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    Giant Cell Arteritis

    I’m looking at cases to post and found one that could be me…because I’m over 60. Here’s the lowdown: over 60 years old with sudden vision loss? over 60 years

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    Rural Medicine: Diabetic Ketoacidosis

    Once a month I will comment on the Rural Medicine podcast from EM:RAP. It’s exciting to read CME that can be applied globally no matter where you live or what

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  • Testicular Torsion – A Convoluted Case

    The 14-year-old male patient complained of right lower quadrant pain which varied in intensity for 1 day. He denied nausea, vomiting or fever. The abdominal exam revealed bowel sounds and

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  • Thumbs Up Nigeria

    Meet Dr. Dare Ogunlusi from Ekiti State University Teaching Hospital in Nigeria. He is an attending in the Department of Accident and Emergency. He is the newest recipient and participant in

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  • Time to Charge Your Battery…

    With a jolt of information on button battery ingestions by pediatrician Ilene Claudius. The November 2017 EM:RAP edition has a podcast sure to shock you. From one end of the

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Advanced Trauma Life Support (ATLS) 10th Edition: Stemming the Hemorrhage of Misinformation

ATLS was a mandatory course during my emergency medicine training with recertification every few years. One of the greatest benefits was recognizing the need to asign a leader and develop a systematic approach to the trauma patient. There is always controvrsy surrounding proptocols and recommendations but the 10th edition is based on decades of trauma experience.

One of the new changes in the shock and circulation section is an emphasis on tourniquets, packing and the application of pressure; some very basic methods that can quickly control hemorrhage. Where do you focus your attention first? Airway? Hemorrhage control?

Wherever you practice and no matter the resources available you will find something in this podcast to strengthen your skills. Take a listen to the September 2019 EM:RAP podcast or read the PDF called: Trauma Surgeons Gone Wild: ATLS 10th edition update by Stuart Swadron MD, Kenji Inaba MD, and Billy Mallon MD.

 

Morell Wellcome tourniquets. (courtesy WikiMedia Commons)

Who Knew? The first recorded efforts to prevent arterial bleeding has been ascribed to Sushruta, the father of surgical art and science, in 600 B.C At that time, he pressed the arteries with pieces of leather that he made himself and it is said that he had used a device in which we now call the tourniquet. (NCBI)

 

 

 

 

Knowledge Translation

 

On September 2, 2019, Dr. Manoj Thomas, President of TWB, and Dr. Vera Sistenich, an Emergency Medicine physician with HandUp Congo, spoke to the Sydney Development Circle about “Knowledge Translation” (KT). The World Health Organization defines KT as: “the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health”.

TWB works in the nonprofit sector under the scope of KT via our Continuing Medical Education on Stick (CMES) Project. It provides health practitioners in remote regions access to up-to-date CME using novel delivery methods, which do not depend on fragile infrastructure. This is assumed to translate into improved clinical practices, self-esteem, and patient outcomes.

However what is the price paid for any intervention when for every action there is a reaction. Dr. Manoj explains, “Given that we have technologies to assist with learning, the real question is about Knowledge Translation and ethical dilemmas around it. However, in reality, there are three barriers: political, cultural/social, and financial constraints.”

In the case of the CMES Project, introducing a product which doesn’t depend on local infrastructure points to the governments deficiencies in providing basic services such as electricity and Internet; a cultural consideration in the DRC is that junior doctors taught a specific medical or surgical technique by the senior doctors are unlikely to contradict their superiors and therefore the introduction of up-to-date CME which challenges long-held beliefs can cause staff internal conflict; and a health practitioner may want to use a product but doesn’t have finances for a smartphone or access to a computer.

We strive to recognize the pros and cons of each CMES Project we launch by working with; local practitioners to identify needs and challenges; local partners engaged in similar work; and local Ministries of Health.
What disruptive consequences have you experienced through your knowledge sharing? What was the relevant ethical issue? Share your story in the comments and help us all understand and work better.

 

 

 

Congratulations Ruxandra Zait, TWB IT Volunteer

Ruxandra was promoted at her state job to Senior IT Auditor after only one year of employment.
Ruxandra describes her job, “I am part of the Internal Audit Unit. It is only two of us that do IT-related audits. We check the systems that hold sensitive data to determine if adequate security controls are in place and if we are compliant with the applicable technical standards. We review everything from access management and data handling to systems and applications development including penetration testing and vulnerability scans. I get to work with people from all units and I truly love this.”


