Blood: the red liquid that circulates in the arteries and veins of humans carrying oxygen to and carbon dioxide from the tissues of the body.
Hemophilia: the ability of the blood to clot is severely reduced, causing severe bleeding from even a slight injury.
The prevalence of Hemophilia A varies by country, with a range of 5.4-14.5 cases per 100,000 males. (Medscape)
Do you know the three major forms of Hemophilia or the most common emergency department presentations? Take a listen or read EM:RAP’s October 2019 podcast: Hemophilia by Anand Swaminathan MD and Nilesh Patel MD to refresh your knowledge.
Who Knew? The first medical professional to describe the disease was Abulcasis. In the tenth century he described families whose males died of bleeding after only minor traumas.(Wikipedia)
Abinash Adhikari is from Nepal and is currently doing a Masters in Information Systems and Technology from Claremont Graduate Univesity, California. He completed his Bachelor’s degree in Computer Science from Waseda University, Tokyo and worked at Rakuten in Tokyo as a full-stack web application engineer during his early career.
Abinash has hands-on experience in building distributed systems using REST web APIs and managing web servers and IT infrastructure. He brings industry-standard expertise and knowledge in all aspects of web technologies like frontend, backend and server deployments to Techies Without Borders projects. He is highly self-motivated and always looking to hone new skills and take on new challenges. We welcome Abinash to the TWB IT team.
Who Knew? A full stack developer is a web developer or engineer who works with both the front and back ends of a website or application—meaning they can tackle projects that involve databases, building user-facing websites, or even work with clients during the planning phase of projects.
Dr. Aloima from Tuvalu Island.
Dr. Dare from Ekiti Teaching Hospital, Nigeria.
Dr. Carmen (2nd from left) from Xela, Guatemala.
Health providers such as Dr. Aloima, Dr. Carmen and, Dr. Dare in Nigeria depend on the CMES content for up-to-date monthly topics on Emergency Medicine, Primary Care, and Core Content.
Photo from Wikimedia.
Most of us are anxious about taking care of infants and children younger than 2 years old who need airway support. It’s intimidating and challenging to face a small airway when most of us face this critical situation only a few times a year. It’s imperative to stay current and review the procedure and medications regularly. The September EM:RAP C3 podcast on Pediatric Airways hits all the vital landmarks for troubleshooting and management. Expertly presented by Jessica Mason MD, Mel Herbert MD, and Stuart Swadron MD, you will take home points such as; Infants and children have a much smaller pulmonary reserve than adults; thus they desaturate much more quickly after preoxygenation. More empowering take-home points await you so take a listen and share the knowledge.
Photo from Wikimedia.
Who Knew: Dr. Crawford Long administered the first documented ether anesthetic to an 8-year-old boy for a toe amputation on July 3, 1842.
Dr. Christian, Santo Domingo Clinic, Ecuador
We are passionate about the Continuing Medical Education on Stick (CMES) Project which delivers cme to hundreds of medical practitioners globally. We couldn’t do this without the generous in-kind donation of the cme content from our sponsor, Emergency Medicine Reviews and Perspectives (EM:RAP). Mel Herbert, EM:RAP CEO, shared his philosophy in this article.
Thank you, Dr. Mel, for your foresight and wisdom.
Who Knew? “Europe’s formal medical education system started in the late Middle Ages, with the rise of the universities in what is now Northern Italy. From approximately ad 1100 until the mid-19th century, two tiers of medical practitioners existed: (1) academic doctors and (2) practically trained surgeons (which consisted of a motley collection of practitioners, including barber–surgeons, traveling practitioners, ship’s surgeons, tooth extractors, etc.).” Read the full article here.
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)
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.
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!
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.