Trainee Section

Trainee Section

Palliative Care – a useful speciality skill for trainees in Acute Medicine

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

I gained a run through number in ACCS (AIM and GIM) in 2007 when Acute Medicine, both as a training programme and a stand alone medical specialty, was in its infancy. As the programme has evolved and developed it has become a curriculum requirement for trainees to attain an acknowledged specialist skill.

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Problem based review: The Pregnant Woman Presenting to the AMU with Palpitations

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

Abstract

Pregnant patients commonly present to the acute medical team with symptoms requiring further investigation. Palpitations are a common reason for presentation on the acute medical take, and most acute physicians will be familiar with the process of investigation. The combination of pregnancy and palpitations raises a broad differential diagnosis and can complicate the management pathway. This problem based review is designed to summarise the key issues which may arise during the management of a typical patient presenting in this way.

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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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Trainee Update September 2014

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

I hope you have all settled well into your new jobs and a very warm welcome to those that have recently joined the ‘family’ of acute medicine. I would first of all like to thank Ruth Johnson for all her hard work as trainee representative over the last 18 months and wish her all the best as she ventures into consultant territory: her replacement will be announced later in the autumn.

July was a busy month, dominated by our Acute Medicine Awareness Week, during which AMUs across the UK undertook events to raise the profile of the speciality and the important work they were doing locally. Barnsley completed a 25 mile virtual marathon, Crosshouse Hospital made £350 in a cake sale, Salford Royal staff walked around every acute medical unit in Greater Manchester, North Staffordshire staff ran a half marathon and there was more cake on sale in Kings College and Leicester Royal. The AMU staff at Southampton raised over £400 with their cake sale and cycle challenge, during which they were joined by the Trust Chief Executive for a ‘virtual’ 120 miles on an exercise bike situated outside the hospital entrance. The highlight, however was the contribution of Dr Nigel Lane, an acute medicine trainee from Southmead Hospital in North Bristol, who put together an outstanding weekly programme of events. This included a visit from the Chief Executive of the trust, visit from local GPs to the unit, daily MDT teaching, daily ‘messages of the day’ located on the trust website and lots of screensavers, banners and information scattered throughout the hospital. I am delighted to announce that Nigel has received the SAM awareness week prize. This involves the opportunity to join the European School of Internal Medicine and attend the winter EFIM school camp in Latvia.

Nigel will also be joining us as one of the speakers in the trainee session at SAM Brighton. He will be speaking on “Preparing for your PYA”. There will also be talks in the trainee session on “Keeping your e-portfolio updated”, “Choosing your specialist skill” and “Preparing for your consultant job”. The session will be aimed at both junior and senior trainees. The trainee that has produced the best poster at Brighton will also have a chance to win a place to attend the summer EFIM school camp. The day before the conference starts there will be a SCE revision session. I attended last year and found it extremely helpful!

Looking forward to seeing you all in Brighton. In the meantime if you have any problems or suggestions please tweet or email me at the addresses below.

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Problem based review: The patient presenting with hyponatraemia

Trainee Section, Volume 13, Issue 2, Pages 53 - 100 (2014)

Abstract

Hyponatraemia is the most common electrolyte anomaly and is associated with significant morbidity and mortality. Patients with severe hyponatraemia often present to acute medical units with non-specific symptoms which can progress to overt neurological manifestations. There are many causes of hyponatriaemia, the most common being drug-induced causes, particularly thiazide diuretics, and the Syndrome of Inappropriate ADH Secretion (SIADH). Initial assessment should include a careful evaluation of the patient’s volume status, which helps to identify the most likely cause. This article utilises a recent case which presented to our AMU to illustrate the importance of a careful and systematic assessment of patients presenting to hospital with hyponatraemia. The new vasopressin receptor antagonists are explored as an option for the management of severe hyponatraemia.

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British Society of Echocardiogaphy Adult Accreditation: An Unrealistic Expectation for Acute Physicians?

Trainee Section, Volume 13, Issue 2, Pages 53 - 100 (2014)

Acute medicine trainees can chose to pursue a specialist interest as part of their training. I decided to train in echocardiography and I’m currently close to attaining the BSE Adult Transthoracic Echocardiography Accreditation. I have found echocardiography a useful tool to rapidly answer important clinical questions and aid management of the acutely unwell patient. For example, an 85 year old was admitted with acute shortness of breath, hypoxia despite high flow oxygen and a normal CXR. A bedside echocardiogram revealed thrombi in the right atrium with mild right ventricular strain. A CTPA confirmed a saddle embolus and she was admitted to CCU as a precaution in case thrombolysis was required. In another case, a 75 year old was admitted to the emergency department after successful DC cardioversion for VF arrest 10 days post primary PCI for anterior STEMI. The post arrest ECG did not show new acute ischaemia. He had 2 further VT arrests with successful DC cardioverison to sinus rhythm. An echocardiogram revealed an acutely dilated right ventricle and he was thrombolysed for a high risk pulmonary embolus.

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Trainee Update May 2014

Trainee Section, Volume 13, Issue 2, Pages 53 - 100 (2014)

Acute Medicine Awareness Week (AMAW) 14-20 July

You may have seen in the Springspring newsletter that there was a plan to do a “virtual marathon” from Edinburgh to Brighton for this year’s AMAW using a GPS tracker App. However, this has now been changed back to same format as in previous years but you can arrange any event you like from parachute jumping to a cake stall. In order to register your AMAW event contact SAM via communications@ acutemedicine.org.uk.

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The Patient with Ataxia

Trainee Section, Volume 13, Issue 1, Pages 1 - 52 (2014)

Abstract

In this article we look at the causes of ataxia, and how the patient presenting with ataxia should be managed. One of the difficulties in managing the patient with ataxia is that acute ataxia has many causes, but usually these can be teased out by means of a careful history and examination. Investigations can then be targeted at confirming or disproving the differential diagnosis. Some patients with ataxia need to be managed in hospital, but many can be investigated, and receive therapy, as an outpatient.

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The patient with Acute Muscular Weakness

Trainee Section, Volume 13, Issue 1, Pages 1 - 52 (2014)

Abstract

Proximal muscle weakness can present acutely or subacutely to the Acute Medical Unit. Early diagnosis of the underlying pathology is essential due to life threatening complications such as respiratory failure and cardiac disturbances as well as causing significant levels of disability. The diagnosis requires thorough history-taking and examination to discern evidence of true weakness, assess its onset, distribution and severity followed by extensive investigations including a CK level, which if high should raise suspicion of rhabdomyolysis. Assessment of respiratory function should be done promptly to identify patients with associated respiratory muscle weakness and treatment should not be delayed waiting for definitive and confirmatory investigations. Poor response to treatment is unusual when diagnosis is correct; this raises the possibility of an alternative diagnosis.

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