Category Archives: Medical

TO BEING DOCTORS-TO-BE

A Must Read for every Practising and Aspiring Doctor …

Mrigank Warrier's Blog

We who were always overachievers. Who missed the dusk of our adolescence solving multiple-choice questions.

We who began our adult lives spending alternate days with corpses. Who carry bones in our bags and books that break our backs. Who spend the prime of our youth in the grime of wards. Who have already witnessed a lifetime’s share of deaths. Who learn about depression but fail to recognise it in ourselves.

We who have no definite college hours. Who don white coats even in the heat of May. Who are accustomed to the deadweight of stethoscopes around our necks. Who will pursue likely teachers for a lesson even into the night.

We who also study law, sociology, psychology, entomology, nutrition, sanitation and statistics. Who are always between exams. Who neglect the pursuit of our other passions. Who sometimes cancel our own vacations. Who covet amphetamines.

We who touch people slathered with…

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Prophylactic Anti-Emetics in Trauma – aka “Prevention of Post-Traumatic Mopping Episodes”

Check out: Prophylactic antiemetics in trauma.
A review by Dr Jason Bendall MStJ – Medical Director for the Ambulance Service of NSW in Australia.

I’ve had the privelage of once working under Dr. Bendall (who began as a paramedic, then became a doctor and has now also completed a masters and PhD in clinical epidemiology) in a voluntary first aid capacity and have witnessed that his presence and knowledge as well as relaxed manner inspires respect and warmth in patients and colleagues alike.

This review looks at the use of anti-emetics in trauma patients.
Ondansetron and Metoclopramide were administered prophylactically to  patients. The study enrolled 196 adult trauma patients.

With an endpoint of decreasing nausea, there was a 56% decrease in nausea with the use of anti emetics and a number needed to treat of 2!

With the endpoint of preventing emesis, the use of anti-emetics prevented 9% of patients from vomiting, a NNT of 12.

The study conclusions were as follows:
Prehospital nausea and vomiting are more common in our cohort of trauma patients than the reported rates in the literature for nontrauma patients transported to hospital by ambulance. These symptoms were associated with female gender, older age, weight, and greater ISS. Our results suggest that antiemetics may be underused in trauma patients, both for prophylaxis and the treatment of active symptoms”. 

Check out Dr. Bendall’s Blog at http://drjasonbendall.wordpress.com for some insightful articles and studies by a giant in the field of advancing EMS, pre-hospital care, EBM and the role and scope of paramedics in Australia and also worldwide.

Cheers 🙂

 

THE VORTEX IN ACTION – RSI IN ED from PHARM

THE VORTEX IN ACTION – RSI IN ED.

I absolutely LOVE this concept!!
The Vortex is an airway decision making algorithm for difficult airway management created by Dr Peter Fitz,  an Emergency Physician and Dr Nicholas Chrimes,  a Consultant Anaesthetist.

“Vortex is different. Its 3 D! Not linear..its circular. Thats cool. Its Non Surgical airway pillars ( tracheal intubation, laryngeal mask airway and bag/valve face mask) are all considered equal and the goal is Alveolar oxygen delivery ( AOD). They even support needle cricothyrotomy”
-Dr Minh Le Cong @ PHARM

Check out the above video demonstrating the Vortex in action AND also this interview on PHARM by Dr. Minh as he discusses vortex with it’s creator’s.

Show me the Evidence! – The NNT Strikes Again!

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The NNT would have to be my all time #1 site when it comes to appraising the positive and negative statistical aspects of treatments in the EBM arena.

Here is a small quick-list of Emergency/Acute Care therapies straight from the awesome team at The NNT with their colour grading system included:

  • Thrombolytics for major Heart attack (STEMI):   [Page]
    • NNT = 43 against mortality, 
    • 2.3% saw benefit by being saved from death
    • 97.7% saw no benefit
    • 0.7% Harmed by Major bleeding within 6 Hours
    • 0.4% harmed by hemorrhagic stroke 
  • Immediate Aspirin for STEMI:  [Page]
    • NNT = 42 against Mortality
    • 2.3% benefit by being saved from death
    • 97.7 saw no benefit
    • 0.6 were harmed by minor bleeding event (anemia – did not require transfusion)
  • Mild Therapeutic Hypothermia for Nuero-protection after CPR:  [Page]
    • NNT = 6 against Mortality
    • 16% saw benefit by neurologically intact survival
    • 84% saw no benefit
    • 0% were harmed
  • Prophylactic antibiotics for simple hand Lacerations:  [Page]
    • NNT = N/A
    • 100% saw no benefit
    • An unknown number were harmed by sequellae.
  • Magnesium Sulphate IV during Asthma Attack [Page]
    • NNT = 3 for prevented hospital administration) 
    • 67% saw no benefit
    • 33.3% of severe asthmatics saw benefit by being prevented from administration to hospital
    • 0% were harmed
    • 100% of non-severe asthmatics received no benefits no harms from therapy.  

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So, that’s just a few of Many reviews, all of which can be found at?
The NNT!

So check out the NNT at http://www.thennt.com

 

Cheers 😀