Description

While the profile of the subspecialty of Acute Medicine continues to rise, so does
the burden of work under which we are continually placed. Changes in General
Practice out-of-hours cover, reduced junior doctor hours, continued pressure
to achieve four hour A&E wait targets along with the arrival of yet another winter will be
familiar themes for many readers. There are times when it may seem difficult to stay positive
in the face of such adversity. In these moments of despair, I have recently taken to reading
our ward admissions list in search of light relief. This list, compiled by non-clinical staff,
describes the problems which doctors referring patients to the AMU ascribe to their
patients. COPD Exasperation appears to be a common problem (not least amongst the
junior medical staff), while I hope that the patient admitted with aspirations of pneumonia
wasnt too disappointed by his final diagnosis. A patient with Wegeners granulomatosis was
admitted several times with acute f lare-up of vagueness, an aff liction with which many of
us will be familiar. My favourite, however, remains the unfortunate patient described as
Bilateral amputee off legs; things clearly could not get much worse for this man!

If your own search for light relief leads you to browse through the following pages you
will find more useful reviews, case reports and the second in our Controversies in acute
medicine series. This time Guha and Sheron tackle the issue of f luid resuscitation in
chronic liver disease, an area which is frequently a source of considerable confusion. I have
only ever treated one patient with thyroid storm, sadly without a favourable outcome; Ben
Turners overview of the management of this rare condition will hopefully equip readers to
deal with the consequences, should you ever be faced with such a problem. At the other end
of the pulse-rate spectrum, bradyarrhythmias are a more familiar on-take emergency. In
part one of a series of reviews on arrhythmias to be published over the next few editions,
this subject is tackled in some detail. Diarrhoea and Cardiac Arrest have both been areas
traditionally avoided by consultant physicians. In these days of the hands-on consultant
(preferably gloved!), I would urge colleagues to be prepared for such eventualities by taking
note of our final two reviews.

I am pleased to report that my continued pleas for submissions has resulted in more than
a trickle of case reports, which has enabled us to publish two Cases to remember in this
edition. More on a similar theme would be most welcome. Mike Jones, originally brought
into the editorial board for his renal expertise, wears his hat as Secretary of the SAC in
General Internal Medicine to give an insight into Training developments in Acute
Medicine in Viewpoint. Submissions for this section would again be welcomed.

I hope you enjoy this edition, and that you continue to find the journal helpful in your
everyday practice and personal CPD into the New Year.