Volume 9, Issue 2, Pages 53 – 96 (2010)

Selected Abstracts from the Society for Acute Medicine Spring Meeting

Society Pages, Volume 9, Issue 2, Pages 53 - 96 (2010)

The quality of abstract submissions for the Society for Acute Medicine meetings has continued to rise over recent years; 4 abstracts were selected for oral presentation at the Spring meeting this year, and 53 posters were displayed in the conference venue. The abstracts from the oral presentations and the two prizewinning posters are published below. In addition we have included the abstract from the prize-winning poster by Dr Phil Jacobs, presented at the Autumn 2009 meeting; an incorrect version of this abstract was published in an earlier edition of this journal.

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The NICE Guideline on chest pain of recent onset: What does it mean for the Acute Physician?

Viewpoint, Volume 9, Issue 2, Pages 53 - 96 (2010)

The long-awaited guideline from the National Institute for Health and Clinical Excellence (NICE) for the management of chest pain of recent onset has now been published. This provides detailed recommendations for the management of patients with chest pain of possible or likely cardiac origin. This clarity should be welcomed by Acute Physicians who have seen a significant increase in emergency referrals to hospital, of which up to 25% in our practice are patients with chest pain. The guidance aims to help and support healthcare professionals to direct their patients into the appropriate referral stream.

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Picture Quiz: All in the head?

Picture Quiz, Volume 9, Issue 2, Pages 53 - 96 (2010)

A 40 year old previously fit bank executive of Cypriot origin presented to the acute medical take with insidious onset frontal and vertex headaches with features suggesting raised intracranial pressure. He had been under investigation in the outpatient department after developing multiple erythematous lesions on his legs, associated with malaise, occasional mouth ulcers and episodic sweats.

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A profile of Nurses working in acute medicine units: What is the future?

Research Report, Volume 9, Issue 2, Pages 53 - 96 (2010)

Abstract

A survey of registered nurses working in two acute medicine acute medicine units (AMUs) was conducted between May & September 2009 to enable a focussed understanding of nursing recruitment and retention, to guide nurse managers for future workforce planning. The NHS collects national information regarding recruitment, retention and leavers, but this is sporadic and hampered by a lack of feedback to clinical areas. In this study, fifty completed questionnaires were collated, totalling a response rate of 57.5%. The results demonstrate that while recruitment is currently buoyant, nurses with significant experience are becoming dissatisfied through lack of opportunity to advance. It concludes that further national research is required to inform a strategy fit for the future development of nursing in acute medicine.

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Training Requirements for Point of Care Ultrasound in Acute Medicine

Research Report, Volume 9, Issue 2, Pages 53 - 96 (2010)

Abstract

The aim of the study was to explore the ultrasound training requirements in acute medicine by comparing the ultrasound skill of an acute medicine trainee (AMT) with that of the radiology department following short ultrasound training.

Results: 43 participants (34 males and 9 females).The mean age was 58 (range 20-93 years). Liver: AMT reported 15/17 as normal (Specificity 88%) and diagnosed ascites in 100% (NPV 93%). Gallbladder: There was 100% sensitivity and NPV for excluding gallstone. CBD: Sensitivity and specificity of 83 and 95% for dilated CBD (NPV 95%). Kidneys: AMT identified 100% of normal kidneys. Spleen: Splenomegaly diagnosed with 95% specifity and NPV.

Conclusion: The AMT achieved a high level of accuracy in diagnosing and excluding gallstone, dilated CBD, ascites and splenomegaly.

CBD = Common Bile Duct, NPV=Negative Predictive Value.

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Acute Sarcoidosis: 3 Cases in an Acute Medical Clinic

Case Reports, Volume 9, Issue 2, Pages 53 - 96 (2010)

Abstract

Sarcoidosis is a cryptogenic multisystem granulomatous disorder. We present three patients who presented acutely with erythema nodosum in our Medical Assessment Unit (MAU) or attended our clinic, subsequently diagnosed with acute sarcoidosis. In doing so, we aim to demonstrate that this presentation can easily be seen on the acute medical take, focussing on the management of acute sarcoidosis in association with erythema nodosum. Although patients will often not display florid systemic upset on presentation, we recommend follow-up after initial presentation, to ensure good resolution of symptoms.

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Buttock Cellulitis as a Presentation of Psoas Abscess: a clinical reminder

Case Reports, Volume 9, Issue 2, Pages 53 - 96 (2010)

Abstract

Cellulitis is a common condition that is frequently managed by the general physicians on an acute medical take. This case report describes buttock cellulitis as a presentation of an iliopsoas abscess and illustrates the importance of considering a deep abscess when there are atypical features, when the cellulitis is in an unusual location or when the patient fails to improve with standard anti-microbial therapy.

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Scombrotoxin poisoning: an important differential diagnosis for anaphylaxis

Case Reports, Volume 9, Issue 2, Pages 53 - 96 (2010)

Abstract

We report a case of scombrotoxin poisoning, an acute illness that develops within minutes to hours of eating poorly processed oily fish, such as tuna or mackerel. It presents with symptoms that can mimic an anaphylactic reaction. It is presumed to arise due to ingestion of histamine that is formed by contaminating bacteria that have flourished during periods of suboptimal refrigeration, following capture. Knowledge of this underdiagnosed malady as a potential differential diagnosis for patients presenting with symptoms suggestive of histamine release is important. It is a notifiable condition. The alternative diagnosis of anaphylaxis may have significant lifestyle implications for the patient. This article reports on one such presentation and the way that the diagnosis was explored.

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Spontaneous spinal extradural haematoma presenting with chest pain: a case report and literature review

Case Reports, Volume 9, Issue 2, Pages 53 - 96 (2010)

An 85 year old lady was admitted to hospital after experiencing an abrupt onset of right sided chest and mid thoracic back pain. This pain was exacerbated by movement and coughing but not by inspiration. There was no history of recent injury. Her past medical history included atrial fibrillation (AF), aortic stenosis, hypertension and chronic obstructive pulmonary disease. Medication on admission included bendrof lumethiazide 2.5mg od, digoxin 125 mcg od, doxazosin 4mg od, enalapril 20mg od, warfarin and salbutamol and seretide inhalers. Prior to the onset of the pain she had been independently mobile with a stick.

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