RESUMEN
The Society for Acute Medicine (SAM) and Intensive Care Society (ICS) have produced joint guidance on the standards of care and infrastructure required to deliver enhanced care within Acute Medicine. The cohort of patients this relates to are in the most part already being looked after on the AMU, but co-location and providing enhanced monitoring and nursing input will ensure safe, high-quality care can be delivered to them. We strongly support the development of enhanced care units, whilst clearly acknowledging that they are not a replacement for critical care where that is indicated. Enhanced care and critical care complement each other and will help foster the close working between the two specialties that modern acute care requires. This guidance draws on expertise and existing relevant guidance from the two societies, alongside that from the Faculty of Intensive Care Medicine (FICM), British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and NHS England / Improvement (NHSE/I). We recognise this is an area with limited evidence and so will aim to review it regularly as the knowledge and experience in this area increases.
Asunto(s)
Medicina , Medicina Estatal , Humanos , InglaterraRESUMEN
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. We therefore hypothesised that simulation training could be an ideal training tool for this cohort. We designed a simulation training day for ST3+trainees which exposed them to ethically challenging scenarios. 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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Competencia Clínica/estadística & datos numéricos , Educación Médica/métodos , Servicios Médicos de Urgencia/métodos , Maniquíes , Modelos Educacionales , Simulación de Paciente , Humanos , Proyectos Piloto , Reino UnidoRESUMEN
Pacemaker lead perforation is a recognized complication of lead implantation, particularly with active fixation leads. Multidetector computed tomography (MDCT) is emerging as the imaging modality of choice in diagnosing lead perforation, identifying associated sequelae such as pericardial effusion and planning extraction. We present a case illustrating the use of MDCT in a case of right ventricular (RV) lead perforation manifesting 5 days after cardiac resynchronization therapy pacing.
Asunto(s)
Ventrículos Cardíacos/lesiones , Marcapaso Artificial/efectos adversos , Disfunción Ventricular Derecha/diagnóstico por imagen , Anciano , Electrocardiografía , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Volumen Sistólico/fisiología , Tomografía Computarizada por Rayos X , Disfunción Ventricular Derecha/fisiopatologíaRESUMEN
Bickerstaff's brainstem encephalitis is a rare syndrome defined by the triad of ophthalmoplegia, ataxia and decreased consciousness. It is considered to be a variant of Miller Fisher syndrome and Guillain-Barré syndrome but is differentiated from the two by the presence of central nervous system involvement, commonly in the form of impaired consciousness. We present an unusual case of Bickerstaff's encephalitis, where the patient presented with pseudobulbar affect.