Volume 8, Issue 1, Pages 1 – 52 (2009)

A Retrospective Analysis of Alcohol Intake and Management on the Medical Assessment Unit

Clinical Reviews, Volume 8, Issue 1, Pages 1 - 52 (2009)

Abstract

A retrospective case note analysis of 100 consecutive admissions to a Medical Assessment Unit to (a) review the current impact of alcohol, and (b) assess the quality of clinical management and adherence to local and national guidelines.

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SAM Acute Medicine Trainees Skills Survey 2009

Clinical Reviews, Volume 8, Issue 1, Pages 1 - 52 (2009)

Abstract

Specialist trainees in Acute Medicine have expressed concerns over skills training in the curriculum, compared with skills training in practice. Thus, an online survey was conducted in 2009 to investigate these comments in detail. The responses from 132 trainees were analysed. The results show that the majority of practical skills are being performed by trainees who feel that they have reached a level of competence sufficient to enable them to teach the skill to others. The major causes for concern were highlighted as temporary cardiac pacing, endotracheal intubation and Sengstaken Blakemore tubes. We recommend that these skills should be taught via simulation where not available in practice, but true competence cannot be expected for the majority.

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Assessment of clinical risk in the out of hours hospital prior to the introduction of Hospital at Night

Clinical Reviews, Volume 8, Issue 1, Pages 1 - 52 (2009)

Abstract

Overnight medical cover in hospital is less than during daylight hours. We aimed to quantify the numbers of patients deteriorating overnight and their clinical outcome. Data was collected in real time on use of the Standardised Early Warning Score (SEWS), ‘time to doctor’, seniority of medical review and clinical outcome.

136 incidents of clinical concern were noted on the general wards with a median response time of 5 minutes for SEWS>4 and 10 minutes if SEWS<4. 159 incidents were recorded in critical care. There was significant inter-speciality variation in median response times and seniority of responding staff, particularly within critical care, which recorded the slowest times across the hospital. This will be reassessed following the establishment of Hospital at Night.

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A Case of Postural Orthostatic Tachycardia Syndrome on the Acute Medical Unit

Case Reports, Volume 8, Issue 1, Pages 1 - 52 (2009)

Abstract

We describe a case of postural orthostatic tachycardia syndrome (POTS) in a young female, presenting several weeks after neurosurgery, to the Medical Admissions Unit. The diagnosis is discussed with reference to differential diagnosis, diagnostic criteria, pathophysiology and treatment.

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Acute abdominal pain: An unusual medical cause

Clinical Reviews, Volume 8, Issue 1, Pages 1 - 52 (2009)

Abstract

Lyme disease is an infectious illness that arises from the spirochete, Borrelia burgdorferi transmitted via a bite by Ixodid ticks. There were 768 cases in the United Kingdom (incidence 1.46/100,000) identified by the Health Protection Agency in 2006. Clinical manifestations of Lyme disease can be multi-systemic. It is important for the acute physician to be aware of this condition. Its relative infrequency and unusual presentation can result in delayed diagnosis with potential for suboptimal outcome. Here, we present a case of Lyme disease presenting with abdominal pain and intestinal dysmotility.

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Internal Carotid Artery dissection presenting as Isolated Hypoglossal nerve palsy

Case Reports, Volume 8, Issue 1, Pages 1 - 52 (2009)

Abstract

Internal carotid dissection most commonly presents as headache, focal neurological deficits or stroke. Rarely it can manifest itself by causing a palsy of the lower cranial nerves (IX, X, XI, XII). The reported incidence of isolated cranial nerve palsies is rare. We report a case of an internal carotid artery dissection manifesting as isolated XII (hypoglossal) cranial nerve palsy.

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Poisoning And Toxicological Emergencies – Current Trends And Practice

Clinical Reviews, Volume 8, Issue 1, Pages 1 - 52 (2009)

Abstract

Poisoning is a common presentation to hospital acute medical units, and can produce a variety of clinical scenarios. This review discusses the epidemiology of poisoning, a framework for managing patients with drug toxicity and considerations in the diagnosis of toxicity with unknown substances. The commonest substances seen in toxicity in the UK – paracetamol, antidepressants, sedatives and opioids are discussed in more detail.

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Acute Asthma in Adults: Controversies and Best Practice

Clinical Reviews, Volume 8, Issue 1, Pages 1 - 52 (2009)

Abstract

Asthma in the emergency care setting is common and may be life-threatening. Last year the British Thoracic Society updated their guidelines for the management of asthma, however some treatments remain controversial and there is variation in adherence to these and other national and international guidelines.

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Management of Non-STEMI and suspected Acute Coronary Syndrome

Clinical Reviews, Volume 8, Issue 1, Pages 1 - 52 (2009)

Chest pain is a common complaint of patients presenting to the Emergency Department, but there is a wide variety of underlying causes. These include ischaemic chest pain (acute coronary syndromes (ACS) and stable angina), non-ischaemic cardiovascular chest pain (aortic dissection, pulmonary embolism, pericarditis) and a wide variety of non cardiovascular causes (musculoskeletal, psychiatric and gastrointestinal causes).

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Editorial

Editorials, Volume 8, Issue 1, Pages 1 - 52 (2009)

Milestones are often seen as opportunities for reflection and reminiscence. As this edition of the journal coincides with the 10th anniversary of my consultant appointment I hope readers will forgive a couple of paragraphs of self-indulgence. The phrase: ‘Where did all that time go?’ will probably be familiar to physicians at a more advanced stage of their career. With medical students now returning as specialist registrars, and former house officers appearing as consultant colleagues, the passage of time is increasingly apparent. I recently realised that our current third year students were born in the year I clerked my first patient: surprisingly I still remember his name, age and diagnosis, unlike many of those (and all of the students!) who I have seen since.

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