Volume 9

The 4 hour emergency access target – a patient journey

Viewpoint, Volume 9, Issue 3, Pages 97 - 148 (2010)

During the late nineties it was not uncommon for patients to wait over 12 hours for admission to hospital and there were isolated reports of patients waiting between 24 and 48 hours on trolleys in accident and emergency and sometimes in corridors. My interest in this problem and the long delays experienced by patients in Emergency Departments in the UK developed during early work with the Modernisation Agency.

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Selected Abstracts from the 4th International Meeting of the Society of Acute Medicine

Society Pages, Volume 9, Issue 3, Pages 97 - 148 (2010)

7th-8th October 2010, Edinburgh International Conference Centre

Delegates at the 4th International conference of the Society for Acute Medicine in October were treated to some un-seasonal sunshine, as well as a programme of exceptional quality. More than 200 abstracts were submitted for consideration of inclusion; 6 were selected for oral presentation and 130 posters were displayed. The oral presentation abstracts and those from the 3 prize-winning posters are included here.

Following the success of these sessions the Society plans to include a poster display at next Spring’s meeting in the Bristol Marriott hotel, on 5-6th May, and there will also be an oral presentation session for those selected. Submissions are invited for inclusion via the SAM website: www.acutemedicine.org.uk

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Acute Medicine Journal Survey

Original Articles, Volume 9, Issue 3, Pages 97 - 148 (2010)

A short survey was circulated by email to members of the Society for Acute Medicine receiving the Acute Medicine journal in January 2010. Responses to the questions relating to journal content and layout are summarised in the figures below (Figures 1-5). There were 75 responses in total, representing just over 10% of those surveyed. Not all respondents answered every question; the number of responses for each question is indicated in the figure legends.

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Picture Quiz: A Bad Case of the Flu (Answers)

Picture Quiz, Volume 9, Issue 3, Pages 97 - 148 (2010)

Our case highlights an uncommon complication of nasogastric tube insertion. Enteral feeding plays an essential role in recovery from critical illness. Benefits include increasing blood flow to the gut, maintaining mucosal integrity, preserving the enterocyte gut-blood defence barrier, reducing translocation of bacteria and enhancing the gut’s role as an immune organ.

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The Changing Face of Chest Pain

Correspondence, Volume 9, Issue 3, Pages 97 - 148 (2010)

I read with interest the article “ The NICE Guideline on chest pain of recent onset: What does it mean for the Acute Physician?”.1 I struggle to recall a day’s take occurring without at least one or two patients presenting to the Acute Medical Unit (AMU) with chest pain, awaiting Troponin results. To admit the majority of these patients for prolonged observation, and ECG monitoring may waste resources, but needs to be weighed up against th risk of missing the one ‘troponin negative’ acute coronary syndrome with an atypical history.

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Cardiac arrest following paracetamol overdose complicated by hypokalaemia

Case Reports, Volume 9, Issue 3, Pages 97 - 148 (2010)

Abstract

We present a case of paracetamol overdose in a 34-year-old female with a history of depression and alcoholism. Following treatment with N-acetylcysteine (Parvolex®) our patient developed ventricular tachycardia resulting in cardiac arrest from which she was successfully resuscitated. Subsequent ECG demonstrated prolongation of the QTc interval and repeat blood tests revealed a significant fall in serum potassium from 4.2mmol/l on admission to 2.2mmol/l. The possible mechanisms contributing to the development of hypokalaemia after overdose with paracetamol are discussed. The existing literature relating to paracetamol-induced hypokalaemia is briefly reviewed.

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Headache and high ESR: A cautionary tale

Case Reports, Volume 9, Issue 3, Pages 97 - 148 (2010)

Abstract

A 69-year-old woman with new persistent right temporal headache and high ESR was diagnosed with temporal arteritis in primary care. She was started on steroids, but developed a right 6th nerve palsy with continuing headache and raised inflammatory markers. Investigation revealed a sphenoid sinus abscess with intracranial extension and extensive cerebral venous sinus thrombosis. The abscess was drained endoscopically and she was treated with antibiotics and anticoagulation. Over the course of two months she made a complete recovery.

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DRESS Syndrome caused by allopurinol

Case Reports, Volume 9, Issue 3, Pages 97 - 148 (2010)

Abstract

DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome is a potentially fatal and probably underrecognized complication of allopurinol. We present the case of a 33 year old male with this condition who required intensive care support and subsequently improved following corticosteroid therapy. We review the literature considering optimal strategies for treatment and prevention of this condition. We believe that acute physicians clinicians should have greater awareness of this complication of allopurinol therapy.

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