Dr. Manoj Thomas visited Timmy Global Healths partner Asociacion Pop Wuj Clinic in Xela, Guatemala this past March. Asociacion Pop Wuj is a collectively owned, non-profit, Spanish language school that promotes community development through a variety of programs including a daycare center, construction of safe stoves, reforestation and ecological education, a student scholarship program, and a comprehensive health and nutrition program.
Working with Dr. Carmen and Dr. Herman he set up a CMES-Pi at the Xela clinic. The regular access to up-to-date continuing medical education content for the staff is welcomed as travel to conferences is difficult and costly for the organization.
We welcome Asociacion Pop Wuj and there impressive work in the community.
The Pop Wuj team with Dr. Manoj Thomas (on right).
The Pop Wuj team tries out the CMES-Pi connectivity.
Who’s next? (Wikimedia Commons)
Jessica Mason MD and Wendy Chan MD discuss the history and present methods of triage in the May EM:RAP podcast of Annals of Emergency Medicine: Emergency Severity Index.
How do you risk stratify in your emergency department? Do you use a three-step system of emergent, urgent or non-urgent? Or the five-step triage protocol with ESI 1 indicating a critical patient to an ESI 5 indicating nothing serious? Neither provide an ideal system, but what about front-end physician triage, split flow and vertical flow? Update your triage knowledge by listening to the podcast…it might make your day flow smoother.
Larreys Flying Ambulance (National Library of Medicine)
Who Knew? Baron Dominique Jean Larrey is credited with inventing triage during the Napoleonic Wars but did you know he invented the first ambulance? The horse-drawn “flying ambulances” could maneuver quickly across a battlefield delivering injured men to field hospitals.
Meet Dr. Dare Ogunlusi from Ekiti State University Teaching Hospital in Nigeria. He is an attending in the Department of Accident and Emergency.
He is the newest recipient and participant in CMES. Techies Without Borders (TWB) was referred to Dr. Dare by his friend and colleague Dr. Lisa Charles from Victoria Hospital in St. Lucia. TWB mailed a thumb drive to Dr. Dare after discussing the cme options that would best work for him. He will be testing the thumb drive and providing feedback on usability and content for his specific location.
CME development and utilization face challenges worldwide because resources are limited and infrastructure for the delivery of healthcare and information is fragile. Feedback from locations around the globe helps us improve our services and products. If you have colleagues who would be interested in either CMES or CMES-Pi, please contact Dr. Debra Stoner at: email@example.com
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)
(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.
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 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.
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)
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.
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?