Still Doing It Wrong – Personal Protective Equipment Indecision 2014

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ppeposter1322I have given up on how many times the CDC has changed its guidance on Personal Protective Equipment for the EBOLA outbreak. I’m not going to bother explaining it because there is a really useful chart that explains it all.  Click on the chart to get a larger view. Some key points to note would be that no skin should be exposed and all health care providers are to be be double gloved.  After handling patient of bodily fluids, first glove needs to be wiped with disinfectant. It is then removed and the second glove wiped down. Then rest is as in the chart.

It also turns out that ‘doffing’ is actually a word.

The updated CDC guidance is located here.

Deliberate Small Moves

I TRAUMACHARGE3D1have been very deliberate about going slow with this blog. For the time being it will be part of my personal site. I haven’t decided fully what it will become, but i’m getting close to completing a draft plan. I was concerned about having the authenticity and the gravitas to do something like this, but I figured that as long as I write about things I’m comfortable preaching, then it should be alright. Incidentally, I was asked by a small Emergency Medicine blog to write for them. That was the fastest ‘no’ I have ever said. If it isn’t going to be my vehicle to my destination, I am going to say no. New policy ? Yes and  its already bearing fruit.

Cat Burglar!

This little Bengal has been robbing the cat food bowl for the past year. Finally had the time to catch him on video. This is why the cat food bill is so high!

EBOLA Update: Is Witholding Care Even Acceptable ?


A horrible situation for patients. Withholding care when care is requested is a crime, especially when necessary safety precautions can be taken. Not doing it because of fear is tantamount to medical negligence.

Some U.S. hospitals weigh withholding care to Ebola patients (REUTERS)
The Ebola crisis is forcing the American healthcare system to consider the previously unthinkable: withholding some medical interventions because they are too dangerous to doctors and nurses and unlikely to help a patient.


EBOLA Update: United States Requiring Travellers from Affected States to Register Details


The U.S. has put in place plans for travellers to have their details recorded upon arrival on U.S. soil. This still falls short of temporary border controls, a hot button issue for the President.

U.S. Plans 21-Day Watch of Travelers From Ebola-Hit Nations (NY Times)
The new federal rules take effect next Monday. All travelers who have visited Guinea, Liberia or Sierra Leone will be required to provide home and email addresses, telephone numbers and other contact details for themselves and at least one friend or relative.


Donate to Médecins Sans Frontières


msf-names_finalAll of the World Health Organisations (WHO) fundings and goals are tied into what member countries think is the best use of the limited funds, and into programmes that will bear the greatest outcome. Non profits like Doctors without Borders however are already working on the ground and saving lives. If you have the time, and some cash – donate to them instead. These guys are doing some amazing work on the ground and in the process risking their lives. Do give a little, because a little goes a long way in developing nations in West Africa. Click on the image on the left to go to the donate page.

Worsening Ebola Crisis in Sierra Leone


To be honest, the Ebola crisis in Western Africa looks far from over. The WHO declaring Nigeria a success story seems like a premature celebration. This disease is ravaging the western front on the continent and its spread is far from being controlled. We need to do more. Our reluctance to help those desperate for medical aide in Africa will hurt everyone as Ebola spreads unchecked.


Small Victories and Negativity

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Today there was a trivial victory in the morning. It was almost instantly followed by negativity from the usual lot. I laughed a little, and the day went off as planned. The big mistake I was making was faking the niceness and well meaning nature when dealing with the negativity. Then I happened to come across this quote and it has changed my perspective forever. Now I laugh and do whatever it takes to make myself happy. Do I forget those who put me down? Of course not. Do I wish them well? Of course not. It would be surely foolish of me to wish well of people who do not do the same for me. Good will is the fuel of the soul, it has to be put to use or all you have is an inefficient machine, generating wasteful heat.


nice ahf feat

Playing NICE with the Acute Heart Failure Guidance

These are the current NICE guidance for patients presenting with Acute Heart Failure(AHF). The problem with these guidelines is the definition of AHF. No mention of whether AHF is the same as ADHF (decompensated) but I’m guessing they are commenting on patients who present early with mild symptoms of heart failure. But for arguments sake, because Emergency Physicians are hammers and this looks like a nice enough nail, I thought I’d dress up as hammer and discuss this.

Diuretics as the main stay again?Then there is also the negative wording with regards to nitrates and NIV.

Haven’t we been through this already?

Patients with AHF are symptomatic because of pulmonary and or systemic congestion and end organ dysfunction from decreased cardiac output.

Furosemide will reduce preload via diuresis, but most of these patients are already clinically dry. Besides the fact that you need to have a functioning kidney to ultrafiltrate out the fluid, loop diuretics have a long duration of action (i.e. 2hours and longer), it is not an easily titratable drug as compared to nitrates. It is hard to ignore the continuous fear of hypokalemia and its complications from high dose loop diuretics.

NIV with PEEP saves lives. The data is there. This should not even come up in 2014.

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