Volume 7, Issue 1, Pages 1 – 60 (2008)

The Society for Acute Medicine (UK) Acute Medicine Training Survey 2007

Society Pages, Volume 7, Issue 1, Pages 1 - 60 (2008)

An online survey of training in Acute Medicine was conducted to assemble a true picture of the current situation in the UK. The specialty is flourishing, with over 60 trainees having predicted CCT dates in Acute Medicine in 2010 and 2011 alone. 128 respondents highlighted a multitude of issues, including the need for improvements in management and special skills training and part time opportunities. We have used the results of this survey to suggest action points for Deaneries, Training Programme Directors, the Society for Acute Medicine (UK) and those involved in workforce planning.

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Acute Medicine and Emergency Medicine are not (Yet?) The Same

Viewpoint, Volume 7, Issue 1, Pages 1 - 60 (2008)

The acquisition of “Level 3” competencies in the setting of the Emergency Room from StR in Acute Medicine raises the question of the boundaries and competences of Acute Medicine and Emergency Medicine. The possibility that phisycians with a training both in Emergency Medicine and Acute Medicine will be involved in the management of Emergency Admission Units and Emergency Medicine Departments in the future is herein considered.

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A Severe Rash (Answers)

Picture Quiz, Volume 7, Issue 1, Pages 1 - 60 (2008)

References Stevens M, Johnson FC. A new eruptive fever associated with stomatitis and ophthalmia; report of two cases in children. American Journal of Diseases of Children 1922; 24: 526–533. 2 Paul C, Wolkenstein P, Adle H, et al. Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. Br J Dermatol 1996; 134(4): 710–4....

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A Severe Rash (Questions)

Picture Quiz, Volume 7, Issue 1, Pages 1 - 60 (2008)

A fifty-one-year-old man with history of treated hypertension and seronegative rheumatoid arthritis presented to hospital with a three day history of a rash affecting the whole body and general malaise. He had been commenced on sulfasalazine 2 weeks ago to control his rheumatoid arthritis, which the patient had discontinued taking three days prior to admission.

On examination, he was comfortable with a temperature of 39oC and a widespread erythematous maculopapular rash. Investigations revealed a normal FBC, UEs, LFTs but high inflammatory markers with a CRP 125.9 and ESR 52.

One day later the patient developed odynophagia and blisters on his lips and mouth shown in the picture below (Figure 1 and 2).

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Stroke due to Thromboembolism from Congenital Aneurysm of Ventricular Septum

Case Reports, Volume 7, Issue 1, Pages 1 - 60 (2008)

We describe the case of a 46-year-old female who presented with recurrent episodes of cerebrovascular events. She had an unremarkable family history and no risk factors for stroke, apart from smoking. A transthoracic echocardiogram with ‘bubble’ contrast was normal. However transoesophageal echocardiography demonstrated an aneurysm of the membranous part of the ventricular septum, representing the likely source of thrombo-embolisation. This case highlights the need for a systematic and rigorous approach to the investigation of young patients with stroke.

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A Case of Fatal Felodipine Overdose

Case Reports, Volume 7, Issue 1, Pages 1 - 60 (2008)

A 54 year gentleman was admitted to hospital within four hours of taking an overdose of modified release felodipine tablets, with a total dose of approximately 250 mg. The initial management comprised fluid resuscitation, calcium chloride and glucagon. He remained hypotensive and was commenced on hyperinsulinaemia-euglycaemic therapy. Hypotension persisted with the development of progressive metabolic acidosis despite increasing inotropic support, haemofiltration and high dose insulin-dextrose infusions. The patient died 60 hours post overdose. The case highlights the profound, refractory circulatory collapse and lethal consequences of significant calcium channel blocker overdose and also reviews potential management strategies to attempt to reverse these changes. Despite the lack of evidence of whole bowel irrigation in overdose per se, its role in the removal of modified release compounds has not been studied. We would strongly urge emergency departments to consider this therapeutic modality, especially in overdoses involving delayed release preparations of calcium channel blockers, which are extremely toxic in overdose and are associated with very high mortality.

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Spontaneous Pneumomediastinum After Oral Ingestion of Ecstasy

Case Reports, Volume 7, Issue 1, Pages 1 - 60 (2008)

We describe a 23 year old male who presented with sudden onset of facial swelling, nasal tone of voice and shortness of breath after taking eight tablets of ecstasy. He was found to have surgical emphysema and pneumomediastinum. Though spontaneous pneumomediastinum is well known in inhalation drug users who try to enhance alveolar resorbtion with repeated Valsalva manouvre, it is rather unusual to see it after oral ingestion of ecstasy. The probable causative event is the prolonged and excessive physical exertion involved in dancing at a “rave”.

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Osteomyelitis as the cause of acute leg pain on the MAU

Case Reports, Volume 7, Issue 1, Pages 1 - 60 (2008)

An acutely painful swollen leg is a common presentation to Medical assessment units, typically secondary to cellulitis or deep vein thrombosis, although alternative diagnoses should to be considered in the presence of atypical features or inconclusive investigations.

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Cocaine abuse: acute medical manifestations & current recommended management strategies

Clinical Reviews, Volume 7, Issue 1, Pages 1 - 60 (2008)

Recreational cocaine use in the UK is steadily rising. This review summarises some of the common clinical manifestations of cocaine use which may be encountered by acute physicians and discusses the available treatment options.

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Management of Exacerbation of COPD

Clinical Reviews, Volume 7, Issue 1, Pages 1 - 60 (2008)

COPD is a progressive debilitating lung condition the clinical course of which is punctuated by acute severe increases in symptoms (exacerbations). These can be life threatening and are a considerable cause of morbidity and mortality as well as frequently requiring hospital admission. The aims of treatment are to prevent attacks through vaccination, smoking cessation, appropriate medication, the provision of pulmonary rehabilitation and also patient education. During an attack treatment should be provided in the most suitable place for the individual (home or hospital) and consists of an accurate diagnosis, clinical assessment and the provision of bronchodilators, corticosteroids and antibiotics where appropriate. More severe attacks necessitating hospital assessment and admission may require ventilatory support and even intensive care. Where possible patients should be involved in decision making, particularly with regard to treatment and a possible ceiling of care.

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