Editorial

Summer is here, the weather is great and acute medicine teams across the country will be looking forward to 3 or 4 months with few (if any) acute admissions, long lunch breaks and plenty of time off……..OK so this is just wishful thinking! However, the misconception that bed pressures are seasonal still seems to abound in many circles. How often do we sit in bed management meetings in January and February and hear someone refer to ‘things getting better in the next couple of months’? Such optimism does help us to get through those dark winter days when the only daylight you see is glimpsed through the ward windows as you review the 11th COPD patient in succession. But seasonal bed pressures are not simply confined to Winter. Spring and Summer bring their own challenges. First is the Bank Holiday Trilogy: this year’s Easter backlog was hardly cleared in time for Mayday and Whitsun. On top of this we have pollen, ozone, Economy Class Syndrome and ‘barbeque bowel’, not to mention the dehydrating effect of any ‘heatwave’ which comes our way. But let’s be positive – Autumn will be with us soon, and with it another important event in the development of the Speciality of Acute Medicine. The Scottish Exhibition and Conference Centre in Glasgow will be the location for the first truly International meeting of the Society for Acute Medicine. This should be a great opportunity for Acute Medicine to show the wider medical world how far we have come as a speciality over the past eight years, and I would urge as many of you as possible to sign up using the on-line registration system via the link: http://www.regonline.com/societyforacutemedicine . The excellent attendance at the Spring meeting in Halifax was encouraging, particularly the large number of SHOs and trainees who made the journey. One Trainee has submitted her own observations on the meeting, which I have included on p. 44. For those of you who were unable to attend I have also included the abstracts from the Free Paper session, along with summaries of the ‘breakout’ sessions. There will not be time in the packed Autumn programme for another Free Paper session (this is planned again for next Spring), but there will be an extensive poster display with a prize for the best poster. Information on how to submit an abstract can be found on the Society’s website. This edition of the journal contains a range of reviews and case reports, which I hope that readers will find interesting. Hammersley and Edge make a strong case for the development of combined paediatric and adult guidelines for the management of diabetic ketoacidosis, emphasising a more cautious approach to fluid replacement that has been traditionally employed in adult patients. The use of near-patient testing for ketone levels is also discussed, with speculation that this may be of use in the future for prevention of admissions in adults with DKA. Avian influenza may have disapperared from the front pages of Tabloid newspapers in recent times, but the need for vigilance amongst front-line clinicians remains as high as ever. Esmail and Aarons’ review should remind readers of the diagnostic algorithms and treatment options when faced with a suspected case. Syncope and pulmonary embolism complete the review section, the latter providing an extensive review of the diagnostic strategies for this important condition. Treatment of pulmonary embolism will follow in a future edition.

Download Full-text

Abstracts from the Society for Acute Medicine Spring Meeting

Acute Medicine Journal ◽

10.52964/amja.0154 ◽

2007 ◽

Vol 6 (1) ◽

pp. 37-42

Author(s):

G McNeill ◽

P Jenkins ◽

MJR Simmonds ◽

T Bewick ◽

M Chikhani ◽

...

Keyword(s):

Paper Session ◽

Free Paper ◽

Acute Medicine ◽

Spring Meeting

Cedar Court Hotel, Halifax ‘Free Paper Session’ 27 April 2007

Download Full-text

Tissue-plasminogen activator for pulmonary embolism resulting in shock: two case reports and discussion of the literature

The American Journal of Medicine ◽

10.1016/0002-9343(91)80169-m ◽

1991 ◽

Vol 90 (2) ◽

pp. 255-260 ◽

Cited By ~ 2

Author(s):

John P. Mitchell ◽

Elbert P. Trulock

Keyword(s):

Pulmonary Embolism ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Case Reports ◽

Tissue Plasminogen

Download Full-text

Septic Pulmonary Embolism: three Case Reports

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2008.400 ◽

2016 ◽

Vol 69 (2) ◽

Cited By ~ 1

Author(s):

Z. Celebi Sözener ◽

A. Kaya ◽

C. Atasoy ◽

M. Kılıckap ◽

N. Numanoglu ◽

...

