This journal now enters its third edition, which means we are now more than half way through our proposed four-year cycle of reviews. As previous readers may recall, our intention was to cover all aspects of acute medicine with review articles over this cycle. Although we have strayed from the original programme on occasions, we remain on track to achieve this goal. This edition contains five such reviews, including Part Two of the Acute Coronary Syndromes series, this time dealing with the ST elevation myocardial infarction. Dr Wallis guides us through the current evidence for management of this condition, concluding with a helpful paragraph outlining how she would like to be treated in this eventuality. In a comprehensive review, Booth and Leary give a critical care perspective on the investigation and treatment of the comatose patient. Readers should take particular note of the useful algorithm on page…., which provides a user-friendly approach to the management of this often challenging problem.
A neurologist once told me that the ‘three F’s of Neurology’ were ‘fits, faints and headaches’, although ‘funny turns’ might perhaps also come into this category. Our next two reviews deal with each of these conditions. Sudden headaches often cause a diagnostic dilemma on our admissions ward – exclusion of subarachnoid haemorrhage is often the easy part; making a positive diagnosis after the CT and LP have proved negative is more of a challenge. Dr Griffin describes some of the less well known causes of this problem, emphasising the need to proceed to MR scanning if there remains a clinical suspicion of significant pathology. Mike Bacon’s review of ‘funny turns’ provides an interesting insight into the approach taken by a consultant experienced in the management of these problems in older people. The diverse nature of the problem is highlighted, along with the need for targeted investigations. Our ‘How-to-do-it’ article this month complements this paper with a detailed description of the Dix-Hallpike and Epley manoeuvres in the management of BPPV.
Our final review is a comprehensive discussion of the management of pleural effusion from the Oxford Pleural Disease Unit. In this extensively referenced article, the diagnostic and therapeutic challenges of this condition are discussed in detail, emphasising some of the newer modalities now available.
I’ll conclude with my usual plea for submissions. I remain a firm believer in the value of case-based learning and most of us see at least one patient each week which emphasises a teaching point worth sharing. Please encourage your colleagues and juniors to submit such case reports to us – anything which would appeal to a ‘generalist’ audience will be considered for publication. In an attempt to stir up some lively debate, future editions will also contain a feature entitled ‘Controversies in Acute Medicine’. Any reader who feels particularly strongly about an aspect of acute care which attracts controversy is encouraged to contribute to this section: anything except MMR!