Society for Acute Medicine Autumn Meeting

The autumn meeting of the Society for Acute Medicine took us to the spectacular city of Edinburgh. More than 150 delegates attended this, the tenth meeting of the Society, by far the largest attendance to-date, and a clear ref lection of the rapid expansion of this new sub-specialty. We were hosted by the Royal College of Physicians of Edinburgh, in their grand building on Queen Street, and were made to feel welcome by all the staff there. A special mention must go to the immaculately turned-out doorman who helped me find my way from the Royal College to my accommodation at a nearby hotel.

Training in Acute Medicine in 2004

There is a school of thought that believes that if something is going right then the downturn is just around the corner! As work progressed to get Acute Medicine recognised as a sub speciality there were many occasions when it was felt that we could still stumble as we came to the final hurdle. Happily that did not occur and by July 2003 Acute Medicine was officially recognised as a new sub speciality within General Internal Medicine. Can we expect any further hurdles? It is often appropriate to recognise the challenges which occur and regard them as opportunities that have to be used for our advantage. Sometimes this is very difficult.

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Simvastatin-induced myositis occurring in a patient with viral hepatitis A

A 60 year old female was admitted with jaundice, malaise & loss of appetite. Two weeks before admission she had complained of diarrhoea with abdominal pain. There was no previous history of jaundice, blood transfusion or foreign travel. She denied pruritus, and stools were of normal colour, although her urine was dark. She was non-smoker & did not drink alcohol regularly. She was known to have ischaemic heart disease & hypercholestolaemia and had been taking ramipril 5mg , clopidogrel 75mg, simvastatin 20mg & omeprazole 20mg daily for the previous two years.

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Thoracic aortic dissection mistakenly diagnosed as pulmonary embolism: A potentially fatal error

Abstract

Thoracic aortic dissection may present in many different ways leading to delayed diagnosis, often with catastrophic results. We present a patient with sudden onset epigastric pain, breathlessness, fever and a left sided pleural effusion, who was initially treated for a chest infection, subsequently for pulmonary embolism, with a serendipitous diagnosis of aortic dissection eventually being made. The strength of association of pleural effusion and aortic dissection and the need for vigilance with regard to the diagnosis of aortic dissection is emphasised.

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Managing fluid balance in patients with liver disease

A fundamental aspect of managing liver patients in the acute setting is assessing and correcting f luid and nutritional status. The intrinsic abnormalities of salt and water handling in patients with liver dysfunction worsen with disease progression. Additionally, they are further aggravated by the processes that cause decompensation and presentation to hospital e.g. sepsis or haemorrhage. Injudicious use or inadequate use of f luids may create further complications in a patient group with a high mortality and morbidity. We have used a case to help illustrate some of the practical points in managing this group of patients.

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Cardiac Arrest: recent advances in recognition and management

Abstract

The features of cardiac arrest will be familiar to any reader who has recently undertaken an Advanced Life Support course. Rather than reproducing algorithms which should be readily available in all UK hospitals, this article emphasises the importance of early recognitions and prevention, and looks at some of the more recent advances in resuscitation technique.

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Acute management of the patient with Diarrhoea

Abstract

Diarrhoea is a relatively common symptom in patients presenting to the acute medical take. The differential diagnosis is wide, although the commonest causes are infection, inflammatory bowel disease and motility disturbances. This article aims to summarise an approach which doctors working at the front door may use to enable rapid diagnosis of the cause of diarrhoea, along with management strategies for its treatment.

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Thyroid Emergencies part 1: Thyroid Storm

Abstract

Thyroid storm is associated with multisystem decompensation and high mortality if untreated. Early clinical recognition and aggressive treatment in a high dependency setting are crucial to a successful outcome. A combination of high-dose antithyroid medication, β-blockade, iodine, steroids and careful haemodynamic management are the essential therapeutic elements, with the potential for a prompt recovery. The pathophysiology, causes and treatment of thyroid storm are reviewed.

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Cardiac Arrhythmias – Part I: Bradycardia

Abstract

Symptomatic bradycardia is a common reason for presentation to Emergency Departments in the UK. Nevertheless, the acute management of bradycardia remains a cause for unnecessary anxiety and confusion among admitting physicians. This article reviews the aetiology, electrocardiographic appearances and management of the common defects of cardiac conduction which may manifest clinically as bradycardia. Particular attention is paid to bradycardia in the context of acute myocardial infarction and the role of temporary cardiac pacing.

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