Keyword(s):

Pulmonary Embolism ◽

Case Reports ◽

Pleuritic Chest Pain ◽

Radiological Findings ◽

Wound Culture ◽

Septic Embolism ◽

First Case ◽

Septic Pulmonary Embolism ◽

Fever Response ◽

Valve Operation

We present three cases of septic pulmonary embolism which occurred as a result of three different causes. The first case, was a 23 year old woman suffering from cough, sputum, hemopthisis and pleuritic chest pain. She had a right subclavian port. On her thorax computed tomography (CT) scans there were widespread bilateral, irregular parenchymal nodular infiltrates and some of them beginning to cavitate. Meticilin resistant stafilococus aureus (MRSA) was isolated from the blood culture and septic embolism was diagnosed. A month after antibiotic theraphy her parenchymal nodules have considerably decreased in size. The second case was a 40 year old woman admitted to our hospital with the same complaints. Her radiological findings were similar. Meticilin sensitive stafilococus aureus (MSSA) was isolated from the blood cultures and antibiotic theraphy was initiated. To investigate the etiology of the nodules due to septic embolism, echocardiography was performed and infective endocarditis was diagnosed. After the antibiotic theraphy and a tricuspid valve operation her parenchymal nodules disappeared. The final case involved a 51 year old man suffering from fever, fatigue, cough and pain in the left arm for one week. His general status was bad. His radiological findings were also similar to the others. Staphillococcus aureus was isolated from blood and wound culture. Following clinical and radiological findings we thought it was a case of septic pulmonary embolism and antibiotic theraphy was started. Despite the therapy we did not take fever response and he died five days after antibiotic therapy. In conclusion, septic pulmonary embolism should be considered in bilateral cavitary nodular infiltrates and must be managed fast.

Download Full-text

Editorial

Acute Medicine Journal ◽

10.52964/amja.0048 ◽

2003 ◽

Vol 2 (3) ◽

Author(s):

Chris Roseveare ◽

Keyword(s):

Emergency Services ◽

Case Reports ◽

Community Acquired Pneumonia ◽

Rapid Expansion ◽

Medical Specialties ◽

Acute Medicine ◽

General Internal ◽

Competency Based ◽

Exciting Time ◽

The Uk

It could be said that the past 12 months have been an exciting time in the field of acute medicine. In addition to the high profile afforded by the publication of Reforming Emergency Care and the ongoing Emergency Services Collaborative, the significance of the recent acquisition of subspecialty status for Acute Medicine cannot be understated. This, in turn has enabled approval of a new competency-based training curriculum by the JCHMT. Hopefully within the next few months, specialist registrars in General Internal Medicine with Acute Medicine will be appointed to the first few numbered posts in this discipline. Clearly a rapid expansion in posts of this nature will be required in the next few years in order to meet the enormous demand for consultants in Acute Medicine. Recently, in common with other medical specialties, hospitals have experienced difficulties in recruiting suitable applicants for such posts resulting in many vacancies across the UK. One challenge for those of us already working in the field is to maintain enthusiasm for the concept, while we are waiting for the trainees to mature into competent consultants. This edition includes another varied selection of reviews. Community acquired pneumonia may be of particular relevance over the remaining winter months, although hopefully the brief mention of SARS in this paper will now only be of historical significance. Patients with hypercalcaemia, dysphagia and Guillan Barre syndrome may be less frequent attenders, but nonetheless often create management dilemmas with which the admitting physician needs to be familiar. In a departure from our previous format, we have included two case reports this time, both highlighting an important clinical scenario. Power kite flying may not be a familiar activity for many readers, but the outcome described by Merrison and colleagues justifies its inclusion as ‘a case to remember’. Mark Mallett, on the other hand, reminds us that syncope can, on occasions, reflect significant underlying pathology, even in an apparently healthy member of the hospital portering staff. Once again we would like to encourage similar submissions for future editions of the journal. After several years of association with CPD Acute Medicine and its predecessor, it is with great sadness that this edition is Paul Jenkins ’last as sub-editor. We wish him well as he moves on to new challenges in his role as President of the Society for Acute Medicine, and gratefully acknowledge all of his hard work in establishing the journal.

