Gastric Lavage: Yes or No?

Antique gastric pump.
(Wikimedia Commons photo)

According to an EMRAP article, orogastric lavage was considered a standard procedure. It has never been proven to be of benefit. There are no recent studies. Although it was thought that removing the gastric contents might decrease the severity of the overdose, this is probably not the case. Why? Listen to the podcast or read the bullet points of the May 2018 article called “Pumping the Stomach” No More, by Anand Swaminathan MD and Sean Nordt MD, PharmD.

Do you still lavage for poison overdose? What substances? Leave a comment and share your knowledge.

Who Knew? Unlike many of our simpler medical and surgical instruments, mention of the stomach and duodenal tubes is not to be found in the classical writings of the ancient Greek and Arabian physicians…the somewhat uncertain origin of the stomach tube may be placed at about 144 years ago. Precursors of the stomach tube, however, were in common usage as early as the days of Imperial Rome. (Annals of Internal Medicine; The History of the Invention and Development of the Stomach and Duodenal Tubes by John R. Paine, MD)

 

 

 

Leeches: Friend or Foe

Leech
(WikiMedia Commons photos)

My experience with leeches is limited to a profound fear while hiking during the Nepal monsoon season where the rainforest leeches drop from the vegetation and make you their personal smorgasbord.

Have you ever used a leech medically to reduce swelling and vascular congestion? How do you remove leeches? How do you treat the wounds? Leave a comment and share your skills with us leech-less colleagues.

Who Knew? Leeches have 32 Brains. Their internal structure is divided into 32 segments. Each of these 32 segments has its own segment of the brain. Every leech also has two reproductive organs and 9 pairs of testes.

The Long & Short of Neck Injuries

Giraffe (WikiCommons photo)

Blunt neck trauma can be an airway nightmare. Listen to the podcast or catch the bullet points about workup and treatment from the May 2018 EMRAP article by Mel Herbert MD and Billy Mallon MD called Blunt Neck Trauma.

Who Knew? A giraffe’s neck is too short to reach the ground. It spreads its front legs or kneels to reach the ground for a drink of water.

 

Dr. Lisa Floats on a Wave of CME in St. Lucia

Dr. Lisa Charles, ED Director at Victoria Hospital, St. Lucia.

St. Lucia Pitons, World Heritage site. (Wikimedia)

Dr. Lisa Charles at Victoria Hospital in St. Lucia runs a tight ship on this Caribbean island. Emergency Medicine trained, she embraces continuing medical education (cme) as a means to keep her staff up-to-date. The staff at Victoria Hospital received thumb drives this past February and are putting them to good use. Several years ago she wrote a procedures manual for her ED staff at Victoria Hospital and is using the CMES articles to update her information.

Living on a small Caribbean island poses challenges for travel and access to cme credits which are mandatory for physicians in St. Lucia. She is permitted by the St. Lucian Medical Council to authorize articles as cme credits for her staff. She is also using CMES to provide some of the mandatory cme credit for her staff.

Who Knew? Together with Caribbean music genres such as Calypso, Soca, Dancehall, Reggae, Compas, Zouk, and Salsa, Saint Lucia has a strong country music tradition. In the 1950s the only radio stations heard in St. Lucia was from Texas, USA, where country music was popular. Even today you can hear George Jones, Patsy Cline and Johnny Cash’s voices drifting out of neighborhood bars.

 

Don’t Let Pediatric Tachycardia Get Your Heart Racing

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)

A Word…or Two…from Mel Herbert at EMRAP

Image result for emrap logo

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.

The Dominica Republic Gets a Piece of CMES-Pi

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?

 



Behind the Scenes: Meet Sarbu

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.”

Behind the Scenes: Meet Ruxandra

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.”

 

 

Back to Basics: Perforated Eardrum

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?

  1. Can you use Cortisporin (neomycin and polymyxin B sulfates and hydrocortisone otic solution) in suspected TMP?
  2. What percent of TMP heal spontaneously?
  3. 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.

 

 

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