Acute Medicine Journal
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Published By Rila Publications Ltd

1747-4884

2021 ◽  
Vol 20 (3) ◽  
pp. 219-222
Author(s):  
S Sivalokanathan ◽  
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MO Syed ◽  
A Sharmila ◽  
◽  
...  

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease that is often the trigger for thrombotic complications. Cerebral venous sinus thrombosis (CVST) represents a small percentage of strokes, frequently proving to be a diagnostic challenge. We report a 31-year-old lady presenting with a persistent headache, 18 weeks after a mild COVID-19 illness. On her second visit, CT venography revealed extensive CVST. She was commenced on low-molecular-weight heparin, and was monitored closely in the neuro-medical intensive care unit. She was discharged 2 weeks later, with no residual neurological deficit, and commenced on a direct oral anticoagulant in the community. CVST should be considered in patients presenting with a refractory headache, with greater suspicion if previously infected with SARS-CoV-2.


2021 ◽  
Vol 20 (3) ◽  
pp. 235-235
Author(s):  
N Rajaiah ◽  
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HK Kainth ◽  
T Knight ◽  
SC Sandwell ◽  
...  

The NHS Five Year Forward View focuses on expansion and development of community services and out-of-hospital care. Hospital at Home is a concept that provides acute active treatment that would traditionally be provided in an inpatient setting, involving nursing staff and therapists. As well as being financially favourable, it is important to acknowledge that often, for a multitude of reasons, people prefer to remain at home rather than be admitted to hospital for treatment. The COVID-19 pandemic has further reiterated that patients are at risk of nosocomial infection. More importantly Hospital at Home care has consistently been associated with greater satisfaction compared to acute hospital care for both patients and their family members.


2021 ◽  
Vol 20 (3) ◽  
pp. 236-236
Author(s):  
M Brabrand ◽  
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S K Nissen ◽  
S Hanson ◽  
M Fløjstrup

Every day, emergency departments and acute medical units all over the world receive and assess thousands of patients. Most are stable, but a few require immediate stabilization. To identify these, all patients are routinely triaged and have vital signs measured. Our group has shown that thermographic images of the face can be an alternative method for identifying patients at increased risk of 30-day mortality. In our previous studies, the thermographic images were taken after the patients had been inside for at least 30 minutes. However, to identify patients at risk, the images have to be available as quickly as triage, i.e. at the door when the patient arrives. Therefore, we have performed a small study, with the aim of illustrating the effect of such heat-gradients on thermal images of the face.


2021 ◽  
Vol 20 (3) ◽  
pp. 161-167
Author(s):  
S Bartlett-Pestell ◽  
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I Adelaja ◽  
A Navaratnam ◽  
V Gandhi ◽  
...  

We conducted a survey exploring the experiences of NHS hospital acute medicine services in England during the 1st wave of the COVID-19 pandemic. Responses were collected from 26th May to 8th July 2020. The results of 91 sites are presented. The total number of patients referred to the medical take for assessment and admitted from the medical take decreased from pre-pandemic levels compared to peak COVID-19 activity. The total number of acute medical beds decreased, however critical care beds increased by 162%. We report the median timeline from first admission of COVID-19 to when baseline critical care capacity was reached. We found regional variation across the results. These findings can assist healthcare leaders prepare for future pandemics.


2021 ◽  
Vol 20 (3) ◽  
pp. 193-203
Author(s):  
AS Jauslin ◽  
◽  
J Kellett ◽  
M Brabrand ◽  
NR Simon ◽  
...  

Background: Elevated D-dimer levels have been observed in COVID-19 and are of prognostic value, but have not been compared to an appropriate control group. Methods: Observational cohort study including emergency patients with suspected or confirmed COVID-19. Logistic regression defined the association of D-dimer levels, COVID-19 positivity, age, and gender with 30-day-mortality. Results: 953 consecutive patients (median age 58, 43% women) presented with suspected COVID-19: 12 (7.4%) patients with confirmed SARS-CoV-2-infection died, compared with 28 (3.5%) patients without SARS-CoV-2-infection. Overall, most (56%) patients had elevated D-dimer levels (≥0.5mg/l). Age (OR 1.07, CI 1.05-1.10), D-dimer levels ≥0.5mg/l (OR 2.44, CI 0.98-7.39), and COVID-19 (OR 2.79, CI 1.28-5.80) were associated with 30-day-mortality. Conclusion: D-dimer levels are effective prognosticators in both patient groups.


