Volume 8

Dermatological Emergencies

Clinical Reviews, Volume 8, Issue 3, Pages 95 - 138 (2009)

Abstract

Acute dermatological problems are seen regularly by physicians. This review aims to provide a framework for the diagnosis and management of urgent dermatological conditions. Cutaneous drug reactions are commonly seen and the different clinical presentations are discussed including the less common but important drug reactions Stevens- Johnson syndrome and toxic epidermal necrolysis. Erythrodermic patients also require prompt evaluation and management. Current guidelines for the management of urticaria and the common acquired autoimmune bullous disorders will be discussed. Patients with complications of eczema and psoriasis frequently require urgent in-patient management and patients with cellulitis and leg ulcers are also seen regularly on acute medical receiving units often requiring both medical and dermatological input.

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Editorial

Editorials, Volume 8, Issue 3, Pages 95 - 138 (2009)

A senior colleague once told me that his life would be ‘dull’ if all a consultant ever did was treat patients. There have been plenty of occasions this winter when I would willingly have traded my yearly salary for a ‘dull life’. Amidst the daily crowd control of Acute Medicine it is easy to immerse oneself in clinical challenges; however it is equally important not to lose touch with management responsibilities during these difficult times. The Economic gloom of the past 12 months will soon have a significant impact on the financial health of the NHS. While Government ministers strive to reassure the Public that the cuts in funding will not impact on patient care, those working in the Service are casting nervous glances over their shoulders, wondering where the axe will fall.

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Gastrointestinal Emergencies

Book Review, Volume 8, Issue 2, Pages 51 - 94 (2009)

Gastrointestinal Emergencies describes itself as “the definitive reference guide for the management of gastrointestinal emergencies and endoscopic complications”, The book covers the huge topic of acute gastroenterology in a succinct and easy to read format. At just over 200 pages it covers a lot more than what you might expect and makes for easy and enjoyable reading.

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Clinical Governance in Acute Medicine

Original Articles, Volume 8, Issue 2, Pages 51 - 94 (2009)

We are all responsible for maintaining our standards and improving the way in which we work. However, keeping up to date with the many guidelines/documents published and finding what is relevant to acute medicine can be difficult. This new section of Acute Medicine will hopefully bring together the relevant updates in the world of clinical governance.

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Use of SimpliRED D-dimer assay and computerised tomography in the diagnosis of acute pulmonary embolism

Original Articles, Volume 8, Issue 2, Pages 51 - 94 (2009)

Abstract

Background: The utility of D-dimer in the diagnostic workup of pulmonary embolism has been established. Several D-dimer tests are available with different sensitivities and specificities. SimpliRED D-dimer is a rapid qualitative whole blood D-dimer assay suitable for bedside use.

Objective: To assess the utility of the SimpliRED D-dimer test in patients with suspected acute pulmonary embolism in the absence of formal ‘risk scoring’.

Design: A prospective study measuring SimpliRED D-dimer in unselected patients undergoing computed tomographic pulmonary angiography (CTPA) examination for suspected acute pulmonary embolism.

Main outcome measures: D-dimer and CTPA results were compared. Sensitivity, specificity, and positive and negative predictive values of SimpliRED D-dimer were calculated for the unselected patient group.

Results: Forty-seven patients underwent D-dimer testing and CTPA. SimpliRED D-dimer was positive in 23 and negative in 24 patients. D-dimer was positive in only 6 (50%) of the 12 patients with positive CTPA. Of the 35 with negative CTPA, 17 had positive D-dimer. The positive predictive value of the D-dimer was 26.1 % and the negative predictive value 75.0%.

Conclusion: SimpliRED D-dimer should not be used in the diagnosis of pulmonary embolism in the absence of risk scoring.

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Providing Better Care for Patients with Complex Needs in Acute Medicine

How to Do It, Volume 8, Issue 2, Pages 51 - 94 (2009)

Abstract

Patients with complex needs are commonly admitted on the acute medical take and comprise a significant proportion of the workload for an acute physician. An innovative multi-professional approach to the assessment of this group of patients has been developed in Edinburgh; this paper summarises the results of a 4 week review of data collected on patients assessed by the multiprofessional team on the Medical Assessment Unit at Edinburgh Royal Infirmary.

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Paracetamol overdose presenting with hyperglycaemia, acidosis and ketonuria in a non-diabetic patient

Case Reports, Volume 8, Issue 2, Pages 51 - 94 (2009)

Abstract

There are a number of cases reported in the literature which describe hyperglycaemia in patients following paracetamol overdose. The majority of these occur in conjunction with hepatic failure. Less well known is the occurrence of hyperglycaemia and acidosis following paracetamol overdose in the absence of hepatic failure. This report describes such a case which was initially misdiagnosed as diabetic ketoacidosis (DKA).

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Tricyclic Antidepressant Overdose causing Acute Respiratory Distress Syndrome

Case Reports, Volume 8, Issue 2, Pages 51 - 94 (2009)

Abstract

We report two recent cases of tricyclic antidepressant (TCA) overdose complicated by the development of acute respiratory distress syndrome (ARDS). The previous literature documenting an association between TCAs and ARDS is reviewed. We propose that the respiratory complications of TCA overdose should be more widely publicised and included in national toxicology databases.

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An Unusual Case of Fever and Lymphadenopathy

Case Reports, Volume 8, Issue 2, Pages 51 - 94 (2009)

Abstract

A 62 year old female presented to the acute medical team with headache, fevers and enlarged axillary lymph nodes. Initial biochemical, microbiological and immunological investigations were normal. However, radiological imaging revealed that her silicone breast implants had ruptured, which may have been responsible for her presentation. A brief overview of the clinical features and management of silicone breast implant rupture is provided.

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