Acute medicine
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Chest pain is a common symptom amongst patients presenting to the acute medical unit, and presents a diagnostic challenge. We present the case of a previously healthy 65 year old year old gentleman with chest pain and subsequent vomiting, treated initially as an acute coronary syndrome, despite normal ECG and troponin. ⋯ This revealed evidence of oesophageal rupture (Boerhaave's syndrome). Despite early surgical intervention our patient suffered a number of complications and continues his recovery in hospital three months post presentation.
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The Surviving Sepsis Campaign (SSC) was launched in 2002 with guidelines created to help manage severe sepsis and septic shock. In response to poor compliance with the SSC guidelines in the UK, the 'Sepsis 6' model of delivery was created. We report some of the innovative methods hospitals from around the UK are using to help deliver the 'Sepsis 6' care bundle. The use of social media, such as Twitter, for disseminating these innovations is also explored.
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Headache and seizures are common presentations to the acute medical unit. We report a case of posterior reversible encephalopathy syndrome (PRES) in a 73-yr-old woman with a history of uncontrolled hypertension who had recently discontinued one of her antihypertensive drugs; such cases are rare but pose a diagnostic challenge given the nonspecific nature of the clinical presentation. However, early diagnosis and treatment leads to full recovery in the majority of patients.
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NCognitive impairment is common amongst acute geriatric hospital admissions but detection is often poor and this is associated with worse outcomes. The four-question abbreviated mental test (AMT4) has previously been promoted nationally in the acute setting as a succinct assessment tool. However, a recent national dementia Commissioning for Quality and Innovation (CQUIN) goal recommends a single screening question followed by the tenquestion abbreviated mental test (AMT10). We aimed to evaluate the negative predictive value of the AMT4 within the acute setting by comparing it to three other validated tools. ⋯ Nearly half of the participants had signs of cognitive impairment despite a negative AMT4. Consequently, there is a risk of under diagnosis with potentially serious consequences for morbidity and mortality. Tests of shortterm memory were strongly associated with cognitive impairment. We propose the addition of such a test in order to increase the sensitivity of the AMT4 without compromising its brevity and utility in the acute setting.
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Summary Care Records (SCRs) have been created for more than 50% of the population of England. The number is increasing at about 100,000 records a week. Fewer than 1.5% of people have elected not to have a SCR. ⋯ SCRs are being viewed by authorised healthcare staff in urgent and emergency care settings all over England. Benefits are being reported in relation to increased patient safety, improved clinical decision making, improved efficiency and improved quality of care. NHS England strongly supports the uptake and adoption of SCRs by Trusts in England.