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?

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

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.

Pediatric Airway: Crash Review

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.

 

 

Advanced Trauma Life Support (ATLS) 10th Edition: Stemming the Hemorrhage of Misinformation

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)

 

 

 

 

MARCH Home Knowledge on Blast Injuries

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.

What’s the Buzz About Honey?

Manuka honey (Wikipedia)

The May edition of Emergency Medical Reviews and Perspectives (EM:RAP), your CME sponsor for the Continuing Medical Education on Stick (CMES) Project, has an article on the use of honey in the emergency department or outpatient clinic. The commonly known medical uses for honey include cough suppression and skin wound antibacterial agent. Other uses that can be life saving are cited in the article titled, Honey for Everything by Ilene Claudius MD and Sol Behar MD. Buzz on over to your thumb drive or CMES-Pi and take a listen or read. It’ll sweeten your day.

 

Five-petaled white flowers and round buds on twigs bearing short spiky leaves. A dark bee is in the centre of one of the flowers.

Manuka bloom (Wikipedia)

Who Knew? The antibacterial effects of honey vary widely depending on the type and production location as cited by Willix et al. of the University of Waikato in New Zealand. Manuka honey found in New Zealand is reported to have high antibacterial activity.

 

Congestive Heart Failure: Bring on the Leeches?

Wikimedia photo.

The April edition of Right on Prime covers everything you need to know about congestive heart failure from the definition to palliative care, including advice on therapeutic phlebotomy. No matter where you practice you will find breath-taking take home points. Take a listen or read: The Generalist: Acute and End Stage CHF in the ED by Vanessa Cardy MD, Mel Herbert MD, and Heidi James MD in the April edition of Right on Prime available to all CMES participants using either the CMES thumb drive or Pi.

Leech application tubes and blood letting tool, probably from 1800s. Photo from Wikimedia.

Who Knew? Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, now called therapeutic phlebotomy, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily fluids were regarded as “humours” that had to remain in proper balance to maintain health. It is claimed to have been the most common medical practice performed by surgeons from antiquity until the late 19th century, a span of almost 2,000 years. (article content from Wikipedia)

C3: Psychiatric Emergencies Part 2

Wikimedia image.

Last week I introduced you to C3, Continuous Core Content, the newest medical education available to all CMES and CMES-Pi participants. The March C3 content is part two of psychiatric emergencies covering depression, anxiety and eating disorders. You can access the C3 folder with the thumb drive or the smartphone apps using the CMES-Pi.

Do you know what endocrine disorder can mimic depression or that pulmonary emboli can present with a common and misleading psychiatric complaint? A quick read of the Take Home Points will lift your spirits and lessen your anxiety when faced with a psychiatric emergency.

Who Knew? Psychiatric illness were recognized over 4000 years ago In the second millennium B.C. in Mesopotamia where there are written accounts of depression. It was thought to be a spiritual condition and therefor treated by priests instead of healers.

Aneurysms: It’ll Blow Your Mind

Abdominal aorta MRI. (Wikimedia)

Practicing in rural and remote regions globally with limited staff and resources poses challenges not faced by your colleagues in larger cities and academic centers. Case presentations from those working in rural regions help us understand the restrictions, challenges, and downright genius solutions from treating to to saving a life. I find these stories uplifting, invigorating, and deserving of a standing ovation.

Take a listen or read about The Case of the Man with the Aneurysm by Vanessa Cardy MD and Mel Herbert MD in the EM:RAP April files. It’ll expand your knowledge.

 

Who Knew?

On 17 April 1955, Einstein experienced a ruptured abdominal aortic aneurysm, which had previously been reinforced surgically by a surgeon in 1948. He took the draft of a speech he was preparing for a television appearance commemorating the State of Israel’s seventh anniversary with him to the hospital, but he did not live long enough to complete it. Einstein refused surgery, saying, “I want to go when I want. It is tasteless to prolong life artificially. I have done my share; it is time to go. I will do it elegantly.” He died early the next morning at the age of 76, having continued to work until near the end. (Wikipedia)

 

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