Newborn Normal

Photo courtesy HandUp Congo.

What is normal and abnormal in a newborn? Stridor, periodic breathing, vomiting, eye discharge? Which of these merits investigation and treatment?

Using your thumb drive or CMES-Pi device take a listen or a quick read of the May 2020 EM:RAP podcast or pdf titled, Newborn Normal by Anand Swaminathan MD and Zach Drapkin MD.

 

 

Part of Great Ormond Street Hospital in London, United Kingdom, which was the first pediatric hospital in the English-speaking world. (Wikipedia)

Who Knew? Some of the oldest traces of pediatrics can be discovered in Ancient India where children’s doctors were called kumara bhrtya.[2] Sushruta Samhita an ayurvedic text, composed during the sixth century BC contains the text about pediatrics.[4] Another ayurvedic text from this period is Kashyapa Samhita.[5][6]

Culture Framework: Tight or Loose

COVID-19 tent at a Swedish hospital emergency entrance. (Wikimedia)

Shankar Vedamtam, NPR Hidden Brain host, interviewed Dr. Michele Gelfand, a psychologist at the University of Maryland about her framework of “tight” and “loose” cultures.

Tight cultures, she says, are more rules-oriented. Loose cultures are more permissive. “Countries like Japan, Singapore, Germany, and Austria tend to veer tight,” she says. “And countries like New Zealand, Brazil, the Netherlands, and Greece tended to veer loose. And of course, all countries have tight and loose elements.”
Her article “To Survive the Coronavirus, The United States Must Tighten Up”, published 3/15/2020 in the Boston Globe describes how the cultural norms of a culture directly impact the trajectory of the virus.

The empty Olympic stadium, Germany (Wikimedia).

How has your culture responded to coronavirus rules instituted to protect your country? Is it working?

Physical Therapy in Times of COVID-19

St. Lucia pediatric physical therapist, Elaine Clements, works remotely to continue therapy treatments for underserved children with disabilities. The island is under mandatory stay-at-home orders during the COVID-19 pandemic. Elaine provides video conferencing with parents and patients using doxy.me.
Elaine said, “We send parents a link and they join me from their home. They show me what they are working on and I am able to tweak what they are doing and add new activities. I’m also able to see the kids in the equipment they have at home which has been useful.”
Information and Communication Technology for Development bridges gaps. TWB gives a “3 Thumb Drive” salute to Elaine and the Child Development and Guidance Center in St. Lucia.

Covid-19 Information on CMES Server from WHO & EM:RAP

CMES participants…you will find EM:RAP Corependium chapter & WHO Covid-19 information for USB and Pi users on the TWB server. Topics range from Hand Sanitizer Formulation to Critical Preparedness. We will update frequently, so check back weekly.
A reminder from our partner in the DRC, HandUp Congo,
“A South African word, Ubuntu describes our recognition that we are all bound together in ways that can be invisible to the eye; that there is a oneness to humanity; that we fulfill ourselves by sharing ourselves and caring for those around us.” Stay well and thank you for being on the frontlines of healthcare.

Salesforce: Helping the Covid-19 Pandemic Crisis

Covid-19. Wikimedia photo.

Salesforce, a TWB sponsor, believes great missions deserve great technology. They have a mission to help nonprofits succeed. They help us build a platform by providing free services that powers team communications, outreach to donors, tracking participants, measuring impact, and tracking donations to name a few of the benefits.

Social and global accountability is also driving Salesforce to respond during the coronavirus pandemic not only to the needs of their employees but the world. To support the global response to this virus, Salesforce is donating $1 million to UCSF’s COVID-19 Response Fund and $500K to the CDC Foundation’s Emergency Response Fund, which is meeting rapidly evolving response needs around the world.

Techies Without Borders applauds Salesforce for their forward-thinking and global initiatives.

 

Cheap Tricks: Isopropyl alcohol inhalation

Treat nausea with a cheap alternative to oral, intramuscular or intravenous medications? Yes, you can. This article, “Inhaled isopropyl alcohol for nausea and vomiting in the emergency department“, by Adrienne J. Lindblad, ACPR PharmD noted 200 nonpregnant adults presenting to the ED found inhaled (smelling) isopropyl alcohol improved mild to moderate nausea and vomiting.

Have you tried this alternative and low-cost treatment? Sniff out the details. Take a listen or read the February EM:RAP’s Right on Prime Introduction titled: Alcohol Swabs for Treating Nausea by Heidi James MD and Vanessa Cardy MD.

 

Wikimedia.

Who Knew? “The term “rubbing alcohol” came into prominence in North America in the mid-1920s. The original rubbing alcohol was literally used as a liniment for massage; hence the name. This original rubbing alcohol was rather different from today’s precisely formulated surgical spirit; in some formulations, it was perfumed and included different additives, notably a higher concentration of methyl salicylate.” Wikipedia

January 2020 Right on Prime

Dr. Shankar Rai, Kirtipur Hospital, Nepal.

Right on Prime (ROP) is our continuing medical education content about primary care, urgent care, low-risk obstetrics, pediatrics, rural, remote and international medicine, and much more! ROP is available using your thumb drives or CMES-Pi and smartphone apps. In the January 2020 edition, you can listen or read topics such as Subclinical Hypothyroidism, Preterm Twins or Low-value Diagnostic Imaging Use in the Pediatric Emergency Department. The topics are presented by in-the-trench doctors working in rural and community hospitals. No matter your country of practice you can find a topic that hits your educational needs.

You can find the ROP cme content by choosing ROP from the list of options once you open the thumb drive or CMES-Pi program.

A special thank you to Emergency Medicine Reviews and Perspectives for donating the content free of charge and making it open source for the CMES Project participants.

Come Clean About Hand Washing

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.

An engraved portrait of Semmelweis: a mustachioed, balding man in formal attire, pictured from the chest up.

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 To The Rescue…Or Not

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.

Hemophilia: Stemming the Crimson Tide

Wikipedia

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)

 

 

 

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