Early ECG machine. Photo from Wikipedia.
According to Medscape, an online medical information site: “a heart rate of more than 160 beats per minute in infants and a respiratory rate of more than 60 per minute are associated with an increased mortality risk and often signal the development of septic shock.”
The May EM:RAP Pediatric Pearls podcast by Dr. Ilene Claudius, Dr. Sol Behar, Dr. James Salway and Dr. Liza Kearl offers prudent advice on differentiating respiratory from cardiac sources of pediatric tachycardia. Or pull up the PDF and have a fast read of the bullet points to keep your rate in check and your knowledge bounding.
Who Knew? Willem Einthoven, working in Leiden, the Netherlands, used the string galvanometer (the first practical electrocardiograph) he invented in 1901 which was more sensitive than previous 1870s inventions. He assigned the letters P, Q, R, S, and T to the waveform deflections. (Wikipedia)
Who and what is EM:RAP? Emergency Medicine: Reviews and Perspectives (EM:RAP) is our sponsor and source of the continuing medical education (cme) materials brought to you by the Techies Without Borders (TWB) program called Continuing Medical Education on Stick (CMES) and CMES-Pi. Listen to a free podcast by Mel Herbert MD MBBS FAAEM as he discusses the future of EMRAP here.
As a participant in CMES or CMES-Pi we wanted you to appreciate this is a company that goes beyond the mission of excellent cme. It makes a commitment to helping you be the best you can and embracing colleagues worldwide. We at TWB gratefully acknowledge EM:RAPs forward vision and passion.
Banelino is a fair trade banana cooperative that partners with TGH to support local healthcare in the DR.
Dr. Yari Rodriguez in Mao, a coastal community on the Haitian border, and Dr. Miguel Garcia in Monti Christi, a northwestern urban city, in the Dominica Republic (DR) are the newest users of CMES-Pi. The doctors are local partners in healthcare with Timmy Global Health (TGH), an Indianapolis based nonprofit that provides access to healthcare through volunteers and empowering local health providers worldwide.
Dr. Manoj Thomas, from TWB, joined the TGH medical brigade in March. He assisted Anny, the local TGH Program Manager, on installation and how to use the Pi device including the smartphone apps for her DR staff.
Anny, TGH project director in the DR, is ready install the CMES-Pi unit.
CMES-Pi…so little providing so much cme.
The doctors in these clinics are providing care in austere rural settings. Accessing the EMRAP cme gives them a source of updated medical information to provide the best care possible for their patients.
Dr. Yari (on the right) in Mao meets CMES-Pi.
Dr. Miguel gets a lesson from Anny on the smartphone app.
Who Knew? The DR is the largest producer of organic bananas worldwide, representing more than 55% of the world’s organic banana production. The DR also makes one of the best rums in the world…banana daiquiri anyone?
Sarbu is the System Architect for Techies Without Borders and CMES. He is simply put…a genius.
“It is my pleasure to be a part of a team that works and communicates well together. I have had the pleasure of working with many teams on many projects over the years but, I can firmly and wholeheartedly say that I have never been so happy and proud to be a team member of a project like I am of the CMES team.
I love that the entire team shares the same work ethics, and no one is afraid of being challenged and everyone’s voice or opinion is listened and discussed to a great extent.
So, what do I do for the project? Well, the short answer to this question is, I am the developer. Needless to say, I don’t do it alone, the entire team is there right beside me on each and every step of the development (mostly virtually as we live in different cities or countries).
Since I joined the project in January of 2016, I have never had a dull moment and with every growing member of the team and the changes in project scope and the products being developed have been getting better and better.
I could continue writing for days but no one wants to read an essay, but I still want to say, thank you Dr. Li, Dr. Thomas and Dr. Stoner for giving me this opportunity and making me a part of a team that is doing something to benefit the world and society we live in.”
Meet Ruxandra, Team CMES.
Ruxandra summed up her CMES experiences by declaring, “When it comes to CMES work, we suffer together when something goes wrong and we share the happiness when the apps are finally up and running.”
Ruxandra describes her contribution to CMES. “To summarize what I usually do for the project, I will say that I do all the tedious work both for English and Spanish versions. More specifically, I update the training materials and upload the CME content on a monthly basis. Even though managing the database through our admin panel should not be very complicated, I never had a dull moment since I joined this project. Either the scope of the project changed, the data files type changed or other constraints occurred. I had to be flexible and work closely with our wonderful developers to address all these issues. Lastly, I tend to be the troublemaker, and this makes me to be maybe the most “hated” person in the group. Due to the nature of my job (IT Auditor), once I start analyzing and testing the applications for errors, I always manage to identify something else that needs to be fixed. Therefore, one of my duties is to escalate these issues to our hard-working developers. After I usually ruin their weekend or their vacation, I get to verify all the bug fixes and only after that I happily return to test the application from a user perspective.”
