Yes we did it!
Congratulations to those who worked hard for the past year and passed the final board exam. Here’s the final results. All hopes for the new R4’s to ace it in the next year.
What matters in EGDT?
1- Does EGDT reduce mortality?
2- Should EGDT be the standard for sepsis?
3- Are all elements of EGDT protocol still necessary?
FCR on 20/10/2015 title will be
Mechanical Ventilation and the points that we will go through are :
1- MV in ARDS and Obstructive lung disease
2- Permissive hypercapnea
3- hemodynamically unstable patients on MV
the links :
Almost all of us are doing first trimester US for our D-side patients. But have you ever thought that you might caused harm for that poor young fetus!.
We all learned that ultrasound is harmless and we even tell our patients so. Well, we might be wrong. As emerging evidence is showing some harm!. US might causes some thermal and mechanical effects which is directly related to the output power. Let’s see how!
As we all know ultrasound works by sending ultrasound waves and measures its reflection. Those waves produce heat as they pass through the tissue which is measures as the Thermal index. It depends on the energy produced and time of exposure. The Higher the index the higher the effect on fetus. So, as doppler will focus the beam to a small area, it’ll accentuate by this the energy force produced on the fetus. Giving that we use doppler for seconds, most probably we cause no harm.
Although, Evidence is weak and no strong in vivo studies supporting harm, guidelines are recommending avoiding using doppler specially in the first trimester.
Then, how can we check for fetal heart activity? By using M-mode, since it has lower power output, keeping with the ALARA principle.
Here’s an example of M-mode.
Do you still need Guidelines?
WFUMB/ISUOG Statement on the Safe Use of Doppler Ultrasound During 11-14 week scans (or earlier in pregnancy)
- Pulsed Doppler (spectral, power and color flow imaging) ultrasound should not be used routinely.
- Pulsed Doppler ultrasound may be used for clinical indications such as to refine risks for trisomies.
- When performing Doppler ultrasound, the displayed Thermal Index (TI) should be less than or equal to 1.0 and exposure time should be kept as short as possible (usually no longer than 5-10 minutes) and not exceed 60 minutes.
- When using Doppler ultrasound for research, teaching and training purposes, the displayed TI should be less than or equal to 1.0 and exposure time should be kept as short as possible (usually no longer than 5-10 minutes) and not exceed 60 minutes. Informed consent should be obtained.
- In educational settings, discussion of first trimester pulsed or color Doppler should be accompanied by information on safety and bioeffects (e.g. TI, exposure times, and how to reduce the output power).
When an embryo/fetus is detected, it should be measured and cardiac activity recorded by a 2-dimensional video clip or M-mode imaging. Use of spectral Doppler imaging is discouraged.
A thermal index for soft tissue (Tis) should be used at earlier than 10 weeks’ gestation, and a thermal index for bone (Tib) should be used at 10 weeks’ gestation or later when bone ossification is evident. In keeping with the ALARA principle, M-mode imaging should be used instead of spectral Doppler imaging to document embryonic/fetal heart rate.
At the End, it all started from here:
Today we have the all new 2015 AHA guidelines click here for the executive summay
Click here for the Highlights of the guidelines
Some of the major changes:
And the ERC 2015 Guidelines: European Resuscitation Council Guidelines for Resuscitation 2015
Update: a nice infografic from boringem.org
I would like to invite everyone to attend our First Academic Halfday for the Year 2015/2016 for the Saudi Board of Emergency Medicine, The Date will be on 6th October 2015.
Due to popular demand, we have altered the schedule to the Following:
09:00 – 09:30 Introduction and Welcoming remarks – Dr. Alsalamah/Dr. Alasgah
09:30 – 10:30 MERS-Cov outbreak in KAMC – Dr. Alamry
10:30 – 12:00 Hajj participants overview of the Mina Stampede Incident – lessons learned.
The Venue will be the Large Auditorium in the College of Public Health & Health Informatics.
The maps are included showing how to enter the collage.
Dr. Majid Al-Salamah