BLS
2018 AHA PALS Update – Nothing New
The optimal sequence of PALS interventions, including administration of antiarrhythmic drugs during resuscitation, and the preferred manner and timing of drug administration in relation to shock delivery are still not known. One
Top 10 Posts of 2017
Mistakes that Kill during Cardiopulmonary Resuscitation
- Too Slow or Too Fast Chest Compressions
- Too Shallow or Too Deep Chest Compressions
- Too Many or Too Slow Breaths
- Leaning on the Chest
- Too Many Interruptions
- Giving Up Too Soon
- Too Slow Adaptation
Oxygen Bubble Bottles or Bacteria Swimming Pools?
Humidified oxygen is widely administered in hospitals and EMS vehicles and this is presumed to alleviate nasal and oral discomfort in the non-intubated patient. Humidification of supplemental oxygen is commonly delivered by bubbling oxygen through either cold or warm sterile water before it reaches the patient. However, the effect on patient comfort is negligible. Bubble humidifiers may, however, represent an infection hazard and should not be used.
Anaesthesia, Trauma & Critical Care
WHO Emergency and Trauma Care e-Learning Training Course
A modular e-learning course that can easily be accessed by medical providers in an effort to improve emergency trauma care. Give it a try.
Guillain Barré Syndrome (GBS)
Surviving Sepsis Guidelines 2016: Recommendations and Best Practice Statements
Treatment of Helicobacter pylori Infection
2017 American Diabetes Association Standards of Medical Care in Diabetes
I am an Emergency Department doctor…I make mistakes
The Health Act 2017 – Emergency Care
Thank you for all the support in 2017. We look forward to providing you with even greater emergency care content in 2018. From all of us at the Emergency Medicine Kenya Foundation, HAPPY NEW YEAR!
And don’t’ forget…
The Health Act 2017 – Emergency Care
Hands-Only CPR
Hands-Only CPR is CPR without mouth-to-mouth breaths. It is recommended for use by people who see a teen or adult suddenly collapse in an “out-of-hospital” setting (such as at home, at work or in a park). It consists of two easy steps:
Did you know Adrenaline doesn’t work for Cardiac Arrest?
Adrenaline may improve return of spontaneous circulation, but it does not improve survival to discharge or neurologic outcome. The timing of epinephrine may affect patient outcome, but Basic Life Support measures are the most important aspect of resuscitation and patient survival.
Mistakes that Kill during Cardiopulmonary Resuscitation
- Too Slow or Too Fast Chest Compressions
- Too Shallow or Too Deep Chest Compressions
- Too Many or Too Slow Breaths
- Leaning on the Chest
- Too Many Interruptions
- Giving Up Too Soon
- Too Slow Adaptation
Top 10 Posts of 2016
10. All Shock Explained
9. Priapism
| Non-ischemic (high-flow) | Ischemic (low-flow) | |
| Physical Exam | Typically painless, not fully tumescent | Painful, fully tumescent with corpus cavernosa rigidity without involvement of corpus spongiosum and glans penis |
| Aetiology | High-flow priapism is extremely rare and most commonly associated with antecedent trauma including blunt trauma, or resulting from needle injury of the cavernosal artery. | Low-flow priapism is caused by impaired relaxation and/or paralysis of cavernosal smooth muscle and in sickle-cell disease |
| Management | NOT Emergency | Emergency |
8. 2016 Guidelines
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Current criteria for the diagnosis of diabetes (2016 guidelines)
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CDC Sexually Transmitted Diseases (STDs) Treatment Guidelines 2015
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Latest guidelines for the management of Hypertension – JNC VIII
7. Sepsis Six in 60 Minutes: World Sepsis Day – September 13th
NEW SEPSIS PATHWAY
FLUIDS
ANTIBIOTICS
…for every hour you delay, the patient has a 33% increased risk of death!
LACTATE
6. Did you know about the RULE OF TENS for Fluid Resuscitation in Burns?
Burns Rule of TENS:
1. Estimate burn size (TBSA) to the nearest 10%.
2. Multiply %TBSA x 10 = Initial fluid rate in mL/hr (for adult patients weighing 40 kg to 80 kg).
3. For every 10 kg above 80 kg add 100 mL/hr to the rate.
5. New 2015 Resuscitation Guidelines Compedium
4. LFTs explained
- LFTs = ‘hepatocellular’ or ‘cholestatic’ arrangement based on the pattern of elevation.
- Hepatocellular pattern = transaminases > ALK
- ALT is generally considered to be more specific to liver damage
- Magnitude of aminotransferase elevation => guide initial diagnosis: mild (<5x), moderate (5-10x), or marked elevation (>10x)
- Mild = NAFLD, Drug Induced Liver Injury, Alcohol-Induced Liver Injury
- Moderate = Alcoholic Hepatitis, Biliary Tract Disease
- Severe = Acute Viral Hepatitis, Ischemic Injury, Acetaminophen Toxicity
3. The GCS is out-of-stock
Contrary to common belief, The Glasgow Coma Scale (GCS) is NEVER out-of-stock and the lowest score possible is 3.
- An intubated patient still gets 1 point for verbal meaning they score 3T…there is nothing like a 2T score (at least not in human beings)
- The phrase ‘GCS of 11’ is essentially meaningless, and it is important to break the figure down into its components, such as E3V3M5 = GCS 11.
- The Scale was described in 1974 by Graham Teasdale and Bryan Jennett (Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2:81-4.) and is the most reference paper in medical literature
2. Nairobi Accident Hotspots
The most dangerous time to walk on Nairobi’s streets is on a Friday, around 7am, particularly along Mombasa Road.
1. Salter-Harris Fracture (remember the mnemonic SALTR)
- Slipped (i.e., through growth plate and not involving bone) / Type I
- Above growth plate (i.e., through metaphysis) / Type II (most common)
- Lower growth plate (i.e., through epiphysis) / Type III
- Through (i.e., through metaphysis growth plate and epiphysis) / Type IV
- Rammed (i.e., Crush injury) / Type V (worst prognosis)