to speed up the diagnostic process, and to improve diagnostic accuracy and correct treatment.

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Mind the bubbles – A patient presents with seizure after haemodialysis

Case Reports, Volume 21, Issue 3, Pages 121-164 (2022)

A patient with patent ductus arteriosus presents with seizure after haemodialysis. Although conscious on arrival to the emergency department with spontaneous limb movement, he develops recurrent convulsion and left hemiparesis after admission. The approach to the haemodialysis patient presenting with seizure is discussed and the role of early hyperbaric oxygen therapy for an uncommon but important diagnosis is highlighted.

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A man who became breathless after tiling a bathroom

Case Reports, Volume 21, Issue 3, Pages 121-164 (2022)

Inhalational lung injury should be considered in patients presenting with acute respiratory symptoms and a history of occupational or recreational exposure to toxic substances. We present the case of a 29-year-old patient who developed pneumonitis following usage of waterproofing sealant spray in an enclosed space, despite the use of a dust mask. The patient was managed with oxygen therapy, corticosteroids and bronchodilators. He made a complete clinical recovery with resolution of almost all changes seen on computerised tomography (CT) imaging within 7 days.

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Sepsis secondary to a misplaced urinary catheter into the ureter

Case Reports, Volume 21, Issue 3, Pages 121-164 (2022)

Misplacement of a urinary catheter in the ureter is a rare phenomenon. The described cases occurred in patients with neurogenic bladder. We describe an unusual case of 58 years old female where the Foley catheter was unintentionally placed in the left ureter. The patient developed sepsis due to complete obstruction of the left ureter treated with antibiotic therapy after repositioning the catheter.

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Improving and Sustaining the Quality of Discharge Summaries

Research Audit and Clinical Practice, Volume 21, Issue 3, Pages 121-164 (2022)

High quality discharge information communication has been linked to a reduction in the incidence of adverse events, decreasing the risk of prescription errors and lost follow up. In this paper we describe how our trust-wide quality improvement project, led by acute physicians, successfully improved discharge documentation. We demonstrate how we identified obstacles to continued success, and the interventions we implemented. We recommend how discharge summary quality can be optimised through training of junior doctors, recruitment of local champions, and use of novel methods to preserve engagement, such as gamification.

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Point-of-care lung ultrasound in the assessment of COVID-19: results of a UK multicentre service evaluation

Original Articles, Volume 21, Issue 3, Pages 121-164 (2022)

Background: Coronavirus disease 2019 has had a dramatic impact on the delivery of acute care globally. Accurate risk stratification is fundamental to the efficient organisation of care. Point-of-care lung ultrasound offers practical advantages over conventional imaging with potential to improve the operational performance of acute care pathways during periods of high demand.
The Society for Acute Medicine and the Intensive Care Society undertook a collaborative evaluation of point-of-care imaging in the UK to describe the scope of current practice and explore performance during real-world application.
Methods: A retrospective service evaluation was undertaken of the use of point-of-care lung ultrasound during the initial wave of coronavirus infection in the UK. We report an evaluation of all imaging studies performed outside the intensive care unit.
An ordinal scale was used to measure the severity of loss of lung aeration. The relationship between lung ultrasound, polymerase chain reaction for SARS-CoV-2 and 30-day outcomes were described using logistic regression models.
Results: Data were collected from 7 hospitals between February and September 2020. In total, 297 ultrasound examinations from 295 patients were recorded. Nasopharyngeal swab samples were positive in 145 patients (49.2% 95%CI 43.5-54.8). A multivariate model combining three ultrasound variables showed reasonable discrimination in relation to the polymerase chain reaction reference (AUC 0.77 95%CI 0.71-0.82).
The composite outcome of death or intensive care admission at 30 days occurred in 83 (28.1%, 95%CI 23.3-33.5). Lung ultrasound was able to discriminate the composite outcome with a reasonable level of accuracy (AUC 0.76 95%CI 0.69-0.83) in univariate analysis. The relationship remained statistically significant in a multivariate model controlled for age, sex and the time interval from admission to scan
Conclusion: Point-of-care lung ultrasound is able to discriminate patients at increased risk of deterioration allowing more informed clinical decision making.

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Early senior decision-making in acute medicine: a critical review of health policy and implications for practice

Original Articles, Volume 21, Issue 3, Pages 121-164 (2022)

UK urgent care health policies advocate senior clinical decision-making at the point of referral into the system. The costs of employing senior clinicians in this role are substantial with little evidence of the value they bring over other strategies, particularly for patient outcomes. We sought to explore current remote and ambulatory emergency care decision-making in acute medical care in a large central healthcare system – NHS Scotland. We found that many sites use remote decision-making for some allocation decisions. However, involvement of clinical expertise varies, and available decision-aids are few. There is also variation in access to resources that facilitate non-admission. Research into the value that senior clinicians bring to this task over other strategies is required.

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What role should social media play in the future of acute medicine?

Perspective Articles, Volume 21, Issue 3, Pages 121-164 (2022)

The screen time app on my iPhone tells me that I spend over ten hours a week on Twitter. And I’m not alone. As Netflix’s The Social Dilemma illustrated, social media platforms are designed to keep us scrolling for hours, even if we only opened the app for a second. Thousands of UK healthcare workers use Twitter every day, discussing everything from cutting edge COVID treatments to staff room fridge etiquette. As strange as it sounds, this esoteric little corner of the internet – affectionately if unoriginally nicknamed “MedTwitter” – has become a thriving online community.

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Guest Editorial – Curry clubs, uncertain times, and social media

Guest Editorial, Volume 21, Issue 3, Pages 121-164 (2022)

COVID-19, the eternal hospital winter, heatwaves, global warming, energy costs, inflation, and an unnecessary war. We truly do live in uncertain times. That said, we would wager our grandparents said the same thing. What gets us through is family, friends and out shared communities, including acute medicine. Which brings us to this edition of the journal, where many excellent articles will hopefully distract our reader from all the doom and gloom, and instead light up your grey cells.

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