Concise Care Bundles In Acute Medicine.

The Queen Elizabeth Hospital in King's Lynn, Norfolk is a 488 bed hospital providing services to approximately 331,000 people across 750 square miles. In 2012 a need was recognised for documentation (pathways) in a practical format to increase usage of national guidelines and facilitate adherence to best practice (gold standards of care) that could be easily version controlled, auditable and provide support in clinical decision-making by junior doctors. BMJ Action Sets[1] fulfilled the brief with expert knowledge, version control and support, though they were deemed too lengthy and unworkable in fast paced settings like the medical assessment unit; they formed the base creation of concise care bundles (CCB).

Problem based review: the pregnant woman presenting to the AMU with palpitations.

Pregnant patients commonly present to the acute medical team with symptoms requiring further investigation. Palpitations are a common reason for presentation on the acute medical take, and most acute physicians will be familiar with the process of investigation. The combination of pregnancy and palpitations raises a broad differential diagnosis and can complicate the management pathway.

Post tracheal extubation stridor.

The authors report an unusual case of post extubation stridor resulting in insertion of a tracheostomy. Regional anaesthesia using interscalene nerve blockade in the presence of an unrecognised contralateral recurrent laryngeal nerve palsy resulted in bilateral recurrent laryngeal nerve palsies. The authors discuss the differential causes of stridor and recurrent laryngeal nerve palsy, their importance and way of identification on preoperative assessment.

A difficult diagnosis - constrictive pericarditis and its treatment: a case report.

The diagnosis of constrictive pericarditis requires a high degree of clinical suspicion, for the signs and symptoms of this disease can be falsely attributed to other causes. Herein, we present a case of a 70-year old retired farmer whose symptoms of right heart failure were initially attributed to co-existing pneumonia and pulmonary embolism. He was discharged.

H pylori-induced thrombocytopenia in a Caucasian female: a case report.

We present a rare, but increasingly recognised, cause of thrombocytopenia in a 69-year-old Caucasian female. Complete haematological investigation, including blood films and autoantibody screen, did not reveal a cause for her thrombocytopenia. Omission of potentially offending medication did not improve the low platelet count.