Handwashing station. (Photo from Wikimedia Commons)
There are no disputes washing hands after patient contact with human excretions or blood is necessary. But what about everyday habits such as wearing a white coat or tie? Do you clean your stethoscope? Do these common articles act as fomites for infection?
The EM:RAP podcast and PDF for October 2019: Handwashing by Dan McCollum MD discusses pearls for handwashing, common misperceptions and the concept of a habit loop. Which is better chlorhexidine or betadine? Alcohol foam/rinse or soap and water? Long or short-sleeved clothing? Take a quick listen or read to ramp up your germ-busting habits.
Who Knew? Ignaz Semmelweis was a Hungarian physician and scientist who advocated antiseptic procedures in the mid-1800s. His concept of physicians washing their hands as a way to reduce the spread of infection from cadavers conflicted with the established medical society. He was committed to an asylum by a colleague, beaten by the guards and died two weeks later as a result of a gangrenous wound at the age of 47. It would be two decades later when Louis Pasteur confirmed the germ theory that Semmelweis’s theory was widely accepted.
Ketamine model (WikiMedia)
One of my favorite conference speakers has always been Dr. Al Sacchetti from Camden, NJ, USA. He is passionate about Emergency Medicine and understands his patients. So when Dr. Sacchetti goes on a rant…I sit up and listen.
Who doesn’t love ketamine? It’s cheap and available worldwide. Use it for pediatric sedation, status epilepticus, and anesthesia. It can be administered intranasally, intramuscularly and intravenously.
But can it safely be used for agitated delirium? Listen to the October 2019 podcast or read the PDF: Rants from the Community: Ketamine by Al Sacchetti MD. It’s sure to calm your agitation when faced with a delirious patient.
Who Knew? Ketamine is a drug of abuse. When the drug is diverted for recreational use, the original pharmaceutical form is often abandoned. The most popular method is snorting ketamine powder. The powder is prepared by evaporation of the original solution or ketamine solution may be transferred to a vaporizer to be administered intranasally. As with all illegally sold drugs the concentration and presence of adulterants are mostly unknown and therefore represents a public health risk.
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.