Standard Oxygen Therapy Ignites Controversy

Does oxygen therapy make a difference in heart attack patients?The European Society of Cardiology, news release, Aug. 28, 2017 cited this Swedish study which found no difference in patient outcomes.

EM:RAP has up-to-date information about using oxygen therapy in the acute setting. So hold your breath and check out these podcasts:

Paper Chase 2: The Oxygen Middle Path by Sanjay Arora MD and Michael Menchine MD

Introduction: Flush Rate Oxygenation by Rob Orman MD and Anand Swaminathan MD

Did you know?  Oxygen was discovered independently by Carl Wilhelm Scheele, in Uppsala, Sweden in 1773 or earlier, and Joseph Priestley in Wiltshire, England in 1774, but Priestley is often given priority because his work was published first. Priestly fled to America in 1793 to escape political persecution. The Joseph Priestley museum is in my hometown Northumberland, Pennsylvania USA…I’ve never been there.

 

 

Fishing for Anaphylaxis Treatment

First up…a really bad pun to get your creative energy flowing: What was the cause of the tech-guru’s most recent seafood reaction?
A new shell-phone!

Log into CMES and scratch up the June 2017 EM:RAP podcast called The Case of the Funky Fish by Stuart Swadron MD and Billy Mallon MD for up-to-date information on the treatment of acute anaphylaxis.

Now challenge your colleagues with a similar case. Which drug do you reach for first? Is epinephrine given in the arm or thigh or doesn’t it matter? Do they use both H1 and H2 blockers and where is the evidence these work? Have steroids even been scientifically proven to help in acute allergic reactions?

The life of your patient may depend on your knowledge of these questions and how quickly you start treatment…hopefully faster than edema swells their airway shut.

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Mind the Migraines

A shift would not be complete without one headache patient. I would wager that is the same wherever you practice because I treated migraine headache patients from remote Himalayan villages to tropical islands in the Caribbean.

The worrisome causes of headaches such as pregnant + hypertension + headache; new onset after age 50; headache + fever, headache + altered mental status; abrupt onset headache; and headache + painful red eye to name a few should prompt investigation and immediate treatment.

But for the treatment of one of the most common types of headache, the migraine, check out the EM:RAP August Pharmacology Rounds: What Works for Acute Migraine? by Rob Orman MD and Bryan Hayes PharmD.

Migraines have been recorded in medical history for a long time, the first found documentation in the Ebers Papyrus written around 1500 BCE. For you language buffs the word migraine is derived from the Greek word hemikrania. This term was corrupted into hemigranea and the common word comes from the French translation, migraine.

EM:RAP – Super Suture Lectures

Last October 2016, I gave a suture lecture at Kathmandu Model Hospital, Grande International Hospital and both CIWEC hospitals in Kathmandu and Pokhara. Although doctors approach suturing in a myriad of ways based on education, preference, and experience, the one thing we agreed on was…reviewing the basics and yearly updates are helpful.

CMES participants can download the excellent suture lecture from the March and April 2017 EM:RAP archives. Share your knowledge and learn from your colleagues by giving a lecture at your institution on wound repair.

March:

Wound Repair Part 1 – Wound Prep

Brian Lin, MD and Zach Shinar, MD
April:

Wound Repair Part 2 – Eversion and Simple Interrupted

Jonathan Kantor, MD, Zach Shinar, MD, and Brian Lin, MD

Congratulations Ruxandra!

Ruxandra graduated from Virginia Commonwealth University (VCU), Richmond, VA. USA in May 2017 with a Bachelor of Science in Information Systems. Ruxandra is the Conceptual Design Developer for CMES.Ruxandra distinguished herself at VCU as Student of the Year and did her poster presentation on CMES. Thank you, Ruxandra, for all your hard work and good luck with your future endeavors.

Congratulations CMES IT Graduates

Over the next few days, I will introduce you to the people who are working on the IT end bringing you the latest and greatest technology for easy access to your cme materials. Several graduated this year.

Special thanks to Sarbu Rana who designed the CMES logo, was the first student to join the CMES team and has devoted hours, days, weeks and months of his time to developing the website and delivery solutions. Officially he is the Senior Application Developer and Systems Architect for CMES.

Sarbu is second from left and received a Masters of Science in Information Technology from Claremont Graduate University, Claremont, CA. USA in May 2017.

Congratulations Sarbu.

 

CMES IT Team in Nepal

Dr. Manoj Thomas and Dr. Yan Li are in Kathmandu this week to install CMES-Pi technology around Nepal. Last weekend they visited Kunde Hospital in the Khumbu Region as their first pilot site.

In our ongoing efforts to improve the delivery of cme, we continue to improve the effectiveness of the technology solutions that we develop. We have developed a solution called CMES-Pi that will enable doctors to access cme content via their smartphone, laptop or another mobile device. Once CMES-Pi is implemented at a hospital or facility the doctors will be able to download and use an app (available for Android or iPhone) to access the CME content. CMES-Pi is a good complement to the thumb drives, and we believe you will find both solutions helpful. Read for yourself how easy it is to be the expert in your facility:

http://cmesworld.org/cmes_product-Pi.html

CMES – Beta

No small feat developing a product that will work in various countries with a plethora of unstable infrastructure. The first round of testing was in Kathmandu, Nepal in May 2016 when the IT team tested a pilot project and networked with potential participants. The team met with the Nepal Medical Council, Minister of Health, Dr. Mahabir Pun and Dr. Arjun Karki; a respected physician and innovator for Nepalese health. All of these individuals provided insight and guidance regarding the needs of the medical community.

Behind the scenes, Sarbu and the IT team continued to work diligently during the summer to get the server functioning and the first batch of thumb drives downloaded with the cme material. Our partner Emergency Medicine Reviews and Perspectives agreed to provide their cme content free of charge and continue to support CMES.

In October I traveled to Kathmandu to work at CIWEC Hospital and dispense the thumb drives to the participants at seven institutions;  Kunde Hospital in the Khumbu district, CIWEC Hospitals in Pokhara and Kathmandu, Grande International Hospital, Kirtipur Hospital, Kathmandu Model Hospital and Nick Simon Institute which serves 22 district hospitals.

 

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