I have learnt over the past 2 years, that expecting divine intervention would be analogous to a thirsty man hoping a river miraculously sprang beneath his feet. Hoping other around also start seeing things the same way soon.
In the end, the Africa we voluntourists photograph isn’t a real place at all. It is an imaginary geography whose landscapes are forged by colonialism, as well as a good deal of narcissism. I hope my fellow students think critically about what they are doing and why before they sign up for a short-term global volunteer experience. And if they do go, it is my hope that they might think with some degree of narrative humility about how to de-center themselves from the Western savior narrative. Most importantly, I hope they leave their iphones at home.
An honest look at the not so altruistic reasons people volunteer for disasters.
Maybe we need to put up strict agreements that prevent these things when people agree to help?
I’m currently writing up a short presentation about how the ARISE Study and PROMISE Trials have affected our care of septic patients in the emergency department. Understanding sepsis requires a good understanding of the definitions, and sometimes these definitions have a way of escaping us during day to day practice. So I thought I’d put it up here as well, for the benefit of those, who like me, have the memory span of a gnat.
SIRS (systemic inflammatory response syndrome) is defined as having 2 or more of the following:
1. Temperature >38 C or <36 C
2. Pulse Rate >90/min
3. Respiratory Rate >20/min or PaCO2 <32 mmHg
4. White Cell Count >12 or >10% immature band forms
Sepsis is SIRS (systemic inflammatory response syndrome) with confirmed or presumed infections
Severe Sepsis is sepsis with organ dysfunction
Septic shock is defined as sepsis with refractory hypotension
1. Hypotension is defined as SBP <90 or MAP <70
2. Refractory means that hypotension persists after 30 mL/kg crystalloid
3. Vasopressor dependence after adequate volume resuscitation
Surviving Sepsis 2012 consists of 2 bundles of care, the first being completed within 3 hours and the second within 6 hours.
Before 3 hours bundle:
1. Measure lactate level
2. Obtain blood cultures prior to administration of antibiotics
3. Administer broad spectrum antibiotics
4. Administer 30 ml/kg crystalloid for hypotension or lactate ≥4mmol/L
Before 6 hours bundle:
1. Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) ≥65 mm Hg
2. In the event of persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate ≥4 mmol/L (36 mg/dL):
3. Measure central venous pressure (CVP)
4. Measure central venous oxygen saturation (ScvO2)
5. Remeasure lactate if initial lactate was elevated
The lung point is an ultrasound finding in cases of pneumothorax, where there is the fleeting appearance of a lung pattern (evidence of lung sliding) which is replaced by a pneumothorax pattern (absent lung sliding and exclusive horizontal lines) in a specific location of the chest wall. Essentially this the transition point between normal lung and air. It has an overall sensitivity of 66 % and a specificity of 100%, making this finding diagnostic if seen.
The current Clinical Practice Guidelines by the American Academy of Pediatrics (AAP) has been rather consistent that care providers should let bronchiolitis run its course, unless the child is showing signs of respiratory distress, diminished alertness or poor feeding. This slider is a summary of the guidelines that I think are important in bronchiolitis management in the Emergency Department.
Note: ‘Mousing’ over the image stops the scrolling.
Reference : Ralston, Shawn L., et al. “Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis.” Pediatrics (2014): peds-2014. http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2014-2742.abstract
After many, many years of arguing and lodging disputes with various domain registration companies, and thanks to some folks at the big boys, I finally have control of my one and only, single word top level domain. Yes that was a really narrow category and a really long sentence. I know it’s only a .org, but I’m thrilled that it’s finally back in my possession. It will automatically forward back to this site from now on until i figure out how best to use it. Such a wonderful day.
I 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.
I have 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.