Selected Abstracts from the 3rd International Meeting of the Society for Acute Medicine

1st-2nd October 2009 National Exhibition Centre, Birmingham

Over 100 posters were presented at the 3rd International meeting of the Society for Acute Medicine, held on 1st-2nd October at the National Exhibition Centre in Birmingham. The following are abstracts from the posters which were awarded 'best poster' prizes by the judging panel, in the categories for Case Reports, Service Organisation and Delivery and Audit/Research.

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Patients’ perception of physical aspects of an Emergency Assessment Unit: a questionnaire study

Abstract

Objective: To explore patient’s perceptions regarding the physical environment of an Emergency Assessment Unit (EAU).

Design/Setting: Questionnaire study at the time of discharge from the EAU of a UK District General Hospital

Participants: All patients who were admitted through the EAU for three consecutive days.

Results: Availability of modern facilities, close proximity to home and cleanliness were considered important parameters by <75% of patients. More than half of the patients considered presence of quiet space, good ward aesthetics and hospital food, provision of telephone and television facility, good ward security and ample hospital parking to be important aspects of an EAU. Conclusions: Patient views should form a key part of design when considering the physical environment of an EAU.

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Minimising delays in commencing therapeutic hypothermia after out-of-hospital cardiac arrest: the importance of a multi-disciplinary team approach

Abstract

Therapeutic hypothermia (TH) is now a well established therapy in resuscitation guidelines. We retrospectively analysed our first 18 months’ data for all patients who underwent TH for out-of-hospital cardiac arrest (OHCA), measuring delays incurred during each patient episode, safety, and ICU outcomes. Sixteen patients received TH for OHCA. A mean delay of 248mins occurred following hospital admission to commencing therapy. Seven patients survived to hospital discharge with a 6 month Glasgow Outcome Score of 4-5 in 100%. A questionnaire evaluating 30 first responders’ familiarity and knowledge of TH demonstrated poor awareness and knowledge, with most viewing it with low priority. TH is a safe and easy to achieve therapy, however in practice there are significant delays in commencing treatment.

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Picture Quiz: Answer

While peripheral lesions account for a significant proportion of cases presenting with isolated motor hand weakness (Box 1), this case illustrates the importance of recognizing infarction of the hand knob area as a cause for such a presentation. An accurate history is essential, along with a detailed systemic and neurological examination performed, particularly looking for other neurological findings that may hint towards a peripheral cause or involvement of more areas cortically. The presence of weakness of all muscle groups is unusual in peripheral nerve lesions and led in this case to the initial investigation with cerebral MRI, which provided the diagnosis.

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Picture Quiz: ‘The Upper Hand’

A 76 year-old right-handed man presented acutely with a sudden onset of weakness affecting his right hand only. This happened while working in the garden.

On detailed history taking, he denied any previous symptoms, trauma or prodromal illnesses. He denied any other neurological symptoms.

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Emphysematous Pyelonephritis in a non-diabetic post-operative Transsexual patient

Abstract

We describe the rare condition of emphysematous pyelonephritis (EPN) in a non-diabetic patient who had previously undergone gender reassignment surgery. The report discusses the acute management and treatment and then provides background to the aetiology and historical aspects of the condition.

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Not Just A Rash!

Abstract

Henoch-Schonlein Purpura (HSP) is the most common systemic vasculitis in childhood and can present in adults. It is a self-limiting disease characterised by a tetrad of manifestations including the mandated typical cutaneous hallmark.

We present a classic case of HSP complicated by gastrointestinal haemorrhage associated with hidradenitis suppurativa.

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Melanomatous Leptomeningeal Carcinomatosis masquerading as Guillain-Barré Syndrome

Abstract

A 49 year old man presented with rapid onset paraparesis, evidence of lower motor neurone features and sensory impairment following a respiratory tract infection. Initially he was treated with intravenous immunoglobulins for suspected Guillain-Barré syndrome (GBS). Subsequent cerebrospinal fluid (CSF) analysis identified unexpectedly high protein levels (attributable to Froin’s syndrome1) and magnetic resonance imaging (MRI) was highly suggestive of leptomeningeal carcinomatosis and cerebral metastases secondary to disseminated malignant melanoma. The disease progressed with rapid deterioration despite high dose corticosteroids and the patient died 12 days after admission.

This case brings several key points to the attention of the acute physician, in particular the need to give serious consideration to the differential diagnosis of cancer in a patient presenting with lower limb weakness.

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Lead Poisoning presenting as acute severe myalgia: Why was the diagnosis delayed and what lessons can we learn as acute physicians?

Abstract

Patients presenting to the “front door” with acute neuromuscular symptoms are challenging. Toxins need consideration as possible causative agents if there is the possibility of relevant exposure. This requires a thorough history1 and an awareness of local ethnic, social and industrial cultures within the practice locality. We describe a case of lead poisoning in a 35 year old man who presented with severe, progressive, myalgia. We consider that basic errors in clinical processing delayed a potentially difficult and serious diagnosis and these are discussed. The importance of maintaining a thorough initial clerking process within the Acute Medical Unit is highlighted. This should include a comprehensive occupational history. Acute physicians should familiarize themselves with local industry and the toxic syndromes they can produce.

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