Despite her demanding job responsibilities, Ruxandra volunteers her skills and experience with TWB as the Conceptual Design Developer. Each month she processes and uploads dozens of EM:RAP MP3 and PDF files containing continuing medical education for 700+ doctors and nurses globally who use the Continuing Medical Education on Stick (CMES) and CMES-Pi content. Thank you, Ruxandra!

MARCH Home Knowledge on Blast Injuries

Ambroise Paré, on the battlefield using a ligature for the artery of an amputated leg of a soldier.(Photo Wikipedia)

Under the best of situations major trauma centers can be overwhelmed with dozens of seriously injured patients but for many CMES participants limited resources are an everyday reality. The August EM:RAP podcast titled, “Blast Injuries” by Anand Swaminathan MD and Josh Bucher MD will help you piece together triage and treatments for a mass casualty.

Tactical Combat Casualty Care (TCCC) uses the mnemonic MARCH for military battlefield medicine. 

 

 

  • Massive hemorrhage is managed through the use of tourniquets, hemostatic dressings, junctional devices, and pressure dressings.
  • Airway is managed by rapid and aggressive opening of the airway to include cricothyroidotomy for difficult airways.
  • Respirations and breathing is managed by the assessment for tension pneumothorax and aggressive use of needle decompression devices to relieve tension and improve breathing.
  • Circulation impairment is assessed and managed through the initiation of intravenous access followed up by administration of tranexamic acid (TXA) if indicated, and a fluid resuscitation challenge using the principles of hypotensive resuscitation. TCCC promotes the early and far forward use of blood and blood products if available over the use colloids and discourages the administration of crystalloids such as normal saline (sodium chloride).
  • Hypothermia prevention is an early and critical intervention to keep a traumatized casualty warm regardless of the operational environment.

A wounded knight is carried on a medieval stretcher. (Photo Wikipedia)

Who Knew? An early stretcher, possibly made of wicker over a frame, appears in a manuscript from c.1380.

Ambroise Pare (c. 1510-1590) is considered one of the fathers of surgery and modern forensic pathology and a pioneer in surgical techniques and battlefield medicine.

Itching to Understand Eczema

Photo from the website of Fondation Dermatite Atopique.

Eczema, also called Atopic Dermatitis affects 15-20% of children and 1-3% of adults worldwide according to a paper recommended by the National Center for Biotechnology Information (NCBI). The paper titled, “Worldwide variations in  the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood”, was originally published in J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):125-38.

Photo from Wikimedia.

This common recurrent or chronic inflammatory skin disease is characterized by dry skin with acute flare-ups of eczematous pruritic lesions. Vanessa Cardy MD, Adrien Selim MD and Heidi James MD offer bullet point clues to understanding, diagnosing and treating this disease which impacts not only our patients health but their psychosocial well being. Take a listen or read the August Right on Prime’s: The Generalist: Eczema.

 

Photo from Wikimedia.

Who Knew? The first dermatology textbook book, “De Morbis Cutaneis”, was written in 1572 by an Italian physician, Girolamo Mercurialis. Translated it means ““Of all skin diseases and waste treatment of the body.”

Flip the Social Media Switch

Glenda, Community Health nurse, Tena, Ecuador.

Social media metrics provides support when applying for grants and shows our partners and donors that the CME Project is successful. Help us flip the switch for equal continuing medical education opportunity globally for all health providers.

Techies Without Borders is on Facebook, LinkedIn, Twitter and Instagram. Connect and share to support our CMES Project which provides free continuing medical education to doctors and nurses in developing countries.

Facebook: https://www.facebook.com/techieswob/

LinkedIn: https://www.linkedin.com/company/34219833/admin/

Twitter: https://twitter.com/TechiesWB

Instagram: https://www.instagram.com/techieswithoutborders/

Blown Away

The EM:RAP July Introduction by Stuart Swadron MD and Jan Shoenberger MD talks about a case that will blow you away…pneumomediastinum presentation and causes. Can you answer these questions:

  1. Can pnuemomediastinum occur after forceful expiration?
  2. Can ECG findings be distorted due to the presence of subcutaneous air?

You will, once you listen to the MP3 file or read the PDF article.

 

Pneumomediastinum. Photo from Wikicommons.

More Slices of Pi for the Oceania Region

Dr. Manoj Thomas, TWB Co-founder and President, works at the University of Sydney Business School. He is in the perfect location to expand CMES and CMES-Pi in the Oceania Region this fall.
Presently the CMES Project is in Fiji, Solomon Islands, Tuvalu, Somoa, Tonga and Cook Islands. The doctors and nurses are sharing a limited number of thumb drives. More doctors and nurses working in these remote islands will receive thumb drives and the major hospitals will have CMES-Pi installed.

