St Emlyn’s at the London Trauma Conference – Day 3

St Emlyns - Meducation in Virchester #FOAMed

The final day of the London Trauma Conference 2014 concentrated on pre-hospital emergency medicine and air ambulance operations. The day was hosted by the Norwegian Air Ambulance and had a mix of Scandinavian and international speakers. A wide range of subjects were covered, from education and training to sobering talks about how we deal with […]

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Ian Stiell Needs YOUR Help


Some of our EM Colleagues are evaluating the impact of Social Media on knowledge uptake.  

They’ve designed an audio message from EBM guru Ian Stiell (embedded below) and very short (~2 minutes) pre-survey.

At the end of the survey you’ll be provided with access to a 1-hour EM Cases podcast by Anton Helman featuring Ian Stiell discussing “Clinical Decision Rules and Risk Scales

In one week, you’ll receive another email with a podcast about A-fib and a short 2-item post-survey.

Please feel free to share this email with any EM provider who might be interested.

Thanks for participating! 

link to get access to his podcast on clinical decision rules and his newest risk scales on EM Cases:
https://www.surveymonkey.com/s/PRE_PODCAST

Stay tuned for a bonus podcast on Atrial Fibrillation in one week. 



Please feel free to share this email with any EM provider who might be interested!

Smartphone Diagnostics at Home: Interview with CellScope Co-Founder Amy Sheng

cellscope Smartphone Diagnostics at Home: Interview with CellScope Co Founder Amy ShengAmy Sheng is the co-founder of CellScope, a mobile health startup based in San Francisco that is focused on creating optical attachments for smartphones. CellScope spun out of a bioengineering lab at UC Berkeley during product development for mobile microscopes that could be utilized for disease diagnosis in developing countries. The company’s mission is to create the “world’s first smartphone-enabled digital first aid kit” by developing “easy-to-use, at-home tools that capture diagnostic-quality data for remote diagnosis.” I asked Amy about the company, its culture, and her day to day efforts as the head of product operations.

Tom Fowler, Medgadget: Why did you start CellScope?

Amy Sheng Cellscope Smartphone Diagnostics at Home: Interview with CellScope Co Founder Amy ShengAmy Sheng: My co-founder Erik Douglas and I decided to start CellScope in late 2010 because we were excited by the potential to improve healthcare access and convenience for very common medical issues. There was tremendous interest in our work in the Fletcher Lab at UC Berkeley and we decided to spin-out a company to begin commercializing products and services that enable “healthcare from the home.”

 

Medgadget: There are other companies out there that have been making medical device attachments for cell phones. What makes CellScope unique in this space?

Amy Sheng: CellScope is building a smartphone-enabled toolkit for families to use in the home to get a remote diagnosis for their most common healthcare concerns. We’re starting with the otoscope because ear infections are such a common pain point for millions of families. There are several differentiators about CellScope: We’re positioned at the exciting intersection of mobile, medical device-enabled services and data. CellScope is building products and services for families to get quick relief and peace of mind. Proper diagnosis of an ear infection requires a visual of the ear drum. Since otoscopes are not common household devices, CellScope is leading the way by creating modern versions of traditional medical devices previously only seen in doctors’ offices. oto cellscope Smartphone Diagnostics at Home: Interview with CellScope Co Founder Amy ShengWith Oto HOME, we’re changing consumer behavior as we empower parents to take a diagnostic-quality video of their child’s ear and send it to a physician for a remote diagnosis. Families will be able to visually track their child’s ear health over time and have a better understanding of what’s really happening. By having access to more longitudinal data for both parents and clinicians, we can improve engagement and understanding and hopefully reduce unnecessary antibiotic use.

 

Medgadget: What is your company culture like? Is there more of a medical or engineering vibe?

Amy Sheng: Our company culture is open, collaborative and inquisitive. We hire people who inspire us, and are curious, creative and driven. We look for people who are good at something, excited to share their perspectives with us and open to hearing other viewpoints.

 

Medgadget: What is a mistake you have made as an entrepreneur that you would warn other budding enterprisers to watch out for?

