Haiyan (Yolanda) Med Ops 2013

In early November 2013, The Philippines was struck by a massive typhoon and its effects have been devastatingly widespread.
Changi General Hospital recently combined with Mercy Relief to send a medical relief team to Ilo Ilo province of Panay Island in the Western Visayas archipelago.

The week long mission saw the team combine with local doctors and american nurses from RNRN to run mobile clinics in northern Ilo Ilo (Estancia area). The team effectively triaged, saw and treated in excess of 1800 patients. The range of cases included malnutrition to infected wounds to psychological debilitation. 

Those of you who know about disaster medicine will appreciate that building capacity for the Philippines will take more than this but the international co-operation and determination of the NGOs is heart lifting indeed. Throughout the effort, HELP Panay and Panay CDR were indispensable for logistics and pharmaceutical support. Do help out these organisations if, however and whenever you can.

We hope 2014 brings happier tidings for our neighbours in the Philippines.

Pics are with permission from patients and the NGOs involved.

CGH Cardiologists getting into the act!

Makeshift pharmacy

Mercy Relief's Mary keeping kids occupied (also called group therapy)

Collage of pics from Mercy Relief's FB page

Sometimes the only place with natural light for procedures was God's table

After a friendly USA vs SG basketball game - kids thrashed us both!

Team Singapore (2nd from left is Thomas Ho from MR) 

Many more (hundreds) of pictures from the trip can be viewed at this link.

A video grab from US television news is shown below. (CGH team at 00:19 and 01:45)

JW's top stories of 2013

Journal watch's Ron Walls has a lovely list of the best articles of 2013. His post is shown below unedited.

December 27, 2013 Emergency Medicine Editors' Choice: Top Stories of 2013 Ron M. Walls, MD, FRCPC, FAAEM A perspective on the most important research in the field from the past year

This has been an exciting year for us, as we embraced a broader collaboration with our colleagues in the NEJM Group and changed our name to NEJM Journal Watch Emergency Medicine. We remain devoted to providing clinicians with the information they need to give their patients the best care — and, as part of NEJM Group, we are now poised to do that better than ever. We are constantly exploring new ways to provide you with richer content, enhanced graphics, and a more useful, convenient website, all intended to make our information and guidance timely, relevant, and succinct. As in past years, we have selected for you the studies we feel most important to your practice, summarized these, and provided insightful and directive comments to help you put the knowledge into a clinical perspective. As we do each year, this month we feature the 10 summaries from 2013 that we feel are most important for you to be aware of, to think about, and to discuss with others. You may want to navigate back to the original studies, or simply to review these summaries again to refresh your memory. The year brought new clarity to compression-only CPR, rapid blood pressure control during acute intracranial hemorrhage, and the endlessly distracting etomidate in sepsis argument. Iconoclastic studies challenged the Wells and modified Geneva scores for acute pulmonary embolism, and the Alvarado score for appendicitis. And, of course, there was more. Our Emergency Medicine Top Stories of 2013 are Is Intensive Blood Pressure Lowering Beneficial in Acute Intracerebral Hemorrhage? More Information on Thrombolysis Benefits for Ischemic Stroke Steroid-Pressor Cocktail for In-Hospital Cardiac Arrest? Etomidate Does Not Increase Mortality in Intubated Septic Patients Meta-Analysis Finds Ultrasound Guidance Superior to Landmark Technique for Central Venous Catheter Placement CPR: Compression-Only Wins the Long Race Acetylcysteine for Prevention of Contrast-Induced Nephropathy Pretest Probability for PE: Structured Scoring System or Clinical Judgment? Poor Performance of an Appendicitis Decision Rule Volume of Crystalloid During Massive Transfusion Is Associated with Increased Mortality

Forwards or backwards vasoactives?

Here's a post from my colleague at work and guest author on this site. Dr Steven Lim:

An 85 year old with symptomatic critical aortic stenosis was uptriaged to resus because of abnormal ECG. She appears comfortable and not in pain. Thankfully, ECG is similar to previous ones.
Questions to ponder:
1. What are the drugs which can destabilise AS?
2. What can you give if she has chest pain?
3. She has been considered for TAVI, what's that?

Haiyan Hiatus

Emergence Phenomena would like to apologise for lack of posts this fortnight. A few of its members are involved in Disaster relief operations in the Phillipines. Typhoon Haiyan has left some indelible marks and the regional NGOs have entered into full recovery mode.

To support the efforts of the NGO involved - go here.

We will bring you more EM insights when we are back.

Webucation 4/12/13

Web learning this time comes form the depths of "bloody" trauma but also from the murky realm of crystalloids.... pun intended. We also get a dose of gynae and neonatology - perennial blind spots for some. 

• Fitz-hugh-curtis syndrome  - EM Tutorials gives us a nice reminder of the pathology, Dx and treatment options for this "blind spot"
• Neonatal CXR - Emergucate brings us a good revision on another rare image
• Collared you say? - The trauma pro brreaks down different types of collaring
• CCF guidelines - Resus.me points us towards the new cross continental CCF guide
• What you though about fluids - Game changing evidence from ICN about fluids
• The trauma arrest - Rob Orman and Scott Weingart discuss trauma arrests

• Watch and wait instead of scan??? - What manner of witchcraft is this?

The last link we truly echo. Clinical examination has taken a back seat to volume-necessitated pathways and unfortunately rampant, random irradiation. The backlash may be coming. It's time to do some doctoring again folks.

SimWARS @ SEMS ASM 2014 - You cant win alone!

Inaugural SimWARS competition at SEMS ASM 2014

• International teams welcome!
• Let us know early, we can place you into teams if you are coming alone.

SIMWARS @ SEMS ASM 2014

The Society for Emergency Medicine in Singapore is proud to present the inaugural simulation competition, SimWARS, as a highlight of its Annual Scientific Meeting (SEMS ASM) 2014 which will be held at Changi General Hospital from 11^th to 13^th April 2014.

SimWARS will be an excellent opportunity for trainee level doctors and critical care staff to showcase their knowledge and skills in simulated patient scenarios. They will go head to head in front of a live conference audience for the semi-finals and final.

Prizes include:

• Challenge Trophy (contested for every year)
• Cash prizes:
• Winning team - $500
•  Runner up team - $200

We would like to invite teams consisting of 4 or 5 members to participate in SimWARS. The team should include at least:

·         1 doctor (trainee level: BST/AST/Resident/MO/Reg/CA/RP)

·         At least 1 nurse or paramedic

·         Additional members can include any medical, nursing, paramedic or allied health professional

Participation is free but all team members have to be registered for the full conference. For further details and registration, head to the following website:

http://www.sems2014.com/page/simwars

 The Organising Commitee - SEMS ASM 2014