Acute medicine
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Isolated Pelvic vein Deep Venous Thrombosis (DVT) is a relatively rare phenomenon, but is usually not identified by conventional lower limb duplex Ultrasound scanning. We present two cases of isolated iliac vein thrombosis; the first resulting in the patient's death from Pulmonary Embolism (PE) after normal lower limb duplex scan. The second case was identified and successfully treated after introduction of a revised investigation algorithm following the first case. The literature supports the use of magnetic resonance imaging, CT venography, or ascending venography, to diagnose this condition.
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The Royal College of Physicians and Society of Acute Medicine have proposed the introduction of Acute Care Quality Indicators. These include the need for rapid initial patient assessment and instigation of a management plan.1 Reductions in junior doctor working hours may impact on our ability to meet these standards. ⋯ This has identified a marked dichotomy between waiting times during daytime and out-of-hours, despite appropriate response to initial triage. We conclude that further service redevelopment is required to reach the standards proposed in the current Acute Care Quality Indicators.
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Troponin assays are a valuable tool in early risk stratification of patients with ischaemic sounding chest pain. However, troponin is often measured outside of this clinical context. The finding of a raised troponin value may be misinterpreted as an acute coronary syndrome leading to unnecessary and sometimes dangerous anticoagulation. This article looks at some of the considerations which need to be made when interpreting the significance of a raised troponin value.
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Training in Intensive Care Medicine is currently undergoing extensive changes, with the introduction of a new curriculum and new examinations. This article explains the new pathways for training in Intensive Care, with specific reference to trainees in Acute Medicine.