Acute medicine (Acute Med)

Publications in this journal

• Article: A case of hemolysis and methemoglobinemia following amyl nitrite use in an individual with G6PD deficiency

  Wong A, Koutsogiannis Z, Greene S, Mcintyre S
  Acute medicine 03/2013;
• Article: An unusual cause of septicaemia.

  Channa Vasanth Nadarajah, Imran Saif, Syed Ali Asghar
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  ABSTRACT: Splenic infarction occurs when occlusion of splenic vasculature leads to ischemia, and subsequent tissue necrosis. It is a rare condition. Most patients have an underlying haematological or malignant process or a potential source of embolism. This article describes a patient who presented with unexplained sepsis to the acute medical unit; investigation revealed a splenic abscess and primary hyperparathyroidism, but no evidence of an underlying cause.
  Acute medicine 01/2011; 10(1):26-8.
• Article: The patient with acute paraplegia: a problem-based review.

  Oloruntoba Elegbe, Mirdhu Wickremaratchi, Martyn Hinchcliffe
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  ABSTRACT: Acute paraplegia is an emergency requiring immediate assessment by the acute medical team because of the need to rule out compressive lesions of the cord. Early intervention may preserve neurological spinal function and limit persistent disability. In addition, acute paraplegia may be complicated by life-threatening problems. These require prompt recognition and treatment. The following clinical scenario, based on a real case of acute paraplegia managed by the authors is aimed at providing a problem-based approach to the management of patients presenting with acute paraplegic weakness.
  Acute medicine 01/2011; 10(1):40-4.
• Article: Trainee update.

  Alice Miller, Tim Bonnici
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  ABSTRACT: The new trainee section of the Acute Medicine journal gives us an excellent opportunity to keep trainees up-to-date with the latest news. We will provide you with a summary of relevant information coming directly from both the Society for Acute Medicine and the Acute Medicine Specialty Advisory Committee (SAC).
  Acute medicine 01/2011; 10(1):39.
• Article: The rebirth of general, 'acute' medicine: will the baby survive?

  George Alberti
  Acute medicine 01/2011; 10(1):3-4.
• Article: An unusual cause of bilateral deep vein thrombosis in a young adult patient.

  Viral Kumar Patel, Ben Warner, Andrew Ceccherini, Ben Mearns
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  ABSTRACT: We describe the case of a 17 year old male who presented with severe groin pain leading to inability to weight bear on his left leg. Investigation revealed extensive bilateral and proximal deep vein thrombosis, in association with an absent inferior vena cava and anomalous venous drainage system. We present a review of the literature surrounding this association, summarise the typical clinical presentation and common characteristics in this group of patients and discuss its management.
  Acute medicine 01/2011; 10(1):29-31.
• Article: Severe recurrent hypoglycaemia following discontinuation of olanzapine.

  Sarah Steven, Rahul Nayar
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  ABSTRACT: Severe hypoglycaemia is a diagnostic challenge.1 It is often explained by mismatch between insulin doses, food ingestion and exercise. Recurrent hypoglycaemia can indicate underlying medical problems. Drug related events usually concern insulin or sulphonylureas. However, withdrawal of drugs which can cause insulin resistance can be causative if insulin or sulphonylureas continue.2We report the case of an insulin-treated patient who presented with severe recurrent hypoglycaemia. After exclusion of secondary causes of hypoglycaemia it was established that at the time of diagnosis of diabetes he had been taking olanzapine. This had subsequently been discontinued. Olanzapine is recognised to cause diabetes and diabetic ketoacidosis. Our patient was able to discontinue insulin therapy.
  Acute medicine 01/2011; 10(1):32-4.
• Article: Picture quiz: a red man on the AMU.

  Ashraf Kamour, Andrew Thompson
  Acute medicine 01/2011; 10(1):53, 55.
• Article: The impact of education on the knowledge and documentation of Driving and Vehicle Licensing Agency (DVLA) driving restrictions by doctors.

  Oliver Kemp, Alistair M Lockwood, Gabrielle L Lockwood, Godwin Simon, Juliette Kemp
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  ABSTRACT: Many hospitals are still setting up acute stroke thrombolysis services, often delayed by fears over workload. However, there are few data on how many patients require urgent assessment before one is treated. We prospectively studied all referrals to the 24-hour stroke thrombolysis service, February 2009 - January 2010, in Southampton General Hospital. 128 patients were referred to the thrombolysis team and 20 received thrombolysis. The most common reasons for treatment exclusion were: stroke severity (37%), time from onset (26%) or CT findings (15%). Approximately six patients required urgent assessment by the thrombolysis team for every one treated. These data are crucial to inform service planning.
  Acute medicine 01/2011; 10(1):13-7.
• Article: What errors can be identified by Pharmacy-led medicines reconciliation? A prospective study.

