We are excited to announce a partnership between the Virtual Operations Support Group (VOSG) and the Emergency 2.0 Wiki for resource and knowledge sharing. Our first two joint projects are the Actionable Graphics Project and supporting the development of VOST Australia.
#actionablegraphics #SMEM project
The Project aims to provide a series of iconic social media public safety graphic messages (a graphic go-kit), available for download from the Emergency 2.0 Wiki website, where selected and approved graphics and messages will be shown side by side in customized English, French and Spanish versions.
The intent is to provide an immediate, trusted (approved and verified) public safety messaging resource, specifically for use by emergency management organizations and the Virtual Operation Support Teams (VOSTs) which support them in amplifying important official messages in an emergency or disaster situation.
Animated GIFs and infographics appeal to the general public who we hope will share widely with their own social media networks, increasing reach and exposure.
The graphics will be for major emergencies such as flood, snowstorm, hurricane, wildfire, earthquake, mass shootings and terrorism.
We will be crowdsourcing feedback and input for this project, so watch this space for developments…
The Emergency 2.0 Wiki is assisting with the development of VOST Australia, a Virtual Operations Support Team to provide surge support for emergency services in times of disaster.
In March 2016 a VOST Australia Meet Up was hosted by the Queensland Fire and Emergency Services (QFES) in Brisbane. Eileen Culleton from the Emergency 2.0 Wiki and Joanna Lane from the Virtual Operations Support Group (VOSG) enjoyed a tour of the State Disaster Coordination Centre by Kathy Wright (QFES).
VOST Australia will be activated by emergency response agencies as an official resource to perform specific functions such as:
- Supplement existing personnel and fill gaps in intelligence
- Hone in on specific data that is requested and actionable
- Amplify official information to wider networks
- Correct misinformation in major incidents
- Ensure key public safety messaging is reaching the whole community or intended audience across all media
- Build relationships with key community groups, using them as a resource
- Monitor and report isolated problems
VOST Australia will be able to upscale and access surge support from the 37 other active VOST Teams around the world. VOST Australia will also act as surge support for overseas VOST teams responding to disasters.
Sharing lessons learned
Key lessons learned from VOST Australia activations will be shared on the Emergency 2.0 Wiki to help accelerate learning across the world.
Feeder for learning and cross collaboration
It is our hope this partnership will foster greater collaboration, learning and knowledge sharing between the Emergency 2.0 Wiki community and VOST teams around the world.
For enquiries, including membership, contact VOST Australia Team Lead Daniel Eshuis via vostaus [at] gmail.com.
The post VOSG & Emergency 2.0 Wiki Partnership #smemau #vost #smem #osint #actionablegraphics appeared first on Emergency 2.0 Wiki Project.
So the two-headed clinical beast known simply as Selby/Tepler demolished this case with excellent wit and management. In summary, a 69 y/o F presented with fevers, nausea/vomiting, and L eye discharge. She was ultimately found to be tachycardic, with a heart murmur, and thrombocytopenia and elevated troponins on bloodwork. Ocular exam revealed a diagnosis of endophthalmitis and the patient then developed sudden stroke symptoms found to be due to a parenchymal bleed. Click HERE to see their answer and read the case in full.
What the heck happened to this patient?
The patient initially presented with an eye infection which was diagnosed as endophthalmitis but then developed an acute stroke. These are likely related and by focusing on this combination we can find the suspected diagnosis more easily. Let’s look at endophthalmitis to start:
Endophthalmitis is inflammation of the intraocular space that is usually a result of infection, but it can be sterile if caused by toxic agents or retained material after ocular surgery. It can be further divided into two types:1
- Endogenous: Hematogenous spread from a distant source of infection through the bloodstream
- Exogenous: Direct inoculation from an outside source, usually as a complication from surgery, foreign body, or direct trauma
Given that this patient reports no trauma or recent instrumentation of the eye, we can assume she has endogenous endophthalmitis and can focus on identifying the index infection.
The development of the acute hemorrhagic stroke, if believed to be related to the diagnosis of endophthalmitis, also needs to be explained with an infectious cause. In endogenous endophthalmitis, there must be some degree of bacteremia to cause significant hematogenous spread, and therefore this patient’s hemorrhage could potentially be secondary to a bleeding mycotic aneurysm. Mycotic aneurysms arise from an infection in the wall of an artery which weakens the strength of the wall. So in an attempt to apply Occam’s razor, we might be able to explain the entirety of this presentation on the hematogenous seeding of an infection. By using the physical exam findings, labwork results, and the etiologies of mycotic aneurysms and endogenous endophthalmitis, a likely diagnosis can be reached.
So what is the final diagnosis?
This patient presented with a case of endocarditis, complicated by endophthalmitis and intracranial mycotic aneurysmal rupture. She has a grade 3/6 murmur on exam and two sites which we may assume have been seeded through bacteremia. Endocarditis can present with all these signs and symptoms and can neatly tie this entire presentation together.
One series identified endocarditis as the cause of bacterial endogenous endophthalmitis in 40% of cases in the US2. Elsewhere in the world, seeding from liver abscesses can account for up to 60% of cases3. It is therefore reasonable to suspect endocarditis as the index infection in a case that occurs in the US4.
25 to 50% of patients with endocarditis are predicted to have some type of septic embolization, however only about 1 to 5% eventually develop mycotic aneurysms5. Intracranial arteries are more commonly involved than other sites. One study found that about 4% of patients with endocarditis undergoing preop evaluation with intracranial imaging had mycotic aneurysms6. So although these are rare, mycotic aneurysms should raise a high suspicion for undiagnosed endocarditis in any patient.
What is the management?
Aside from what has already been done, performing a bedside ultrasound may help confirm the presence of vegetations or valvular dysfunction. However, TEE is more accurate in identifying valvular lesions. Blood cultures drawn from multiple sites and broad-spectrum systemic antibiotics are paramount in the treatment of mycotic aneurysms and endocarditis. This is in addition to the intravitreal injections the patient will receive. Further inpatient workup will involve assessing valvular competency and the presence of cardiac abscesses/fistulas and identifying the primary organism in an attempt to determine whether valvular surgery is indicated as well.
- Egan DJ, Peak DA, Peters JR. http://emedicine.medscape.com/article/799431-overview
- Okada AA, Johnson RP, Liles WC, D’Amico DJ, Baker AS. Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study. Ophthalmology. 1994;101(5):832.
- Wong JS, Chan TK, Lee HM, Chee SP. Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction. Ophthalmology. 2000;107(8):1483.
- Eran Pras, Alexander Rubowitz, Joseph R Ferencz, Judith Raz, Y. Rotenstreich, Ehud I. Assia. Endogenous endophthalmitis as the leading sign of endocarditis. Annals of Ophthalmology, June 2001, Volume 33, Issue 2, pp 148-150
- Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O’Gara P, Taubert KA, American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015;132(15):1435.
- Monteleone PP, Shrestha NK, Jacob J, Gordon SM, Fraser TG, Rehm SJ, Bajzer CT, Kapadia SR, Pettersson GB, Lytle BW, Blackstone EH, Shishehbor MH. Clinical utility of cerebral angiography in the preoperative assessment of endocarditis. Vasc Med. 2014 Dec;19(6):500-6. Epub 2014 Oct 31.
British Thoracic Society/Intensive Care Society published a guideline regarding ventilatory management of acute hypercapnic respiratory failure(AHRF). I believe there are good recommendations for junior residents who do not know to deal with NIV machine and also setting initial parameter. This is augment our practice that how to approach COPD patient in ED with NIV.