This might be the perfect video to start my little writing spree.
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