Trainee Section

Trainee Section

Trainee update – May 2013

We are delighted to introduce Ruth Johnson and Nerys Conway who have been elected as your new SAM trainee representatives. Kirk and Amy have completed their training but Kirk will continue in an advisory role until October when his official term concludes, to allow time for handover and to ensure continuity. If you want to get in touch or need any help or advice we can be contacted on our usual email address of: traineerep@acutemedicine.org.uk.

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Problem based review: The patient taking methadone

Methadone Maintenance Treatment (MMT) is an effective therapy for opioid-dependence; its use is based on a harm reduction philosophy and represents one of a range of treatment approaches for opioid-dependent individuals.

The medical literature supports MMT as a well established and cost-effective treatment for opioid-dependence that allows a return-to-normal physiological, psychological and societal functioning. The effectiveness of MMT is enhanced by psycho-social interventions such as contingency management and addressing other co-existing health and social needs. MMT saves lives and reduces violent and non-violent crime, drug use and the transmission of HIV, hepatitis C and other communicable diseases. For some people, MMT may continue for life, while others may eventually be able to discontinue and remain abstinent.

Methadone interacts with numerous drugs and prolongs the corrected QT interval (QTc) with risk of sudden cardiac death. It has a prolonged half-life and premature discharge of patients after methadone overdose may be fatal.

Each patient must be assessed, treated and monitored on an individual basis. Successful outcomes through MMT require knowledge, experience, vigilance, and diligence on the part of the physician, the patient and all of those involved in treatment.

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Problem-based review: The patient with acute heart failure

Acute heart failure is a common and potentially life threatening presentation to hospitals in the UK. Acute Physicians at the front door of the hospital will often be involved with the initial management of these patients. Despite its many underlying causes, certain general treatment principles exist. We present a typical clinical scenario followed by an overview of the pathophysiology and management of acute heart failure and cardiogenic pulmonary oedema. The aim is to cover a broad spectrum of therapies ranging from medical treatment up to invasive devices, thereby discussing the available options from the Emergency Department to the Intensive Care Unit.

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Problem-based review: The Patient with Acute Adrenal Failure

Acute adrenal crisis is an important condition to consider in any shocked patient presenting to the acute medical unit. This article aims to highlight the key aspects of initial management, focussing on the importance of rapid recognition and prompt initiation of steroid treatment.

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