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.
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.
Dr. Christian, Santo Domingo Clinic, Ecuador
We are passionate about the Continuing Medical Education on Stick (CMES) Project which delivers cme to hundreds of medical practitioners globally. We couldn’t do this without the generous in-kind donation of the cme content from our sponsor, Emergency Medicine Reviews and Perspectives (EM:RAP). Mel Herbert, EM:RAP CEO, shared his philosophy in this article.
Thank you, Dr. Mel, for your foresight and wisdom.
Who Knew? “Europe’s formal medical education system started in the late Middle Ages, with the rise of the universities in what is now Northern Italy. From approximately ad 1100 until the mid-19th century, two tiers of medical practitioners existed: (1) academic doctors and (2) practically trained surgeons (which consisted of a motley collection of practitioners, including barber–surgeons, traveling practitioners, ship’s surgeons, tooth extractors, etc.).” Read the full article here.
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)
On September 2, 2019, Dr. Manoj Thomas, President of TWB, and Dr. Vera Sistenich, an Emergency Medicine physician with HandUp Congo, spoke to the Sydney Development Circle about “Knowledge Translation” (KT). The World Health Organization defines KT as: “the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health”.
TWB works in the nonprofit sector under the scope of KT via our Continuing Medical Education on Stick (CMES) Project. It provides health practitioners in remote regions access to up-to-date CME using novel delivery methods, which do not depend on fragile infrastructure. This is assumed to translate into improved clinical practices, self-esteem, and patient outcomes.
However what is the price paid for any intervention when for every action there is a reaction. Dr. Manoj explains, “Given that we have technologies to assist with learning, the real question is about Knowledge Translation and ethical dilemmas around it. However, in reality, there are three barriers: political, cultural/social, and financial constraints.”
In the case of the CMES Project, introducing a product which doesn’t depend on local infrastructure points to the governments deficiencies in providing basic services such as electricity and Internet; a cultural consideration in the DRC is that junior doctors taught a specific medical or surgical technique by the senior doctors are unlikely to contradict their superiors and therefore the introduction of up-to-date CME which challenges long-held beliefs can cause staff internal conflict; and a health practitioner may want to use a product but doesn’t have finances for a smartphone or access to a computer.
We strive to recognize the pros and cons of each CMES Project we launch by working with; local practitioners to identify needs and challenges; local partners engaged in similar work; and local Ministries of Health.
What disruptive consequences have you experienced through your knowledge sharing? What was the relevant ethical issue? Share your story in the comments and help us all understand and work better.
Meet Dr. Vonetta George who works at Mount St. John’s Medical Center (MSJMC) in Antigua. Dr. Vonetta works in all critical care areas of the hospital including supervising the 15 doctors and 2 dozen+ nurses in the Emergency Department.
Antigua is located in the West Indies, a Leeward Island in the Caribbean. Mount St. John’s serves the population of Antigua and also Barbuda. Working on an isolated island directly affects the doctors and nurses ability to access current continuing medical education in a cost effective manner. Dr. Vonetta was the gail force hurricane behind getting the CMES-Pi Project installed in her hospital. MSJMC installed a CMES-Pi in June last year. Using our smart phone apps the staff can look up CME current practice topics at bedside. The CME is provided by our partner Emergency Medicine Reviews and Perspectives. The PDF files provide helpful bullet points and take seconds to read. The MP3 files are providing topics for weekly group CME conferences and discussions. The CMES-Pi Project directly impacts access to CME for 101 doctors and 179 nurses at the hospital. Thank you Dr. Vonetta!
Who Knew? The first inhabitants were the Siboney, who can be dated back to 2400 BCE. Arawaks settled subsequently, around the 1st century CE. The Caribs arrived later, but abandoned Antigua around the 16th century, due to the shortage of fresh water. Christopher Columbus sighted the larger island in 1493, and named it after a church in Seville, Santa Maria de la Antigua. (Commonwealth)
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)
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.
Photo from Wikimedia.
WooHoo…C3 is here for your listening and viewing pleasure! EM:RAP has generously provided Techies Without Borders their C3 content to add to our cloud based server. This CME content is available to participants using either the thumb drive (USB) or Raspberry-Pi access options. It will be in a separate folder and you can use the Search for specific topics.
C3 is a clinical based review on how to assess and treat common and grave Emergency Department and Urgent Care complaints. It’s ideal for all practitioners wanting to review the basics efficiently and quickly. Think of it as your basic Lego set.
The same great MP3 and PDF formats are available. The audio file contains a focused summary at the end of the talk, so if you are short on time you can fast forward. The PDF files start off with the all important Take Home Points for a quick update. You can also test your knowledge with the uploaded questions and answers.
Build up or reinforce your basic knowledge with C3. Thank you EM:RAP.
Who Knew? “The Lego Group began in the workshop of Ole Kirk Christiansen (1891–1958), a carpenter from Billund, Denmark, who began making wooden toys in 1932. In 1934, his company came to be called “Lego” derived from the Danish phrase leg godt [lɑjˀ ˈɡʌd], which means “play well”.” (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.