ABSTRACT
Despite still being seen as a relatively 'new' specialty, Acute Internal Medicine (AIM) has reached full adulthood, with its 23rd birthday being celebrated in 2023, and as a new specialty it is somewhat apt that it's the same age as the new millennium. Arguably, the coming of age of the specialty has been its role in helping deal with the increased pressures on the urgent and emergency care system, not least with Covid pandemic. However, AIM still faces challenges in its implementation in certain areas. The specialty continues to innovate with regards to service development including Same Day Emergency Care (SDEC), a new Higher Specialty Training curriculum including innovations such as mandatory Point of Care Ultrasound (POCUS) as well as the guidance for Enhanced Care Units (ECUs) allowing centralised care for those patients needing closer monitoring and specialized care.
Subject(s)
Emergency Medical Services , Emergency Medicine , Humans , Adult , Point-of-Care Testing , Ultrasonography , Internal Medicine/education , Curriculum , Emergency Medicine/educationABSTRACT
This syllabus is intended to act as a guide for students and their instructors in medical schools. It describes the range of clinical presentations that they should be able to recognize and the underlying conditions that they should know how to treat. It also includes knowledge of the practice of Acute Internal Medicine and systems of care. The appropriate level of knowledge is that which would be expected of a non-specialist Foundation level doctor.
Subject(s)
Curriculum , Education, Medical, Undergraduate , Humans , Students , Internal MedicineABSTRACT
Editor- Thank you for giving us the opportunity to respond to the letter received regarding the Joint Royal College of Physicians Training Board (JRCPTB) curriculum for Acute Internal Medicine (AIM) that has previously been circulated for comment and consideration of implementation in August 2022. Dr Williamson is correct in asserting that the proposed curriculum hopes to produce doctors with generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of medical symptoms and conditions. It does aim to produce a workforce that reflects the current trends of increasing patient attendances to both primary care and emergency departments- one that has a high level of diagnostic reasoning, the ability to manage uncertainty, deal with co-morbidities and recognise when specialty input is required in a variety of settings, including ambulatory and critical care.
Subject(s)
Emergency Medicine/education , Physicians , Curriculum , Emergency Service, Hospital , Humans , WorkforceABSTRACT
Accidental and intentional poisoning from prescribed, illicit and organic substances remains a major cause of morbidity and mortality worldwide and accounts for just under 1% of the total number of NHS hospital admissions, or around 170,000, a year in the UK1. A knowledge of the constellation of signs and symptoms that constitute specific poisonings (referred to as toxidromes) may enable early empirical decontamination, antidote administration, enhanced elimination and supportive care, and may also help to predict the clinical course. This paper presents a series of clinical vignettes to demonstrate emerging presentations in toxicology to help inform the practice of Acute Physicians, who alongside colleagues in Emergency Medicine and Critical Care, are at the front line of diagnosing and treating poisoned patients.
ABSTRACT
Purple urine bag syndrome is a potentially alarming phenomenon caused by bacterial metabolism of urinary tryptophan into indigo (blue) and indirubin (red) pigments. We report the case of a 46-year-old female with an ileal conduit who presented with a 2 week history of abdominal pain and purple discolouration of her urine. In addition, we review the literature on purple urine bag syndrome, and identify potential new risk factors and management considerations.
Subject(s)
Clostridium Infections , Tryptophan , Urinary Diversion , Urinary Tract Infections , Urine , Clostridium Infections/complications , Clostridium Infections/diagnosis , Color , Female , Humans , Middle Aged , Syndrome , Tryptophan/metabolism , Urinary Catheterization , Urinary Tract Infections/complications , Urinary Tract Infections/diagnosisABSTRACT
Pneumothorax is defined as the presence of air in the pleural space, between the lung and the chest wall. It is a significant global health problem, with considerable morbidity and healthcare costs. Best management strategy remains controversial, with significant variation in practise, both nationally and internationally. The lack of consensus is driven by the paucity of the evidence base. Current research trials, particularly those looking at ambulatory management, are making progress and may help streamline future guidelines. This review presents five case reports of patients treated with methods which are not entirely synchronous with the current British Thoracic Society (BTS) guidelines; providing guidance for acute medical physicians who are routinely presented with such cases and exploring future developments in pneumothorax management.
Subject(s)
Pneumothorax , Practice Guidelines as Topic , Acute Disease , Humans , Lung , Pneumothorax/therapyABSTRACT
Three times a year, the first Wednesday of the month heralds a changeover of junior doctors within our hospital. This year, the first Wednesday in December provided a different kind of challenge. The voice on the phone confirmed the words that no one wanted to hear: "You have three confirmed cases of Norovirus and you have to close to new admissions".
Subject(s)
Caliciviridae Infections/epidemiology , Cross Infection/epidemiology , Disease Eradication/organization & administration , Emergency Service, Hospital/organization & administration , Infection Control/organization & administration , Norovirus/isolation & purification , Caliciviridae Infections/diagnosis , Communicable Disease Control , Disease Outbreaks , Humans , Leadership , Male , Patient Isolation , Risk Assessment , United KingdomABSTRACT
BACKGROUND: It is well recognized that alcohol is a growing problem in the UK with significant morbidity and mortality and associated resource implications for the National Health Service (NHS). The inpatient management of alcohol withdrawal is felt to be variable between hospitals. The aim of this study was to assess the variation in pharmacological management and acute inpatient alcohol services across NHS hospitals in the UK. METHOD: A web-based survey was distributed to Society for Acute Medicine (SAM) members and others with an interest in Acute Medicine between January and March 2008. RESULTS: The results suggest poor utilization of guidelines, variable drug regimens and differences in acute alcohol-related support services. CONCLUSION: In response to these findings, we suggest that a simplified national approach is required for what is now recognized to be an epidemic problem.
Subject(s)
Alcoholism/drug therapy , Hypnotics and Sedatives/therapeutic use , Substance Withdrawal Syndrome/drug therapy , Thiamine/therapeutic use , Alcoholism/rehabilitation , Guideline Adherence , Health Care Surveys , Hospitalization , Humans , Practice Guidelines as Topic , Program Evaluation , Substance Withdrawal Syndrome/rehabilitationABSTRACT
Acquired von Willebrand syndrome (AvWS) is a relatively rare bleeding disorder. It has been reported in association with myeloproliferative disorders, autoimmune diseases, plasma cell dyscrasias and certain drugs. Cefotaxime is a third generation cephalosporin widely used for surgical prophylaxis and as empirical treatment of bacterial meningitis. We report a case of a transient AvWS in association with cefotaxime therapy.