“In conclusion, when I don’t focus on the content management, the research aspect of the project or the blog maintenance, I love to get involved with the super-technical issues the team confronts. Finally, I love spending time with the CMES team and learn from them as much as I can. This is because I have the ultimate advantage to be the youngest and nevertheless the luckiest for being surrounded by so many smart and wonderful people.”
1800s cartoon. WikiCommons.
1800s ear trumpet. WikiCommons.
Infection is the leading cause of tympanic membrane perforation (TMP). As practitioners decrease the use of antibiotics for acute OM, the question arises…will there be an increase in TMP?
Take a few minutes to read the bullet points or listen to the March EMRAP podcast: Perforated Eardrum by Rob Orman MD and Clay Finley MD. How would you answer these questions?
- Can you use Cortisporin (neomycin and polymyxin B sulfates and hydrocortisone otic solution) in suspected TMP?
- What percent of TMP heal spontaneously?
- How to treat otorrhea in a patient with tympanostomy tubes?
Who Knew: At the end of the 18th century, eardrum perforation was indiscriminately performed by untrained “physicians” in England, France, and Germany. Because of the negative results of indiscriminate eardrum perforation, the operation soon acquired a bad reputation and was not performed for decades until Herrmann Schwartze reintroduced paracentesis into the daily practice of otorhinolaryngology.
Kunde Hospital. Photo from WikiCommons.
Kunde Hospital staff. Photo courtesy of Dr. Kami.
Last year a CMES-Pi
device was installed in the remote Khumbu Region in northeast Nepal. Dr. Mingma and Dr. Kami have been avid users. Dr. Manoj followed up this month with the Kunde Hospital team and here is what Dr. Kami had to say:
“Thank you so much again for the CMES-Pi, I can now download on my Apple iPad. Great information and it has been very useful for us at Khunde. Thank you.”
Kunde is a good example of a remote location benefiting from up-to-date cme. Situated 3800 meters above sea level, it was founded by Sir Edmund Hillary in 1966. Now funded by the Sir Edmund Hillary Foundation of Canada
(SEHF) it serves 8000 local people and trekkers.
Historically cme is not a new concept. From the start of institutionalized medical education practitioners used grand rounds, case discussions and meetings to discuss published papers and share knowledge. However bias was a leading concern when the pharmaceutical companies began funding cme in the 1950s.
WikiMedia Commons photograph.
If you look at the statistics in the USA most myocardial infarction patients survive with a 3-6% mortality rate, but the ST-Segment Elevation Myocardial Infarction (STEMI) and cardiogenic shock patients have an uphill battle no matter where they present. Dr. Greg Adaka offers 5 bullet points, less than a minute to read, on the February EMRAP pdf called: Cardiogenic Shock in Acute MI. Thumb drives up…take less than a minute to refresh your hearty knowledge base.
Who Knew: Myocardial Infarction, according to the WHO, is second only to lower respiratory infections as the leading cause of death in lower income countries. Worldwide, more than 3 million people have STEMIs and 4 million have NSTEMIs a year. Courtesy: Wikipedia.
“Stayin’ Alive” is a disco song written and performed by the Bee Gees in 1977…anyone still have their mirror ball?
Meet Jack, a Web Application Developer for Techies Without Borders.
“At first, it’s my graduate classmate joined this team and asked me to join and work with her in May of 2016, even though she left the team because of private reason, I am happy that I am one of the members of the project.
It’s also my first opportunity to work in this kind of project for helping people in resources poor area in other countries. All of us in the team have been working and cooperating hard in what we are responsible, and we also had
meetings many times even some of us is in different time zone.
I also want to say thank to Dr. Li and Dr. Thomas. You really did very well in leading us and gave us many suggestions on the problems I faced and continued to let me work with you even I’ve come back to Taiwan.
Finally, I hope this project can help as many people in world as possible.”
“I am mainly responsible for building Continuing Medical Education on Stick (CMES
) admin panel for the team to create and edit topics. In the beginning, the features were simple and had many things to be improved; by our hard work and cooperations little by little, the panel was upgraded to V2 version and the Spanish version is also now supported.
I am really happy to see this good result for CMES project.”
Over the next few months, I will post about the creative and dedicated Techies Without Borders (TWB) IT team that makes CMES and CMES-Pi possible. They donate their talent and time because they believe in you and the CMES mission: providing current cme for doctors and nurses in resource-challenged countries with our partner Emergency Medicine Reviews and Perspectives (EMRAP).
Meet Ben Yu, Web Application Developer. During March TWB partnered with Timmy Global Health to provide CMES and CMES-Pi to their partner clinics in the Dominican Republic and Guatemala. This required creating a Spanish version of all our products. Ben had this to say:
“We did all the translation preparing the USB version and packing the exe, for the CMES-Pi as well. We also regularly updating the Spanish version to make sure that everything is on point and working. At last, we did a few backend changes to make user’s usability more fluid.”