Acute Internal Medicine Trainee Survey 2015.

OBJECTIVES: To ascertain current Acute Internal Medicine (AIM) trainees' opinions on their training programme, practical procedures, specialist skills and AIM as a specialty. This can then be used to feedback to the national training committee to help shape training priorities. METHODS: Online survey sent to all AIM Higher Specialty Trainees registered on the Society for Acute Medicine database, and advertised through e-mail communication and social media. RESULTS: The majority of trainees (55.5%) were quite happy or very happy with their training currently, although significant difficulties were highlighted with time off for specialist skill training and difficulty achieving certain procedural skills. The majority of trainees believe ultrasound should form a core component of AIM training (82.3%). A high proportion of trainees would recommend AIM as a specialty despite these difficulties. CONCLUSIONS: A number of issues were highlighted causing difficulties within AIM training, despite which the vast majority of trainees would recommend AIM as a career choice. The results were fed back to the training committee in March.

The acupunctured lung.

We discuss a 72-year-old woman admitted with acute shortness of breath and severe sharp chest pain several hours after receiving acupuncture therapy. She was subsequently diagnosed as having an iatrogenic pneumothorax secondary to acupuncture. We discuss the complications of acupuncture and why patients should be informed of the risks of such procedures.

Panic-related hyperventilation resulting in hypophosphataemia and a high lactate.

A 22-year-old lady presented to the emergency department with dyspnoea and pleuritic chest pain. Life-threatening asthma, pulmonary embolus and pneumothorax were all excluded. However, investigations did show an unexplained hypophosphataemia and raised lactate, both of which were subsequently attributed to hyperventilation with a component of panic. Here we explore the mechanism of these findings and the management of hypophosphataemia.

Conservative management of a ruptured mycotic aneurysm.

Mycotic aneurysms are a well-recognised complication of infective endocarditis. In contrast to many sequelae of endocarditis, they can present late in the course of the disease, despite adequate treatment. We discuss the case of an 82-year-old patient who was successfully treated for Enterococcus faecalis endocarditis, but presented late with a hypotensive collapse. CT imaging demonstrated a ruptured mycotic aneurysm. He underwent laparotomy, but the decision was made to treat conservatively to protect the vascular supply to the bowel. The patient subsequently made a full recovery.

Urinary retention secondary to mephedrone.

We discuss a case of a 25-year-old man who presented to the acute medical take with a mixed overdose of mephedrone and paracetamol. Sixteen hours after ingestion, he reported that he was unable to micturate. A bladder scan confirmed that he was in urinary retention and he was catheterised. We discuss the increasingly popular recreational drug mephedrone including its more common side effects.

Assessment and management of mercury poisoning with an unusual abdominal x-ray!

This case discusses a gentleman who presented to the medical team after ingesting mercury liquid. We discuss the assessment, management and different types of mercury poisoning.

Malignant pericardial effusion in a patient with prostate adenocarcinoma.

The authors discuss a rare case of pericardial effusion secondary to carcinoma of the prostate. A month after therapeutic pericardiocentesis there was a haemodynamically significant recurrence, necessitating a pericardial window. The authors discuss pericardial effusion and the management of such patients.