Management

The patient with Acute Thrombocytopenia

Clinical Reviews, Volume 16, Issue 2, Pages 49 – 100 (2017)

A wide variety of conditions can present with acute thrombocytopenia, ranging from those that are relatively benign and self-limiting to those that require urgent therapeutic intervention. Initial decision-making relies on a good history and the results of some simple investigations. Although a precise diagnosis of the underlying cause might often not be possible in the acute setting, supportive treatments should be provided to all patients. This article describes a practical approach to the diagnosis and initial management of patients presenting with acute thrombocytopenia, with the aid of a case vignette.

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Problem based review: The patient with recent onset Polyarthritis

Trainee Section, Volume 13, Issue 3, Pages 101 - 148 (2014)

Abstract

A wide variety of conditions can present as acute polyarthritis, ranging from those that are potentially life threatening, to those that are self-limiting, and those that represent the early stages of a persistent and potentially destructive form of arthritis. In this article, we describe the diagnostic approach and initial management of patients with recent onset polyarthritis, with the aid of an illustrative case vignette.

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Problem Based Review: The Patient with Acute Monoarthritis

Trainee Section, Volume 12, Issue 2, Pages 65 - 124 (2013)

Acute monoarthritis is a common medical emergency with wide differential diagnosis. Common underlying causes include trauma, septic arthritis, crystal induced arthritis (gout and pseudogout), and reactive arthritis. Of these, septic arthritis is the diagnosis not to miss because of its association with significant morbidity and mortality. Precise diagnosis of the underlying cause of monoarthritis relies on a good history, physical examination findings, and results of focussed investigations. In this article, a practical approach to diagnosis and initial management of patients presenting with acute monoarthritis is described with the aid of a case vignette.

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Septic Pulmonary Embolism in an Intravenous Drug User

Case Reports, Volume 9, Issue 1, Pages 1 - 52 (2010)

Abstract

A recent case of septic pulmonary embolism in an intravenous drug user, complicated by issues of recurrent self discharge and delays in diagnosis yields opportunity to increase awareness of this uncommon yet life-threatening disorder. The literature is reviewed and includes suggested aids to raise clinical suspicion and improve subsequent management.

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Diagnosis and Management of Deep Vein Thrombosis

Clinical Reviews, Volume 8, Issue 2, Pages 51 - 94 (2009)

Abstract

Awareness of deep venous thrombosis has increased considerably in the last decade including recognition of the importance of thromboprophylaxis for acutely ill hospital inpatients as preventative therapy. Combinations of a pre-test probability score plus a D-Dimer analysis can identify those patients where the chances of DVT are very low and radiological investigation can be obviated. The gold standard for diagnosis is still either ascending venography or venous Doppler ultrasound. Low molecular weight heparin has taken over from unfractionated calcium heparin as the initial treatment of choice. There are many challenges in management, especially deciding the optimum duration of anticoagulant treatment in order to balance the risks of drug induced bleeding against recurrent venous thromboembolic events.

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Managing Pleural Disease in Acute Medicine (II): Spontaneous Pneumothorax

Clinical Reviews, Volume 7, Issue 2, Pages 61 - 104 (2008)

Spontaneous pneumothoraces occur in individuals who have not experienced antecedent thoracic trauma. Primary spontaneous pneumothorax occurs in otherwise healthy individuals with no clinically apparent lung disease, whereas secondary pneumothorax is a consequence of an underlying lung disease. This review focuses on their management in the acute medical setting. The specific issues of simple aspiration versus intercostal tube drainage, who can be discharged home safely, and when to refer to a respiratory physician are addressed. In addition, recent developments in the management of pneumothorax are presented.

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Management of Suspected Avian (H5N1) Influenza in a Non-pandemic Setting

Clinical Reviews, Volume 6, Issue 1, Pages 1 - 48 (2007)

Abstract

Avian (H5N1) influenza has been responsible for millions of wild bird and poultry deaths throughout the world. Sporadic human cases with a high mortality have occurred, almost exclusively in association with very close contact with sick, dying or dead birds. Appropriate management of suspected cases requires their prompt recognition via attention to travel and bird-exposure history. The early isolation, diagnosis and treatment of suspected cases as well as prompt involvement of the health protection unit should enable patients to be optimally managed with minimum risk to health care staff.

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Management of transient ischaemic attacks

Papers, Volume 5, Issue 2, Pages 41 - 80 (2006)

Abstract

Symptoms compatible with a transient ischaemic attack (TIA) are a common reason to seek medical attention. Most TIAs resolve within an hour and leave no residual symptoms or signs. This can make the diagnosis problematic, but perhaps more importantly, can lead both patient and doctor to underestimate the importance of the event, and the urgency with which it should be addressed. The risk of a subsequent stroke is high: around 8% after seven days and 17-18% after three months.1,2 This review aims to discuss some of the issues surrounding the investigation and management of TIAs, including the potential role of Acute Medicine in the provision of timely and appropriate management for these patients.

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Management of Acute Ischaemic Stroke

Clinical Reviews, Volume 4, Issue 3, Pages 81 - 112 (2005)

Abstract

National audits of stroke care in the UK have repeatedly shown deficiencies in basic care. The key to good care is prompt thorough assessment, investigation and management of physiological parameters i.e blood pressure, glycaemia, temperature and oxygenation. Three interventions are of proven benefit in acute ischaemic stroke: admission to an organised stroke service, early aspirin and intravenous thrombolysis. The use of multidisciplinary guidelines and education and audit around these improves care.

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The Emergency Management of Adult Bacterial Meningitis

Clinical Reviews, Volume 3, Issue 2, Pages 45 - 84 (2004)

Abstract

Over the last decade, new protein-conjugate vaccines against Haemophilus influenzae type b (Hib) and Neisseria meningitidis serogroup C (MenC) have had a dramatic effect on the epidemiology of childhood meningitis in the United Kingdom. Amongst adults, bacterial meningitis remains an important cause of preventable morbidity and mortality. Clinicians need to remain vigilant for the possibility of this infection. The identification of the one patient with meningitis out of many with trivial viral infections remains a difficult task. Even once the diagnosis is made clinically, the subsequent investigation and management of the patient remains controversial, with strong opinions often influenced by one or two adverse experiences. Potential improvements in the way we identify and manage meningitis patients have been identified in recent years. This review will focus on those areas relevant to the emergency care specialist. Meningitis in the immunocompromised patient often has a different clinical and epidemiological pattern and is beyond the scope of this review.

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