Volume 23

Additional value of geriatric parameters to Quick Sepsis Related Organ Failure Assessment score for predicting clinical deterioration in older emergency department patients with a suspected infection: post-hoc analysis of a prospective observational study

Original Articles, Volume 23, Issue 3, Pages 97– 168 (2024)

Aim: To investigate the additional value of geriatric parameters such as physical impairment to the quick Sequential Organ Failure Assessment (qSOFA) tool for predicting clinical deterioration in older ED patients with a suspected infection and to validate the final prediction model.Methods: Post-hoc multivariable regression analysis from a prospective observational cohort study of adult patients visiting...

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Additional value of geriatric parameters to Quick Sepsis Related Organ Failure Assessment score for predicting clinical deterioration in older emergency department patients with a suspected infection: post-hoc analysis of a prospective observational study Read More

Emergency physicians’ experiences with defensive medicine and their motives for acting defensively – an interview study

Original Articles, Volume 23, Issue 3, Pages 97– 168 (2024)

Background: Defensive medicine (DM) has been increasingly studied in recent years. This study aims to investigate the understanding of DM and the motives for practicing DM among emergency physicians.Methods: Focus group interviews.Results: Themes identified: The understanding of DM, DM is a matter of self-confidence, DM or tests to ensure diagnosis and patient flow, DM due...

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A Retrospective Comparison of Emergency Department Throughput Before and After Instituting a Waiting Room Evaluation Process

Original Articles, Volume 23, Issue 3, Pages 97– 168 (2024)

Background: The COVID-19 pandemic has strained the healthcare system with emergency department (ED) boarding and workforce shortages. This prompted the need for strategies to evaluate and treat patients while they waited for an ED room.Objectives: The objective is to describe a waiting room evaluation process and ED throughput in the setting of ED staffing shortages...

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Should respiratory rate be measured on admission over a few seconds by a smartphone application or over 15 minutes by a piezoelectric device? A prospective observational pilot study of acutely ill medical patients admitted to alow-resource Ugandan hospital

Original Articles, Volume 23, Issue 3, Pages 97– 168 (2024)

Background: the optimal period over which respiratory rate should be measured is uncertain.Setting: medical ward of low resource Ugandan hospital,Methods: comparison of the first respiratory rates measured on admission over seconds using a smartphone application with measurements over 15 minutes using a piezoelectric device.Results: There was a poor correlation between respiratory rates measured by the...

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Should respiratory rate be measured on admission over a few seconds by a smartphone application or over 15 minutes by a piezoelectric device? A prospective observational pilot study of acutely ill medical patients admitted to alow-resource Ugandan hospital Read More

Research in Acute Medicine. The results of a national survey of Society for Acute Medicine members

Original Articles, Volume 23, Issue 3, Pages 97– 168 (2024)

Background: Medical research improves patient outcomes, patient satisfaction, staff morale and retention. It is unclear what research opportunities and training staff in acute medicine had.Methods: The Society for Acute Medicine supported a survey to assess current research activity, training and perceived opportunities and barriers.Results: 292 responses were received from diverse professional backgrounds. Few respondents had...

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Evaluating acute medical service performance against assessment time metrics: the Society for Acute Medicine Benchmarking Audit 2023 (SAMBA23)

Original Articles, Volume 23, Issue 3, Pages 97– 168 (2024)

Performance within acute medicine services is impacted by ongoing pressures on acute care services. Data from the Society for Acute Medicine Benchmarking Audit 2023 (SAMBA23), was used to assess performance of acute medicine services compared to key clinical quality indicators, comparing performance by initial assessment location. Data was analysed for 8213 unplanned attendances across 161...

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Thyrotoxic Periodic Paralysis: A Case Report with Patient Perspective

Case Reports, Volume 23, Issue 2, Pages 53 – 96 (2024)

We present a case report on a spot diagnosis of Thyrotoxic Periodic Paralysis (TPP) with a unique first-person account of events from the patient. It illustrates the importance of pattern recognition and exemplifies how timely treatment enables quick resolution of a life-threatening medical emergency. Patient X’s account affirms the condition’s insidious onset and rapid deterioration. This case highlights the need for raising awareness of diseases that are more prevalent in specific ethnic groups and is particularly crucial for work in culturally diverse environments. We hope by sharing our experience, readers will be prompted to consider TPP as a differential diagnosis for acute limb weakness in an acute setting; with prompt testing of thyroid function and initiation of the appropriate treatments.

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Balancing acute medical management of acute kidney injury and hyperkalaemia versus medicines optimisation for long-term Cardio-Renal-Metabolic (CaReMe) diseases: a narrative review

Review Articles, Volume 23, Issue 2, Pages 53 – 96 (2024)

Cardio-Renal-Metabolic (CaReMe) diseases, in the form of heart failure, chronic kidney disease and diabetes mellitus, justify prescription of multiple prognostically beneficial medications, specifically renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter-2 inhibitors. Use of these medications is complicated by association with adverse effects, particularly acute kidney injury and hyperkalaemia. Balancing risk and benefit is a common dilemma in acute medicine, with increasingly frequent and complex treatment decisions. Physicians should contemplate adjustments to medications within the context of not just acute illness but also long-term benefit. In the setting of hyperkalaemia, potassium-binding medications can be utilised. At hospital discharge optimisation of therapy can be achieved through clear safety netting advice, scheduled biochemical follow-up, and planned clinical review.

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