Volume 24

Acute Toxicity Following Occupational Exposureto Anti-Fouling Marine Paints: A Case Series of Five Adult Patients

Introduction: Anti-fouling marine paints contain toxic components such as copper-based biocides, organotin compounds, and volatile organic solvents. Acute occupational exposure may result in respiratory, gastrointestinal, hepatic, and neurological manifestations; however, clinical data in emergency medicine regarding such exposures remain limited.
Case Presentation: Five male shipyard workers aged 23–39 years presented to the emergency department following acute occupational exposure during anti-fouling paint application. Three patients experienced inhalational exposure and presented with dyspnoea and throat irritation requiring supplemental oxygen therapy. One patient presented with nausea and vomiting and was found to have a two-fold elevation in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Another patient reported dizziness, throat burning, and palpitations. Other laboratory parameters were within normal limits. All patients were hospitalised for close observation and received supportive treatment, including oxygen therapy, intravenous fluids, and symptomatic management. No severe systemic toxicity or organ failure developed. Clinical and laboratory findings improved within 72 hours, and all patients were discharged without complications.
Conclusion: Acute exposure to anti-fouling marine paints may cause heterogeneous clinical presentations, including respiratory compromise and transient hepatic enzyme elevation. Emergency physicians should recognise this occupational hazard and consider extended observation and supportive management when clinically indicated.

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Use of PERC/Wells in Combination with OtherClinical Prediction Rules to Reduce CTPA Demand in Same Day Emergency Care: A Retrospective Cohort Study

Pulmonary embolism (PE) is a common and potentially life-threatening condition encountered in acute medicine. Clinical prediction rules (CPRs), including PERC, Wells, Revised Geneva, YEARS and LEGEND, have been developed to support rational use of computed tomography pulmonary angiography (CTPA). This study evaluated whether retrospective co-application of Revised Geneva, YEARS or LEGEND alongside an existing PERC/Wells-based diagnostic pathway could reduce CTPA utilisation in a Same Day Emergency Care (SDEC) population.
We conducted a retrospective cohort study of all patients who had CTPA for suspected PE in a UK SDEC unit between January and June 2024. CPRs were applied retrospectively using documented clinical data. The primary outcomes were the potential reduction in CTPA utilisation and the proportion of scans that would have contained PE.
Of 433 CTPAs identified, 362 patients met inclusion criteria. The prevalence of PE among those scanned was 16.6%. Retrospective co-application of Revised Geneva, YEARS and LEGEND would have reduced CTPA utilisation by 5.5%, 29.0% and 39.2% respectively. No PEs were identified among scans potentially avoided using Revised Geneva, whereas PE was present in 4.8% and 5.6% of avoided scans using YEARS and LEGEND. Missed events occurred in a clinically stable ambulatory cohort and were not associated with radiological evidence of right ventricular strain; however, the clinical significance of these findings remains uncertain.
In this selected SDEC population, layering additional CPRs onto an existing diagnostic pathway may have the potential to reduce CTPA utilisation, although strategies achieving larger reductions were associated with missed diagnoses. These findings should be regarded as hypothesis-generating and require prospective validation before informing changes to clinical practice.

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Use of PERC/Wells in Combination with OtherClinical Prediction Rules to Reduce CTPA Demand in Same Day Emergency Care: A Retrospective Cohort Study Read More

Editorial – The “To LP or not to LP” conundrum. An example of the two phases of peer review and the importance of post-publication discourse

Issue 4 of the Acute Medicine Journal (AMJ) reports an interesting exchange between the authors of a service evaluation investigating the prevalence of subarachnoid haemorrhage (SAH) in patients undergoing a lumbar puncture (LP)1, and readership colleagues evaluating its merit, in light of the current evidence base and clinical recommendations2. This discourse highlights the two phases of scientific peer review, which operates as the quality control mechanism for academic publishing.

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Procalcitonin use in Acute Medicine in the United Kingdom: a survey of practice, barriers and facilitators

Introduction: Use of procalcitonin (PCT) across Acute Medical Units (AMUs) in the United Kingdom (UK) post-COVID-19 is not well understood. We aim to explore clinician knowledge and behaviours relating to PCT-guided antimicrobial decision making for patients managed in NHS AMUs across the UK.Methods: A web-based survey was sent via email to members of the Society...

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What does a job in Acute Medicine look like? Insights from the RCP 2023 Workforce Census

Acute Internal Medicine (AIM) is a dynamic specialty that addresses the urgent medical needs of adult patients. This study analyses data from the RCP 2023 workforce census to understand for the first time how Acute Physicians allocate their clinical working time across key service areas. Results reveal that the majority of AIM consultants focus on...

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Embedding penicillinde-labelling in the AMU: a feasibility and safety pilot study with exploratory economic and environmental analysis

Background: Penicillin allergy labels affect 6-10% of the UK population, yet over 95% are inaccurate. These labels drive unnecessary broad-spectrum antibiotic use, antimicrobial resistance, healthcare costs, adverse patient outcomes and carbon emissions.Methods: This pilot study embedded a penicillin allergy de-labelling (PADL) clinic within an Acute Medical Unit, using a direct oral amoxicillin challenge for patients...

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‘Not All Swellings Are Angioedema’ – An Overview And Systematic Approach For Acute Medical Physicians

Angioedema refers to a localised area of swelling affecting the subcutaneous and submucosal tissues due to release of vasoactive peptides, such as histamine or bradykinin. Despite being a relatively common presentation in the emergency room, the diagnosis can present a challenge to many healthcare professionals. Several conditions presenting with muco-cutaneous swellings may be misdiagnosed as...

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The experiences of international medical graduates (IMGs) new to the NHS: an interpretive phenomenological analysis

Introduction: International Medical Graduates (IMGs) comprise a large portion of the NHS workforce and within Acute Medicine. There is little research exploring the lived experiences of IMGs in the context of their own socio-cultural background and past experiences. This study aimed to explore these experiences.Methods: Semi-structured interviews were conducted with 6 IMGs in a university...

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Editorial – Differential attainment in training in the United Kingdom

The current issue of the journal includes an article providing unique insight into the experiences of international medical graduates (IMGs) new to the NHS, offering a unique perspective on their views, feelings and struggles. An important, connected and often underestimated matter is the thorny issue of differential attainment, and how it affects and blights IMGs’

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Editorial – The evolving research landscape in the United Kingdom

Over the current and subsequent few financial years, a set of significant changes will be implemented affecting the research landscape in the United Kingdom. On the 22nd of September 2025 NHS England released the paper “Increasing research activity in the NHS”1. This paper highlights the clear ambitions of decreasing trial set up times, from the current 250 to under 150 days, while doubling commercial interventional trial participants by 2026 and again by 2029 in the UK. The paper also reveals the UK’s aspiration to become a more attractive Country for international research and commercial investments from the biotechnology industry sector. The plan builds on the Government’s “Life Science Sector Plan”2, published in July 2025, which followed “Fit for the Future: 10 Year Health Plan for England”3. The government has consistently highlighted a commitment for the NHS to support the life sciences industry in the UK. Importantly, research performance will be monitored at both aggregate and individual site level. Furthermore, each NHS organisation’s research budget will be allocated based on historical performance, number of studies and recruitment activity (with weighting based on the type of study), and new performance, including study set up times, efficiency of delivery and commercial research activity expansion.

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