Amy Sheng: Stay focused, especially early on when you haven’t yet demonstrated product-market fit. It’s easy to get distracted as an entrepreneur because there’s so much going on and a lot of opportunities come your way. But ultimately the only thing that really matters is if you’ve built something that people love.

 

Medgadget: If I gave you a $2 billion research grant, what would you work on developing?

Amy Sheng: So many people in the world don’t have access to good healthcare. I would use the grant to massively improve healthcare access and delivery worldwide. I would develop and deploy low-cost tools and systems that deliver care broadly to rural and low resource settings.

 

Medgadget: Lastly, what is your favorite quote of the day?

Amy Sheng: Startups are hard. Hardware startups add another layer of complexity. Medical device startups add yet another layer of complexity. Medical device-enabled services startups add even one more layer of complexity. This week we’re announcing that our first product, the Oto HOME, is available to consumers in California. It’s an amazing feeling to see all the hard work come together to make this happen.  That is why this quote by Randy Pausch resonates with me: “The brick walls are there for a reason. The brick walls are not there to keep us out; the brick walls are there to give us a chance to show how badly we want something. The brick walls are there to stop the people who don’t want it badly enough. They are there to stop the other people!”

divider Smartphone Diagnostics at Home: Interview with CellScope Co Founder Amy Sheng

Link: CellScope company website…

Flashbacks: CellScope, a “Mobile Phone Based Clinical Microscopy for Global Health Applications”The Latest on Cellscope’s Smartphone-Based Microscope and OtoscopeCellScope for Rural Microscopy On The Go

CASO 162: Varón de 65 años con ANEMIA severa

Varón de 65 años acude por cuadro de astenia, debilidad generalizada (más manifiesta en EEII) y disnea progresiva hasta hacerse de reposo de 2-3 meses de evolución. Refiere también pérdida de apetito con adelgazamiento de unos 10 Kg en el último año.

Antecedentes personales: – Hepatopatía crónica etílica. Ingresado en el 2008 Hemorragia Digestiva Alta: Síndrome de Mallory Weiss. No consumo de alcohol desde hace 2 años. // – Fibrilación auricular persistente en tto con Clopidogrel 75 mg/día.

Exploración general: PA 124/69 mmHg. Fc 62 lpm. Tª 36.5ºC. SO2 99%. Fr 22 rpm. Consciente, ligero deterioro cognitivo. Pálido. Ictericia de piel y mucosas. Taquipnea sin uso de musculatura accesoria. No rigidez de nuca. No ingurgitación yugular. AC: arrítmica con soplo sistólico panfocal. AP: crepitantes bibasales. Abdomen: blando y depresible, sin dolor a la palpación, hepatomegalia de 2 traveses de dedo. EEII: edemas en ambas piernas, sin signos de TVP.

Pruebas complementarias:

* ECG: ACxFA a 109 lpm,  descenso de ST en cara antero-lateral e inferior con  T negativas “asimétricas”. HVI.

* Rx de Tórax: Cardiomegalia sin claros signos de IC.

caso 162

*ANALÍTICA: (entre paréntesis los valores normales):

- TnT 75 (0-14) / Pro BNP 3566 (0-300) —> SCASEST/IC ??

- Severa ANEMIA MACROCÍTICA: Hematíes 1.200/ Hb 4.9 / Htc 13.6 / VCM 115

Reticulocitos% 2.83 (0.67-1.92) / Reticulocitos absolutos 0.033 (30.4-93.5).

Leucocitos 5.300 con fórmula normal.

- Plaquetopenia 50.000 / Coagulopatía: INR 1.63

- Signos de HEMOLISIS: Bilirrubina total 6.5 / Bilirrubina directa 1.7 / LDH 4224 / Haptoglobina < 0.1 (esquistocitos)

- Función renal normal: Creatinina, Urea e Iones (Cl, Na y K)

- Glucosa 209 (70-110) / Proteinas totales 5.6 (6.6-8.7)

- GPT 47 (0-41)/ GOT 60 (0-37) / GGT 19 (10-71)/ FA 64 (40-129)/ Lipasa 36 (13-60)

- Metabolismo del hierro: Hierro 160 (59-158) / Saturación transferrina 87% (15-50) / Transferrina 126 (200-400) / Ferritina 744 (30-400)

* MORFOLOGÍA, Frotis de sangre periférica:

- Serie roja: macrocitos, policromasia, anisocitosis, poiquilocitosis, dacriocitos, aislados esquistocitos, eliptocitos.