A Honey of an Idea


Meet Dr. Vera Sistenich, an Emergency Medicine physician from Sydney, Australia. Dr. Vera is the Project Leader for HandsUp Congo, an Australian nonprofit, “Building a Healthy Congo” Project. In collaboration with local partners and the Democratic Republic of Congo’s (DRC) government they are committed to bring Emergency Medicine training and integration to the DRC healthcare system. This is her story on one way she supports their goals.

“I started in 2015 when I lived in a seaside suburb here in Sydney called Coogee. As a child, I grew up in Hong Kong (my Mum is Chinese) but our family spent our summer holidays in Germany (my Dad is from Munich). We had a very rural home in a Bavarian suburb next to a forest. Our neighbour, an old man, used to keep his hives in the forest which I used to pass walking our little sausage dog daily. I was always fascinated, and we could see the old man at night through the window processing wax and honey. I thought to myself as a girl I’d love to keep bees one day. When I moved to Sydney and bought my own home for the first time, I came across The Urban Beehive, a business and movement promoting responsible beekeeping in the urban environment. The owners Doug Purdie and Vicky Brown are Australian beekeeping royalty now! I did a course with them and then started my own hive in the outdoor area of my ground floor unit in Coogee.

The weather here is so good that my one hive was producing around 100kg of honey a year. There are only so many birthday and Christmas presents you can make with all this honey! This volume would give around 300 jars a year, so I tried my hand at a little social enterprise, creating a label called “Coogee Bees for Congo” and selling each jar for AUD $15 and putting all the profit towards our Congo EM Project. There is a famous building in Coogee right by the beach called The Coogee Pavilion. It has a blue and white dome, which is what inspired the blue and white bee of my label, set within the contour of the landmass of the DRCongo. I changed the sting of the bee into a little heart, a reminder to myself of our duty to translate compassion into practice towards those in need everywhere. 

I now have 2 hives, producing about 200kg per year. I have raised over AUD $ 10,000 since the start of the project with the honey.

Beekeeping is very successful in the city. The Sydney Bee Club, of which I’m a committee member, has partnered with several universities here for research, providing dead bees and honey samples from our members from numerous suburbs. It turns out that the honey produced in cities is less contaminated with chemicals and pesticides than a lot of rural honeys and the flavours more complex due to the diversity plants and lack of monocultures in the urban setting. Heavy metals from the city environment are stored within the bodies of the bees themselves and secreted somewhat into the wax, but not into the honey. This came as a big and welcomed surprise to us all. Challenges, though, included minimising swarming in the urban environment so our hives don’t become a public nuisance, and adhering to rules and regulations regarding safety towards our neighbours. The practice is popular here and encouraged by our local counsellors. 

I don’t do any formal marketing as such. I work at two hospitals here in Sydney and just by word of mouth, colleagues, family and friends buy out the honey every time. I post on Facebook when I have a new batch and also on the HandUp Congo Facebook page. I also make candles from the wax as gifts.

In addition to raising funds for the EM project, one year, we chanced upon the only beekeeper training collective in the whole of the Congo whilst traveling to one of our teaching sites by road. From that, a completely separate Be A Honey Project was born – we have raised funds to bring these experts to the remote village of Lotumbe, where Lucy of HandUp Congo grew up, to train them in sustainable beekeeping, in particular to empower the Pygmy population there.”

What’s the Buzz About Honey?

Manuka honey (Wikipedia)

The May edition of Emergency Medical Reviews and Perspectives (EM:RAP), your CME sponsor for the Continuing Medical Education on Stick (CMES) Project, has an article on the use of honey in the emergency department or outpatient clinic. The commonly known medical uses for honey include cough suppression and skin wound antibacterial agent. Other uses that can be life saving are cited in the article titled, Honey for Everything by Ilene Claudius MD and Sol Behar MD. Buzz on over to your thumb drive or CMES-Pi and take a listen or read. It’ll sweeten your day.

 

Five-petaled white flowers and round buds on twigs bearing short spiky leaves. A dark bee is in the centre of one of the flowers.

Manuka bloom (Wikipedia)

Who Knew? The antibacterial effects of honey vary widely depending on the type and production location as cited by Willix et al. of the University of Waikato in New Zealand. Manuka honey found in New Zealand is reported to have high antibacterial activity.

 

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