Download Full-text

Editorial

Acute Medicine Journal ◽

10.52964/amja.0019 ◽

2002 ◽

Vol 1 (3) ◽

Author(s):

Chris Roseveare ◽

Keyword(s):

Case Reports ◽

Gastrointestinal Haemorrhage ◽

Medical Emergency ◽

Editorial Team ◽

Original Research ◽

Acute Medicine ◽

Previous Edition ◽

Interesting Paper ◽

Medical Emergencies ◽

A Minor

So the brief ‘respite’ of summer is over, and we find ourselves plunging, once more towards the abyss of winter bed pressures. Hopefully those of you working at the coalface will find time to browse through the following pages. The production of a third issue in this ‘shortened’ year, following the launch of the Journal in July, is a credit to the hard work of the editorial and publishing teams. I am, as ever, grateful for their support. Next year will see a return to the planned 4-monthly cycle, with issues anticipated in March, July and November. One casualty of the tight schedule has been a minor adjustment to the cycle of reviews – COPD will now appear next Spring. In its place we have included an interesting paper reviewing the management of Neuroleptic Malignant Syndrome and Serotonin Syndrome, submitted by Consultant Psychiatrist David McNamara. Gastrointestinal haemorrhage and atrial fibrillation will be more familiar to readers, while Dr Joanna Girling’s review of the management of medical emergencies in pregnancy is essential reading for any physician working close to a maternity unit. Myasthenia gravis may not be the commonest medical emergency; nonetheless it is important that physicians are able to suspect, diagnose and initiate treatment for this condition. As I mentioned in my last editorial, I am keen to encourage submissions of case reports, audits, and pieces of original research provided they would appeal to a general medical readership. Cases need not be rare conditions, but must contain a clear teaching message for the reader. In future editions case reports will be categorised as ‘Tales of the Unexpected’, and ‘A Case to Remember’ (a memorable case or one with a message that readers should remember in future). The report on page 106 is an example of the latter – an important reminder that a radiological diagnosis of ‘pneumonia’ does not always imply an infective cause. Finally, I would like to thank those of you who have written with feedback following the previous edition of CPD Acute Medicine. We are clearly attempting to appeal to physicians from a broad range of backgrounds, and I hope that all readers find something which appeals to them in the pages which follow. Please feel free to write with your comments on any issue which you would like to share with the editorial team – depending on the response we may consider including a correspondence section in future editions of the journal.

Download Full-text

Editorial

Acute Medicine Journal ◽

10.52964/amja.0066 ◽

2004 ◽

Vol 3 (2) ◽

Author(s):

Chris Roseveare ◽

Keyword(s):

Bacterial Meningitis ◽

Medical Staff ◽

Case Reports ◽

Rapid Development ◽

Working Party ◽

Significant Shift ◽

Multiple Choice Questions ◽

Acute Medicine ◽

Junior Staff ◽

The Uk

Over the past three years it has become apparent to me that referring to ‘current affairs’ in these columns can be a mistake, serving only to highlight inevitable printing delays. By the time this edition arrives on your doormat Euro 2004, ‘Big Brother’ and the early summer heat wave will be nothing but a distant memory. However the ‘recent’ publication of the Royal College of Physicians document ‘Acute Medicine – making it work for patients’ cannot be allowed to pass without a mention. This report represents a significant shift in the position of the College in relation to Acute Medicine since the previous working party reported its findings in 2000. The value of consultants specialising in Acute Medicine is now clearly recognised and supported – every trust should now have one, with the minimum figure of three per hospital being proposed by 2008. Whether this is achievable will depend on the rapid development of training schemes across the UK, as well as the generation of enthusiasm for the specialty amongst junior staff. The number of applicants for our Wessex programme indicates no shortage of the latter. Although developing a training scheme takes a lot of hard work, it is vital that those already working in the specialty make this a high priority. We have already seen benefits from the appointment of high quality middle grade staff and are looking forward to a ‘flood’ of future applicants for local consultant posts, 4 years from now. This edition comprises four more important review papers on aspects of acute medicine, along with the first in our ‘Controversies in acute medicine’ series. The latter was designed to try to stir up some correspondence, for future publication. The confusion over oxygen delivery in the acute setting seems to reign fairly widely amongst junior, and indeed some more senior medical staff. Hopefully Dr Cooper’s well-written paper will serve to dismiss some of the misconceptions in this area. Our reviews cover relatively uncommon, but nonetheless important aspects of acute medicine. Tuberculosis and HIV are both on the increase in the UK. The success of anti-retroviral therapy will undoubtedly lead HIVrelated illness to be a significant part of our practice over the next decade. An understanding of the range of conditions specific to this group of immunocompromised patients is therefore crucial for physicians involved in the acute take. Hypoglycaemia and suspected bacterial meningitis are both conditions which require immediate action by medical staff. Both of these reviews comprehensively cover their respective topics with a combination of well written text, illustrations tables and algorithms. Dr Hartman highlights recent evidence supporting the use of dexamethosone in bacterial meningitis and re-iterates some of the points made in an earlier edition regarding the use (and abuse) of CT scanning prior to lumbar puncture. For a change we have no case reports this time, although Dr Macdonald’s audit of the innovative review clinic in the Emergency Assessment Area of Heartlands hospital provides a worthy substitute. Submission of similar articles in future would be most welcome. Once again, a reminder that multiple choice questions are for self assessment and ‘personal’ CPD only; I hope you will find this edition helpful in your clinical practice.

