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.
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)
Dr.Mereoni Voce from Labasa Hospital at the DevelopingEM Conference in Fiji.
DevelopingEM is a partner of Techies Without Borders. DevelopingEM is a nonprofit corporation from Australia with a model to promote and develop Emergency Medicine globally through collaboration. Last December Dr. Deb was invited to speak at their sixth conference in Fiji. Each conference is designed to deliver excellent emergency medicine and critical care content. Not only is the conference for practicing EM specialists but the model brings local health providers to the conference supported by the conference fees and contributions. They encourage global collaboration between countries where EM is developing and gaining momentum as a specialty.
DevelopingEM is heading to Cartagena, Colombia for their seventh Emergency Medicine and Critical Care conference. Consider joining them in March 2020 for a chance to support this forward-thinking team.
I’m looking at cases to post and found one that could be me…because I’m over 60. Here’s the lowdown: over 60 years old with sudden vision loss? over 60 years old with transient vision loss? over 60 years old with transient double vision? Think Giant Cell Arteritis and take a listen to the March EM:RAP podcast: Giant Cell Arteritis by Ilene Claudius MD and Edward Margolin MD.
Or take a quick look at the PDF and bring home the take home points…it’ll make you a giant in the know.
Who Knew? Tales of giants are found in many cultures. The word giant, first attested in 1297, was derived from the Gigantes (Greek: Γίγαντες) of Greek mythology. (Wikipedia)
Dorothy’s original ruby slippers (Wikicommons)
Neonatal stools are a source of concern for parents and color changes can trigger a visit to the emergency department or outpatient clinic. What colors raise your index of concern for serious pathologies such as necrotizing enterocolitis, malrotation with midgut volvulus or intussusception? Plug in your thumb drive or roll out your CMES app and take a listen to Jess Mason MD and Jason Woods MD as they discuss the EM:RAP podcast called Neonatal Stool Rainbow. You won’t find the Wizard of Oz but you’ll take home some knowledge…even without your ruby slippers.
Glucometer. Courtesy Wikicommons.
Once a month I will comment on the Rural Medicine podcast from EM:RAP. It’s exciting to read CME that can be applied globally no matter where you live or what resources you have at hand. Diabetic Ketoacidosis (DKA) In The Village by Vanessa Cardy MD and Stuart Swadron MD can be found in the February 2019 EM:RAP podcasts or take a quick read of the PDF for bullet points.
The question of the month? How do you manage DKA when you don’t have access to labs?
Urine dip strip. Courtesy Wikicommons.
And…is the urine ketone strip a good test?
Pediatric patients at mobile clinic, Tena, Ecuador.
Each month EM:RAP offers a podcast called Pediatric Pearls. Take a listen or read the January edition titled: Pediatric Gynecology Complaints by Ilene Claudius MD and Emily Willner MD. Neonates with blood in the diaper, difficult catheterizations, and how are vaginal exams different in children are a few of the useful topics covered.
Share your experiences and advice. How does your facility manage pediatric emergencies?
Your working at 5000 rpms as patient after patient after patient arrives at your Emergency Department for treatment. It’s a typical shift but this one never stops gaining momentum until you and the staff are at the breaking point. You think you can manage, but like any excellent racer…some days you can hit a wall, flame and die.
Take a listen or read the August 2018 EM:RAP podcast and PDF called; “Beating Burnout” by Annahieta Kalantari DO. It’s there for you to access using a CMES-Pi or the CMES thumb drives and it’s worth a listen. Even being retired, I was able to understand better why I felt the way I did and what happens to all of us as we deliver medical care.
Take care of yourself and your staff…it’s the only way to win the race.
Dr. Aloima is an Emergency Department Registrar at the Princess Margaret Hospital in Tuvalu. It is the only hospital in the country, and the primary provider of medical services for all the islands of Tuvalu.
She was a delegate at the DevelopingEM Conference held in Fiji in early December. As a regional delegate she networked with similar doctors struggling to introduce Emergency Medicine concepts and management into their Oceania countries.
Dr. Aloima trained on the CMES thumb drive and will share it’s content with her colleagues at the Princess Margaret Hospital. TWB plans to install a CMES-Pi at the hospital in 2019.
Who Knew? The food culture of Tuvalu is based on the coconut and the many species of fish found in the ocean and lagoons of the atolls. Desserts are made from coconut milk instead of animal milk. The traditional foods eaten in Tuvalu are pulaka, taro, bananas, and breadfruit. Food taken from the sea includes coconut crabs, fish and seabirds.
Airway Management is just that…managing the airway upside down and inside out. Take a quick read of the PDF or listen to EM:RAP’s November MP3 audio podcast called Strayerisms: Fluid Filled Airway. It’ll float your boat.
Correct ET tube placement, but if you tube the esophagus, leave the ET tube in place and use it as a landmark.
According to Dr. Reuben Strayer MD, the author, there are four ways to harm your patient during airway management: failure to oxygenate; failure to ventilate; worsening perfusion; and aspiration. His suggestions are doable no matter where you practice or what resources you lack…remember…your greatest resource is knowledge.
Who Knew? Probably the oldest recovered boat in the world, the Pesse canoe, found in the Netherlands, is a dugout made from the hollowed tree trunk of a Pinus sylvestris that was constructed somewhere between 8200 and 7600 BC. This canoe is exhibited in the Drents Museum in Assen, Netherlands. (Not looking too seaworthy these days.)
Napo River, Tena, Ecuador. Local means of travel for many doctors and nurses in the Amazon.
Tomorrow is Giving Tuesday…the kickoff to end-of-year and charitable giving.
If you have previously donated this year consider sharing this information via social media and spreading the word.