2021 ◽  
Vol 20 (3) ◽  
pp. 234-234
Author(s):  
N Smallwood ◽  

I read the recent article by Apsey et al with interest, which recommended "the potential benefits of thrombolytic therapy in massive and submassive pulmonary embolism". This would appear to go against current NICE guidance which states "Do not offer pharmacological systemic thrombolytic therapy to people with PE and haemodynamic stability with or without right ventricular dysfunction". Both recent NICE and European pulmonary embolism (PE) guidance are clear that only high-risk PE (previously called 'massive') should routinely be thrombolysed.


2021 ◽  
Vol 20 (3) ◽  
pp. 174-181
Author(s):  
S Posth ◽  
◽  
ET Anteskog ◽  
M Brabrand ◽  
◽  
...  

Objective: To assess the correlation between urea and mortality in acutely ill medical patients admitted to hospital. Methods: We included consecutively admitted adult patients from the medical admission unit at a regional Danish hospital. Data on mortality was extracted. The association with 30-day mortality was described using cubic splines, and discriminatory power, crude association and adjusted analyses were performed. Results: We included 5,894 patients, with a 30-day mortality of 5.6%. We found a dose-response relation between urea and 30-day mortality with an increase from 2.7% to 19.5% (p<0.001). Conclusion: Elevated urea is strongly associated with 30-day all-cause mortality in acutely admitted medical patients with acceptable discrimination and good calibration.


2021 ◽  
Vol 20 (3) ◽  
pp. 187-192
Author(s):  
J Russell ◽  
◽  
M Dachsel ◽  
A Gilmore ◽  
R Matsa ◽  
...  

The Society for Acute Medicine launched their ultrasound accreditation in September 2016, involving a practical course alongside completion of scanning competencies. Candidates require a registered supervisor to oversee their training. We present here the results of a survey of attendees of practical courses approximately 2 years after launch. The majority of respondents were Consultants or trainees within AIM. Fourteen of 76 (18.4%) respondents had completed the whole accreditation process, whilst 51 (67.1%) had not completed any of the three individual modules. The biggest barriers to accreditation were seen to be lack of supervisors, and lack of dedicated training time. There was good uptake of available online learning resources with good feedback. These results will be used to help develop the training pathway further and widen access to ultrasound training within the specialty and beyond.


2021 ◽  
Vol 20 (3) ◽  
pp. 227-230
Author(s):  
B Mohidin ◽  
◽  
M Sheaff ◽  
RD Wheeler ◽  
G Khamba ◽  
...  

A 53 year old female with a background of hypertension, hypothyroidism and Raynaud’s was admitted with an acute ischaemic stroke and referred to the renal team after a routine urine dip revealed microscopic haematuria and nephrotic-range proteinuria. Blood tests revealed renal impairment, a monoclonal IgM kappa paraprotein, low complement C4 concentration and a positive rheumatoid factor. Active cryoglobulinaemia was suspected and testing demonstrated type II cryoglobulins secondary to the monoclonal IgM kappa paraprotein. Bone marrow biopsy was normal. Renal biopsy revealed cryoglobulinaemia associated membranoproliferative glomerulonephritis. Treatment with steroids and rituximab improved renal function and proteinuria. This case fits within the evolving spectrum of disorders now termed Monoclonal Gammopathy of Renal Significance and highlights the value of biopsying and treating these patients early.


2021 ◽  
Vol 20 (3) ◽  
pp. 204-218
Author(s):  
J Hart ◽  
◽  
CL Cox ◽  

Background: diagnostic uncertainty is ubiquitous. Its communication to patients requires further investigation. Aims: To determine: 1) What is known about how and why diagnostic uncertainty is communicated in acute care; 2) evidence of the effects of (not) communicating diagnostic uncertainty in the acute setting; 3) associated ethical issues. Methods: systematic review of Medline, Web of Science and SCOPUS for (acute or emergency care) AND (diagnostic uncertainty) AND (ethics OR behaviours). Critical interpretive synthesis and ethical analysis were conducted. Results and conclusion: Nine studies (primarily surveys and interviews) were identified. Doctors are not trained in communicating diagnostic uncertainty and perceive it to have negative effects on patients; however not communicating diagnostic uncertainty can disempower patients, resulting in delayed/missed diagnoses or inappropriate use of resource.


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