Trainee Section

Trainee Section

Trainee Update January 2014

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

We hope you all had a lovely Christmas and New Year. Apart from making all the usual resolutions, New Year is always a time to think about our careers, look at our CV’s and strive to improve ourselves towards our ARCP or CCT. Our spring conference will take place in Amsterdam this May on 1st-2nd May and there is plenty of opportunity for you to get involved! This year we will be joined by the Dutch Medical Society (DAM). The SAM conferences always provides us with an opportunity for networking, presenting our hard work and meeting other trainees throughout the UK (and in this case Holland). It will be interesting to hear what the Dutch trainees think about their training and how it is structured. There is a dedicated session on acute medical education and training. It will be useful to certainly combine and share ideas with our Dutch colleagues. We certainly could learn a lot from each other and therefore improve our training.

Our acute awareness week will take place on 14th-20th July. This is a huge chance for us to raise awareness of our speciality to the public and other hospital workers. You often find that people don’t understand what acute medicine actually is or what an acute medical registrar or consultant actually does. This is an opportunity for us to ‘celebrate’ our speciality and enjoy team bonding. The junior doctors enjoy getting involved and this often encourages them to think about a career in acute medicine. Full details and information packs will be available via our website shortly. We will be interested to hear what you are all planning as we both have a huge part to play in this year’s acute awareness week. Perhaps one day we could have a training awareness day? It would be great if you got in touch with us to let us know your plans or suggestions! We hope to see as many of you in Amsterdam. Please feel free to contact us with any suggestions, ideas or concerns

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Problem based review: pulmonary embolism in pregnancy

Trainee Section, Volume 12, Issue 4, Pages 185 - 252 (2013)

Pulmonary embolism (PE) in pregnancy carries a significant mortality. Pregnant patients often present via the acute medical take with symptoms of possible PE and require timely assessment and investigation. The symptoms of PE are sometimes very difficult to differentiate from those of normal pregnancy and the vast majority of patients will require imaging. The radiation risks to mother and foetus from imaging may cause considerable anxiety (to both patients and healthcare providers) and need to be explained to patients in the context of a potentially life-threatening condition so they can be actively involved in decision-making on how best to proceed. When PE is diagnosed in pregnancy, there are obstetric considerations around the time of delivery and women should receive specialist follow-up.

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The patient presenting with decompensated cirrhosis

Trainee Section, Volume 12, Issue 4, Pages 185 - 252 (2013)

The rates of liver disease in the UK are rising and hence more patients than ever are presenting to acute medical units with potentially life threatening sequelae. Early recognition and treatment of sepsis, kidney injury, bleeding and alcoholic hepatitis can significantly improve outcomes, but requires a comprehensive approach to assessment. This patient cohort often suffers from a perceived uniform poor prognosis, especially in alcohol related disease, but evidence for this is changing and reassessment of prognosis after 48 hours of organ support may be more accurate than that made ‘at the front door’. This article summarises the most important complications of decompensated cirrhosis, their early management, and presents a targeted system of care: ‘RING Liver’ – Renal failure, Infection, Nutrition, Gastrointestinal bleeding and transit, Liver dysfunction/transplantation. Factors favouring transfer to tertiary units are also explored.

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The patient presenting with ‘Acopia’

Trainee Section, Volume 12, Issue 3, Pages 125 - 184 (2013)

Patients may be referred to Acute Medical Units (AMUs) with a diagnosis of ‘acopia’. This term is offensive and lazy, implying fault on the part of the patient and allowing the assessing doctor to erroneously label the patient as a ‘social admission’ when, in fact, such patients are likely to be frail with co-morbidities and have an acute (potentially reversible) illness. Frail older patients should be assessed using the principles of Comprehensive Geriatric Assessment, informed by an understanding of the concept of frailty and of geriatric syndromes such as falls and delirium.

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Problem Based Review: The patient who has taken an overdose of long-acting insulin analogue

Trainee Section, Volume 12, Issue 3, Pages 125 - 184 (2013)

Insulin overdose can cause harm due to hypoglycaemia, effects on electrolytes and acute hepatic injury. The established long-acting insulin analogue preparations (detemir and glargine) can present specific management problems because, in overdose, their effects are extremely prolonged, often lasting 48-96 hours. The primary treatment is continuous intravenous 10% or 20% glucose infusion with frequent capillary blood glucose monitoring. Surgical excision of the insulin injection site has been used successfully, even days after the overdose occurred. Once the effects of overdose have receded, diabetes treatment must be restarted with care, especially in patients with type 1 diabetes. Monitoring serum insulin concentration has been successfully used to predict when the effects of the overdose will cease.

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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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Problem Based Review: The patient with a Pyrexia of Unknown Origin

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

Pyrexia of unknown origin (PUO) is a frequent presentation to the Acute Medical Unit, and is a source of significant morbidity, both the psychological burden of an uncertain diagnosis and prognosis and untreated complications of the underlying pathology. We present a problem based review of the management of PUO, illustrated by a patient who recently presented to our unit with fever and systemic malaise after returning from abroad and in whom no cause could be found for more than two months. We describe a structured approach making use of complex modern techniques such as Positron Emission Tomography-Computed Tomography (PET-CT) which ultimately provided the diagnosis for our patient.

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