A 38 year old male presented with worsening breathlessness and cough for 6 months duration. He was treated in the community with salbutamol and steroid inhaler by GP for suspected asthma but with no benefit. He presented to the emergency department complaining of further worsening breathlessness. His initial ECG (Figure 1) was abnormal. Subsequent CT...
We have successfully been running with a Consultant presence in day-time (0900-1700) in the admissions area for a number of years. The recent NCEPOD report – an Acute Problem, criticised the lack of Consultant input into care of patients being transferred to Critical care areas out of hours. The DoH Hospital at Night project has...
Abstracts from the Society for Acute Medicine: Spring meeting Read More
The investigation and management of patients presenting with hypercalcaemia is not always straightforward. We describe the case of a middleaged man presenting with severe symptomatic hypercalcaemia. The difficulties encountered here - in striving for biochemical and symptom control, and in establishing a definite diagnosis - are fortunately rare. The case illustrates the range of options in the treatment of severe hypercalcaemia, and highlights the use of haemodialysis in treatmentresistant cases.
A Challenging Case of Malignant Hypercalcaemia Read More
Abstract We present the case of a patient who presented with evidence of pneumonia, sepsis and anaemia but no significant abdominal signs. A routine abdominal ultrasound scan revealed evidence of spontaneous splenic rupture. He underwent splenectomy but passed away subsequently from respiratory complications. The many associations of spontaneous splenic rupture are discussed. The diagnosis should...
Spontaneous Splenic Rupture in a Patient with Pneumonia and Sepsis Read More
Abstract
Aneurysmal subarachnoid haemorrhage (SAH) is an acute life-threatening neurological disorder. A delay in diagnosis can lead to substantial and avoidable morbidity and mortality. It is important to identify patients with SAH promptly, to enable specialist referral to neurosurgical centres. This review aims to provide an up-to-date practical guide concerning the interpretation of spinal fluid results in patients with suspected SAH.
Cerebrospinal Fluid analysis in Suspected Subarachnoid Haemorrhage Read More
Abstract
Psoas abscess is an uncommon presentation on the acute medical take. However recognition and appropriate treatment is essential. This review is designed to highlight the clinical features, microbiology, diagnostic tests and treatment for this condition. In order to illustrate some of the pitfalls and complexities in the management of psoas abscess we have included a case history of a patient who was recently treated in our department.
Psoas Abscess: Diagnosis and Treatment Read More
Abstract
Sickle cell disease is the commonest haemoglobinopathy within the United Kingdom.1 Although the majority of patients will present to hospitals within major cities, this is not invariably the case. It is therefore important that all physicians on acute medical take are familiar with the acute management of sickle cell disease. This review encompasses the initial management which is subdivided into analgesia, investigations and supportive care. In addition the more severe complications of sickle cell, including the acute chest syndrome and stroke are covered. It should be remembered that close collaboration is required with the haematology department, particularly in those patients with respiratory distress or stroke, so that prompt arrangements can be made if exchange transfusion is required.
Management of Acute Complications Associated with Sickle Cell Disease Read More
Abstract
Chronic liver disease is becoming more common in the UK. There has been much media coverage due to recent change in licensing laws and celebrity figures suffering from cirrhosis. This review highlights the common complications of cirrhosis that frequently present to the acute physician, focussing on initial presentation and subsequent management, based on the current best available evidence.
Emergency Management of Acute on Chronic Liver Disease Read More
Few will deny that the past 6 months have been particularly challenging for all clinicians working in hospital medicine. The pressures of ward closures, which many acute hospitals have faced recently, have undoubtedly increased the ‘bottle-neck’ effect at the front door. Any ‘slack’ which might have existed in the past has now disappeared – 82%