Download Full-text

Editorial

Acute Medicine Journal ◽

10.52964/amja.0057 ◽

2004 ◽

Vol 3 (1) ◽

Author(s):

Chris Roseveare ◽

Keyword(s):

Case Reports ◽

Current Evidence ◽

Diagnostic Dilemma ◽

Acute Medicine ◽

Interesting Insight ◽

Firm Believer ◽

Case Based Learning ◽

Teaching Point ◽

Significant Pathology ◽

Coronary Syndromes

This journal now enters its third edition, which means we are now more than half way through our proposed four-year cycle of reviews. As previous readers may recall, our intention was to cover all aspects of acute medicine with review articles over this cycle. Although we have strayed from the original programme on occasions, we remain on track to achieve this goal. This edition contains five such reviews, including Part Two of the Acute Coronary Syndromes series, this time dealing with the ST elevation myocardial infarction. Dr Wallis guides us through the current evidence for management of this condition, concluding with a helpful paragraph outlining how she would like to be treated in this eventuality. In a comprehensive review, Booth and Leary give a critical care perspective on the investigation and treatment of the comatose patient. Readers should take particular note of the useful algorithm on page…., which provides a user-friendly approach to the management of this often challenging problem. A neurologist once told me that the ‘three F’s of Neurology’ were ‘fits, faints and headaches’, although ‘funny turns’ might perhaps also come into this category. Our next two reviews deal with each of these conditions. Sudden headaches often cause a diagnostic dilemma on our admissions ward – exclusion of subarachnoid haemorrhage is often the easy part; making a positive diagnosis after the CT and LP have proved negative is more of a challenge. Dr Griffin describes some of the less well known causes of this problem, emphasising the need to proceed to MR scanning if there remains a clinical suspicion of significant pathology. Mike Bacon’s review of ‘funny turns’ provides an interesting insight into the approach taken by a consultant experienced in the management of these problems in older people. The diverse nature of the problem is highlighted, along with the need for targeted investigations. Our ‘How-to-do-it’ article this month complements this paper with a detailed description of the Dix-Hallpike and Epley manoeuvres in the management of BPPV. Our final review is a comprehensive discussion of the management of pleural effusion from the Oxford Pleural Disease Unit. In this extensively referenced article, the diagnostic and therapeutic challenges of this condition are discussed in detail, emphasising some of the newer modalities now available. I’ll conclude with my usual plea for submissions. I remain a firm believer in the value of case-based learning and most of us see at least one patient each week which emphasises a teaching point worth sharing. Please encourage your colleagues and juniors to submit such case reports to us – anything which would appeal to a ‘generalist’ audience will be considered for publication. In an attempt to stir up some lively debate, future editions will also contain a feature entitled ‘Controversies in Acute Medicine’. Any reader who feels particularly strongly about an aspect of acute care which attracts controversy is encouraged to contribute to this section: anything except MMR!

Download Full-text