  Maria Richards, Diane Ashiru-Oredope, Nigel Chee
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  ABSTRACT: To establish the nature and frequency of discrepancies identified by pharmacy staff during medicines reconciliation.(MR) METHODS: Pharmacy staff collected data prospectively from 161 patients over a 1 week period, including information on any prescription errors identified. In total, 62 patients (48%) taking one or more medications prior to admission to hospital had one or more discrepancies found by pharmacy staff during MR. The most common discrepancy was omission of one or more drugs. Pharmacy staff identified several unintentional discrepancies in prescribing of medications at admission to hospital. Doctors should ensure that intentional changes to patient prescriptions are clearly documented.
  Acute medicine 01/2011; 10(1):18-21.
• Article: Budd-Chiari syndrome--a review of the diagnosis and management.

  M A Fox, J A Fox, Mervyn H Davies
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  ABSTRACT: Budd-Chiari syndrome (BCS) is the liver disease resulting from hepatic venous outflow obstruction comprising a triad of abdominal discomfort, hepatomegaly and ascites. Advances in the management of this disorder over the last three decades have dramatically improved survival. We present a review of the management of BCS followed by a case which illustrates some key points in the diagnosis and treatment of this condition.
  Acute medicine 01/2011; 10(1):5-9.
• Article: The workload of stroke thrombolysis: a prospective study in a district general hospital setting.

  Seán J Slaght, N U Weir, J K Lovett
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  ABSTRACT: Many hospitals are still setting up acute stroke thrombolysis services, often delayed by fears over workload. However, there are few data on how many patients require urgent assessment before one is treated. We prospectively studied all referrals to the 24-hour stroke thrombolysis service, February 2009 - January 2010, in Southampton General Hospital. 128 patients were referred to the thrombolysis team and 20 received thrombolysis. The most common reasons for treatment exclusion were: stroke severity (37%), time from onset (26%) or CT findings (15%). Approximately six patients required urgent assessment by the thrombolysis team for every one treated. These data are crucial to inform service planning.
  Acute medicine 01/2011; 10(1):10-2.
• Article: Delivering outpatient antibiotic therapy (OPAT) in an Acute Medical Unit.

  Yin May Yan, Manjit Singh, Karl Tonks, J Kavi, Nigel J Langford
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  ABSTRACT: Outpatient antibiotic therapy (OPAT) is being developed and practised in an increasing number of acute hospitals within the United Kingdom. This article is a review of the OPAT service delivered by a large inner city hospital over the last two years. The service demonstrates the key elements of OPAT demonstrating different delivery models, aspects of patient selection, spectrum of infections treated, choice and delivery of antimicrobials, efficacy, patient safety, outcomes, and the cost-effectiveness of this programme.
  Acute medicine 01/2011; 10(1):22-5.
• Article: Not just a 'simple stroke'.

  Wendy Russell, William Taylor, Gautamanada Ray, Jane Gravil, S Davidson
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  ABSTRACT: A 51-year-old man presenting with left arm weakness and slurred speech was referred to the acute medical team. Admission chest X-ray showed a cavitating lesion, which had not been present 2 weeks earlier. Systemic enquiry elicited a 2 month prodromal illness and back pain. Urgent CT of his head and chest revealed evidence of thoracic discitis spreading anteriorly into a pleural-based lung abscess and an intracerebral abscess causing his neurological deficit. He was transferred for urgent craniotomy and evacuation of a Streptococcus milleri abscess. Following several weeks of neurosurgical care and antibiotics he made a near full recovery.
  Acute medicine 01/2011; 10(1):35-7.
• Article: The patient with haematemesis and melaena.

  A J Kent, J O'Beirne, Rupert Negus
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  ABSTRACT: Bleeding from the upper gastrointestinal (GI) tract is a common medical emergency, with an incidence of between 50-150 cases per 100,000 per year.1 A recent audit by the British Society of Gastroenterology showed the mortality rate from upper GI bleeds has fallen from 14%2 in 1993 to 10% in 2007.3 However, despite the use of proton pump inhibitors (PPIs), admission rates for peptic ulcer haemorrhage have increased in older age groups,4 probably related to increased use of antiplatelet agents such as aspirin and clopidogrel and anticoagulants in acute coronary syndromes, stroke and atrial fibrillation. The rising age of the population may also have offset further reductions in mortality and morbidity that may have otherwise come about through improved supportive and endoscopic care.
  Acute medicine 01/2011; 10(1):45-9.
• Article: Picture Quiz: An Unusual cause of 'Troponinaemia'.

