Acute medicine
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First dose intravenous antimicrobial therapy should be administered within 1 hour of admission but this is achieved in a minority of patients. ⋯ A nurse led protocol can be effective in improving compliance with the 1 hour target. Early administration of intravenous antibiotics in cancer patients with sepsis is associated with a shorter length of inpatient stay and a trend to decreased mortality.
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A 25-year man presented to the Accident and Emergency Department complaining of dizziness and shortness of breath after taking 70 grams of cocaine over 10 hours. He said a friend had noticed that his skin had turned dark blue. On examination the patient was severely centrally and peripherally cyanosed. ⋯ An arterial blood gas showed a methaemoglobin level of 45.6%. The patient was diagnosed with cocaine-induced methaemoglobinaemia and given methyl thioninium chloride (methylene blue). He made an uneventful recovery.
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Review Case Reports
Problem-based review: The patient with acute adrenal failure.
Acute adrenal crisis is an important condition to consider in any shocked patient presenting to the acute medical unit. This article aims to highlight the key aspects of initial management, focussing on the importance of rapid recognition and prompt initiation of steroid treatment.
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Simulation training is a method of interactive teaching and training for healthcare professionals. Medical education research demonstrates that high fidelity simulation leads to effective learning. Acute Medical Specialist Year Three-plus Trainee (ST3+) doctors are often required to manage high-pressure situations, requiring a combination of clinical and non-clinical abilities. ⋯ The learning objectives were mapped to the acute medical curriculum, focusing on areas trainees may traditionally describe as either difficult to achieve, or for those for which providing evidence may be challenging. Simulation scenarios and debriefing sessions enabled trainees to explore different views in a protected environment, and feedback was strongly positive. We strongly recommend simulation training as a teaching tool for Acute Medical ST3+ doctors.
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Giant bullous emphysema is an uncommon condition characterised by large asymmetric bullae with upper lobe predominance. This condition is most frequent in young male smokers. ⋯ A computed tomography scan is needed to delineate the lung pathology. We describe two cases with this condition that presented acutely and discuss the management of bullous emphysema.