Acute medicine
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Therapeutic hypothermia (TH) is now a well established therapy in resuscitation guidelines. We retrospectively analysed our first 18 months' data for all patients who underwent TH for out-of-hospital cardiac arrest (OHCA), measuring delays incurred during each patient episode, safety, and ICU outcomes. Sixteen patients received TH for OHCA. ⋯ Seven patients survived to hospital discharge with a 6 month Glasgow Outcome Score of 4-5 in 100%. A questionnaire evaluating 30 first responders' familiarity and knowledge of TH demonstrated poor awareness and knowledge, with most viewing it with low priority. TH is a safe and easy to achieve therapy, however in practice there are significant delays in commencing treatment.
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A 49 year old man presented with rapid onset paraparesis, evidence of lower motor neurone features and sensory impairment following a respiratory tract infection. Initially he was treated with intravenous immunoglobulins for suspected Guillain-Barré syndrome (GBS). ⋯ The disease progressed with rapid deterioration despite high dose corticosteroids and the patient died 12 days after admission. This case brings several key points to the attention of the acute physician, in particular the need to give serious consideration to the differential diagnosis of cancer in a patient presenting with lower limb weakness.
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A 65 year old woman presented to the Emergency Department of our district general hospital three hours following ingestion of a blended mixture of apples and foxglove leaves, mistaking them for spinach leaves. She complained of nausea, vomiting, abdominal cramps, dizziness and blurred vision.
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Numerous studies have demonstrated the value of echocardiography in the assessment of critically ill patients in the Intensive Care Unit (ICU) and Emergency Room (ER). We seek to encourage expansion of echocardiography in these areas. However it is important to establish training programmes, standards of knowledge and skills, assessment methods and quality assurance if echocardiography is to be offered with confidence in these clinical areas. We have undertaken discussion with the many groups with a relevant interest in critical echocardiography and developed a consensus on proposals for the appropriate provision of training in echocardiography for the ICU, ER, and increasingly the medical high dependency and admissions wards.
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A key component of training in Acute Medicine is the assessment and initial resuscitation of severely ill medical patients. The curriculum for General Internal Medicine (Acute Medicine) states that all specialists in Acute Medicine should attain Level 3 competencies in all emergency presentations.1 Different training programmes have variable exposure to the emergency department, to which the majority of these patients present. ⋯ This means that the SpR works as part of the receiving team, seeing patients first hand, rather than taking secondary referrals. At our hospital over 80% of alerts brought in the resuscitation room are medical emergencies.