Trainee Section

Trainee Section

The patient presenting with acute hemiparesis

Trainee Section, Volume 11, Issue 1, Pages 1 - 56 (2012)

Acute hemiparesis is a common cause of presentation to hospital. In the majority of cases the cause is acute stroke, which is ischaemic in 80% of cases. This article aims to provide the reader with a practical approach to the initial management of suspected stroke.The problem-based format highlights some of the specific questions raised in the 2009 curriculum for training in Acute Internal Medicine, with reference to recent guidance from the National Institute for Health and Clinical Excellence (NICE).

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Journal Watch: November 2011-January 2012

Trainee Section, Volume 11, Issue 1, Pages 1 - 56 (2012)

The importance of potassium homeostasis in the post-infarction period has become a cornerstone in modern clinical practice. Several studies have shown that potassium levels of less than 3.5 led to a higher risk of arrhythmia induction. This study investigated what the optimal target potassium level should be, given the lower rates of serious arrhythmias following interventions such as beta-blockade and reperfusion therapy.

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Investigation of Pleural Effusions

Trainee Section, Volume 10, Issue 4, Pages 173 - 232 (2011)

Pleural effusion is a common medical condition which often presents on the AMU. There are more than 50 recognised causes of pleural effusion which include diseases local to the pleura or underlying lung, systemic conditions, organ dysfunction and drugs.1 The normal pleural space contains approximately 1mL of fluid. The balance between hydrostatic and oncotic pressures in the visceral and parietal pleural vessels maintains this environment; any disorder affecting this balance will result in a pleural effusion.

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Problem-Based Review: Paracetamol Overdose

Trainee Section, Volume 10, Issue 4, Pages 173 - 232 (2011)

A 29-year old male presents to the emergency department 1h after an overdose of cocodamol. He admits to taking approximately 60 x 8/500mg tablets, with alcohol, over a 20 minute period. He has a past history of depression, treated by his GP with citalopram 20mg OD. He has no previous history of deliberate self-harm. His past medical history is otherwise unremarkable and he is not on any additional medications. He drinks approximately 40 units of alcohol per week. Physical examination is unremarkable, his pupils are normal diameter and his Glasgow Coma Scale is 15. He weighs 82kg.

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Acute Medicine Trainee Update

Trainee Section, Volume 10, Issue 4, Pages 173 - 232 (2011)

In the recent SAM elections, there were three nominations for trainee representative, and we are pleased to announce that Kirk Freeman was the successful candidate. Kirk is an ST6 trainee in the Wales Deanery, and will be taking over from Alice when her term ends in May 2012. He will also be helping out over the next few months while Amy is on maternity leave.

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Problem-Based Review: Self-Harm and Suicide Risk

Trainee Section, Volume 10, Issue 3, Pages 121 - 172 (2011)

170,000 people present to Emergency Departments in the UK each year following an act of self-harm1 and this incidence is increasing. Deliberate overdose currently accounts for ≥10% of all acute medical admissions.2 The frequency and importance of this presentation to trainees in Acute Medicine is emphasised in the curriculum for Acute Internal Medicine 20093 which states that trainees must be able to perform a risk assessment following self-harm and formulate a management plan for care upon discharge from hospital. This article uses a common clinical case vignette to address these competencies.

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Problem-Based Review: Calcium Channel Blocker (CCB) Poisoning

Trainee Section, Volume 10, Issue 3, Pages 121 - 172 (2011)

A 56-year-old female presents to the emergency department 6h after taking an overdose of verapamil MR 120mg x 28 capsules. She has a past medical history of hypertension and atrial flutter. On admission her GCS is 15, HR 50/min, BP 100/64, Capillary blood glucose (CBG) 10.2. ECG shows sinus bradycardia with prolongation of the PR interval. You estimate her weight to be 60kg.

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Journal Watch

Trainee Section, Volume 10, Issue 3, Pages 121 - 172 (2011)

The aim of this study was to look at the association between new onset atrial fibrillation (AF) and mortality as well as the influence of cardiovascular co-morbidities on risk in middle-aged women without cardiovascular disease at baseline. This large study demonstrated that those women who developed AF had an increased risk of all-cause, cardiovascular, and non-cardiovascular mortality compared with women who did not develop AF. Excess mortality associated with AF appears attributable to the occurrence of nonfatal cardiovascular events prior to death. It would seem that cardiovascular risk factors should be managed aggressively in patients with AF to try to reduce these deaths.

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