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)

Introducing C3: Continuous Core Content

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.[7][8] In 1934, his company came to be called “Lego” derived from the Danish phrase leg godt [lɑjˀ ˈɡʌd], which means “play well”.” (Wikipedia)

 

 

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)

 

DevelopingEM: A Model for Emergency Medicine Collaboration

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.

Sepsis and Pregnancy

Pregnant graffiti in Lebanon (Wikimedia)

According to an excerpt from Randi Hutter Epstein’s book Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank, five hundred years ago a folk healer advised Catherine de Medici, then the queen of France, to drink mare’s urine and bathe in cow manure to increase her chances of getting pregnant. And she did it. Fortunately, you won’t need mare’s urine to treat pregnant patients with sepsis. But you will need to listen to the March EM:RAP podcast or read the PDF called Sepsis and Infections in Pregnancy by Stewart Swadron MD, Gillian Schmitz MD, Rachel Bridwell MD and Brandon Carius PA.

What are the most common infections seen in pregnancy in your region? Are vital signs good indicators during maternal and fetal resuscitation? If you don’t have much time there are five quick Take Home Points for a 30-second read.

Wikimedia photo.

Who Knew? Some of the earliest women’s health books were written by monks…although they would not be my first or even seventh guess as authors. One of the most popular monk guides, Women’s Secrets, or De Secretis Mulierum, has been translated from the original text into modern language by Helen Rodnite Lemay, a medieval scholar.

Giant Cell Arteritis

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[1]) of Greek mythology. (Wikipedia)

Somewhere Over the Rainbow

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.

 

 

Rural Medicine: Diabetic Ketoacidosis

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 Wisdom

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?

 

 

Stress & Burnout

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.

 

 

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