- Serie blanca: presencia de neutrófilos hipersegmentados, pleocariocitos.

- Serie plaquetar: trombopenia confirmada, no se observan agregados

Comentario: el lenguaje de los hematólogos no es fácil de entender y mucho menos para gente descerebrada como nosotros los urgenciólogos (hablo de mí). Cuando vemos una hemoglobina muy baja automáticamente pedimos pruebas cruzadas y pensamos en sangrado. Si el paciente tolera bien su anemia -> en  sangrado crónico, fundamentalmente de origen digestivo o ginecológico si es mujer; otras veces son pacientes ya conocidos con anemias crónicas y transfusiones periódicas. Si el paciente tiene historia de etilismo, como el del caso que se expone, su VCM elevado nos reafirma en su adicción pese que la niegue. En general los alcohólicos minimizan su ingesta, al preguntarles: Cuánto beben? responden: “lo normal”, y después de palparles un hígado agrandado nuestro pensamiento se dirige a la posibilidad de sangrado por varices esofágicas, hipertensión portal.

El paciente tiene una ligera alteración de enzimas hepáticas pero la GGT es normal y eso va a favor de la credibilidad de su abstinencia. No refiere clínica de sangrado: no hematemesis, melenas, ni rectorragia.

Cuestiones:

- Cuál es la causa de su severa anemia? y su trombopenia? y los signos de hemólisis?

La respuesta es relativamente sencilla. Os adelanto que ni la Endoscopia esófago-gastro-duodenal, ni la Colonoscopia que se le realizaron mostraban signos de sangrado, tampoco lesiones neoplásicas.

- Qué otras pruebas confirmarían el diagnóstico?

RELAX: Sharon Van Etten “Magic Chords”; (el video no lo entiendo. Me llama la atención ver como los supuestos muertos, a la deriva del río, se mueven, para no ahogarse):


[NUEVO] Intubación prehospitalaria en trauma cerebral: ¿tanto te importa?

El objetivo de este estudio fue estudiar el efecto de la intubación prehospitalaria (IPH) en pacientes que sobrevivieron una lesión cerebral traumática aislada severa (LCTA). Se realizó un análisis retrospectivo de todos los pacientes intubados con LCTA  entre 2008 y 2011. Se compararon aquellos que fueron intubados en el prehospitalario versus los que fueron intubados en la […]

Laughs and good vibes! Extremely curious workshop, by Thedoctorwearsprada

What I love the most of being a doctor is that it still has the hability to surprise me…and I think this will last forever! Everyday duties, shifts, sleeping recovering days, ventilation conferences and unaffordable congresses to attend…

But three days ago, still enjoying a couple of days in Paris, I received the weirdest text ever: SENSE OF HUMOR AND CLOWN WORKSHOP FOR HEALTH PROFESSIONALS. Gabi, my chief resident, always involved in a thousand projects, was now organising the mos hilarious workshop ever!


No doubt I couldn’t miss that chance! So there I showed up in the Hospital of Torrejón, surrounded by complete strangers from the most different fields of health system, with José I. Ricarte, a Family practice doctor ready to let us wear a new pair of glasses to watch the world, our health world, from a different side.

We ‘ve learned that sense of humor doesn’t really mean to laugh out loud, that a nice word or just to remember the birthday of a patient could be the greatest gift, and that a smile between needles and plasters heals more tan amoxiciline!

How??? We’ve been back to our chidhood playing catch, we ve walked down the catwalk like stars, we ve given a thousand hugs and danced with strangers!!! My face muscles still hurt for laughing so much!

Theory and practices. Laughs. Good vibes…what else!? I can’t wait for the next event with José and the great family I’ve discovered and with whom I’ve won my big red nose. Now I am ready to make my patients a Little less hard their stay with us!


See you in the next! (because this, is addictive!)

Thedoctorwearsprada