  A Chakraborty, Arti Bhimjiyani, Richard William Smith
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  ABSTRACT: A 58 year old policeman presented with a 4 week history of cough, haemoptysis, exertional dyspnoea, ear discomfort and sore throat. He was previously healthy and taking no regular medications. He was a non-smoker and had no risk factors for coronary artery disease. He had recently completed two courses of antibiotics for a presumed ear infection. He had also experienced occasional minor epistaxis with constitutional symptoms of weight loss and night sweats over recent months. Clinical examination was unremarkable.
  Acute medicine 01/2009; 8(3):131.
• Article: Providing better care for patients with complex needs in acute medicine.

  A G Crosswaite, H Dougall, I Duguid, N Mearns, M Jones, D Bell
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  ABSTRACT: Patients with complex needs are commonly admitted on the acute medical take and comprise a significant proportion of the workload for an acute physician. An innovative multi-professional approach to the assessment of this group of patients has been developed in Edinburgh; this paper summarises the results of a 4 week review of data collected on patients assessed by the multiprofessional team on the Medical Assessment Unit at Edinburgh Royal Infirmary.
  Acute medicine 01/2009; 8(2):80-4.
• Article: Use of SimpliRED D-dimer assay and computerised tomography in the diagnosis of acute pulmonary embolism.

  Deepak Subedi, Derek Bell, Marina J Brochwitz-Lewinski, Shazad Aslam, John T Murchison
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  ABSTRACT: Background: The utility of D-dimer in the diagnostic workup of pulmonary embolism has been established. Several D-dimer tests are available with different sensitivities and specificities. SimpliRED D-dimer is a rapid qualitative whole blood D-dimer assay suitable for bedside use. Objective: To assess the utility of the SimpliRED D-dimer test in patients with suspected acute pulmonary embolism in the absence of formal 'risk scoring'. Design: A prospective study measuring SimpliRED D-dimer in unselected patients undergoing computed tomographic pulmonary angiography (CTPA) examination for suspected acute pulmonary embolism. Main outcome measures: D-dimer and CTPA results were compared. Sensitivity, specificity, and positive and negative predictive values of SimpliRED D-dimer were calculated for the unselected patient group. Results: Forty-seven patients underwent D-dimer testing and CTPA. SimpliRED D-dimer was positive in 23 and negative in 24 patients. D-dimer was positive in only 6 (50%) of the 12 patients with positive CTPA. Of the 35 with negative CTPA, 17 had positive D-dimer. The positive predictive value of the D-dimer was 26.1 % and the negative predictive value 75.0%. Conclusion: SimpliRED D-dimer should not be used in the diagnosis of pulmonary embolism in the absence of risk scoring.
  Acute medicine 01/2009; 8(2):85-7.
• Article: Assessment of clinical risk in the out of hours hospital prior to the introduction of Hospital at Night.

  Dj Beckett, Cf Gordon, R Paterson, S Chalkley, Dc Macleod, D Bell
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  ABSTRACT: Overnight medical cover in hospital is less than during daylight hours. We aimed to quantify the numbers of patients deteriorating overnight and their clinical outcome. Data was collected in real time on use of the Standardised Early Warning Score (SEWS), 'time to doctor', seniority of medical review and clinical outcome. 136 incidents of clinical concern were noted on the general wards with a median response time of 5 minutes for SEWS>4 and 10 minutes if SEWS<4. 159 incidents were recorded in critical care. There was significant inter-speciality variation in median response times and seniority of responding staff, particularly within critical care, which recorded the slowest times across the hospital. This will be reassessed following the establishment of Hospital at Night.
  Acute medicine 01/2009; 8(1):33-8.
• Article: SAM Acute Medicine Trainees Skills Survey 2009.

  Hannah Skene, David Ward
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  ABSTRACT: Specialist trainees in Acute Medicine have expressed concerns over skills training in the curriculum, compared with skills training in practice. Thus, an online survey was conducted in 2009 to investigate these comments in detail. The responses from 132 trainees were analysed. The results show that the majority of practical skills are being performed by trainees who feel that they have reached a level of competence sufficient to enable them to teach the skill to others. The major causes for concern were highlighted as temporary cardiac pacing, endotracheal intubation and Sengstaken Blakemore tubes. We recommend that these skills should be taught via simulation where not available in practice, but true competence cannot be expected for the majority.
  Acute medicine 01/2009; 8(1):39-42.