Acute Medicine最新文献

We present the case of an 81 year old man, admitted with ataxia and hyponatraemia. Biochemical analysis was suggestive of Syndrome of Inappropriate ADH (SiADH) which was initially attributed to a recent respiratory infection or treatment with omeprazole. Neurological symptoms worsened despite normalisation of sodium levels and further examination revealed generalised areflexia; subsequent investigation by the Regional Neurology team led to a diagnosis of Guillan Barre syndrome, and symptoms improved following treatment with Intravenous Immunoglobulin and prolonged in-patient rehabilitation. Guillan Barre syndrome is a recognised cause of SiADH and this case highlights the importance of considering this diagnosis along with full neurological examination when patients with hyponatraemia present with neurological symptoms.

Care of patients in corridors of emergency departments is being normalised in many hospitals across the United Kingdom. Clinicians within Emergency Medicine and Acute Medicine have been discussing the impact of this care on patients, as well as the 'morale injury' on the staff looking after them. Whilst the authors of this paper have seen evidence of harm caused by delays of care to patients facing long waits in the emergency department, we believe that this is the first analysis that describes the case mix in a large UK hospital. Care in corridors affected patients with a broad range of conditions; 16% had a NEWS of 5 or more, 67% were elderly patients with markers of frailty, and 42% had a history of mental health problems or substance abuse.

A man in his 50s with a history of end-stage kidney disease on haemodialysis and chronic mental health issues underwent thoracoabdominal CT to characterise a prolonged lower respiratory tract infection. A single metallic density foreign object was noted within the lower oesophagus. (Figure 1).

We present a case report on a spot diagnosis of Thyrotoxic Periodic Paralysis (TPP) with a unique first-person account of events from the patient. It illustrates the importance of pattern recognition and exemplifies how timely treatment enables quick resolution of a life-threatening medical emergency. Patient X's account affirms the condition's insidious onset and rapid deterioration. This case highlights the need for raising awareness of diseases that are more prevalent in specific ethnic groups and is particularly crucial for work in culturally diverse environments. We hope by sharing our experience, readers will be prompted to consider TPP as a differential diagnosis for acute limb weakness in an acute setting; with prompt testing of thyroid function and initiation of the appropriate treatments.

Acute dyspnea represents one of the most common presentations to the emergency department. Identifying the cause of this non-specific symptom among patients with complex medical histories can be challenging. This case report describes a patient in their 60s with worsening dyspnea on exertion, fatigue and orthopnea on the background of a single chamber pacemaker. Our case demonstrates an often-missed diagnosis of pacemaker syndrome which can be identified on the bedside electrocardiogram (ECG). This is a disease with high morbidity and yet is easily treated once diagnosed.

Headache accounts for 1 - 3% of emergency department (ED) visits globally and is associated with elevated blood pressure (BP). It is unclear if anti-hypertensive therapy provides benefits. This retrospective study assessed effects of anti-hypertensive therapy in ED headache patients on rescue analgesic need, hospital admissions, and length of stay (LOS). 1385 patients were included. 366 received anti-hypertensive therapy. The anti-hypertensive therapy cohort was older (p < 0.001) with increased odds of admission (p < 0.001) and 2.385 hrs longer ED LOS (p < 0.001). No difference in rescue analgesia was found (p < 0.429). Anti-hypertensive therapy in hypertensive ED headache patients is associated with increased hospital admission and ED LOS, but no difference in rescue analgesia utilization.

Background: Medical research improves patient outcomes, patient satisfaction, staff morale and retention. It is unclear what research opportunities and training staff in acute medicine had.

Methods: The Society for Acute Medicine supported a survey to assess current research activity, training and perceived opportunities and barriers.

Results: 292 responses were received from diverse professional backgrounds. Few respondents had formal research qualifications or were undertaking research, but the majority valued research and wanted more research experience including formal training. Barriers included time constraints and perception that research in acute medicine was less valued by healthcare organisations. Preferred mechanisms to increase research included mentorship, advocacy, and increased opportunities.

Conclusions: Strategies to increase research in acute medicine should consider these results in forward planning.

The NHS and social care services remain under immense pressure. Each part of the system continues to experience demand beyond its capacity which exacerbates the problem. This is most vividly illustrated in urgent and emergency care. Once again, this winter, media is full of pictures of patients in corridors; long queues of ambulances outside of emergency departments and stories of horrific patient experiences: reflecting the appalling situation witnessed and practiced by acute medical teams daily.

Background: The COVID-19 pandemic has strained the healthcare system with emergency department (ED) boarding and workforce shortages. This prompted the need for strategies to evaluate and treat patients while they waited for an ED room.

Objectives: The objective is to describe a waiting room evaluation process and ED throughput in the setting of ED staffing shortages and boarding.

Methods: This is a retrospective before and after cohort study evaluating ED throughput before and after initiation of the assessed waiting room (aWR) process. The aWR process is a joint effort by emergency clinicians and ancillary staff to evaluate and treat patients in the ED waiting room when no ED bed is available. Throughput data 6 months before and 6 months after institution of aWR was collected and analyzed.

Results: The arrival to provider time and the number of patients who left without being seen (LWBS) decreased with initiation of the aWR process. The remainder of throughput metrics remained unchanged. There was more ED boarding at Wisconsin sites during the aWR process period.

Conclusions: The aWR process may minimize LWBS and improve arrival to provider time in the setting of staff shortages and more ED boarders. It may help other ED throughput metrics although numerous confounding factors make it difficult to make definitive conclusions. This process may be trialed during times of challenging healthcare landscape, such as pandemic conditions and with workforce shortages.

Performance within acute medicine services is impacted by ongoing pressures on acute care services. Data from the Society for Acute Medicine Benchmarking Audit 2023 (SAMBA23), was used to assess performance of acute medicine services compared to key clinical quality indicators, comparing performance by initial assessment location. Data was analysed for 8213 unplanned attendances across 161 hospitals. Comparing by initial assessment location, performance against the clinical quality indicators was unchanged from 2022. Only 29% of daytime arrivals assessed within the Emergency Department received consultant review within target times. Delays were seen in transfer between acute care locations. 29% of patients requiring admission were not admitted to the AMU. There is ongoing variation in acute medical service performance nationally, with significant delays in patient access to appropriate assessment locations.