Tag Archives | prehospital

iPhone apps for rural doctors

In the last few years, the number of medical applications (or apps) for the iPhone has expanded exponentially.

Some are gimmicky, or seek to address a need that doesn’t exist.  However, there are also some excellent apps out there, making a huge amount of knowledge and rapid calculation available to both hospital and GP doctors.

Here, we point to some of the most useful applications – some of which are great for regular general practice, others which suit those who need to work in a community hospital/A&E environment.  If you can add any other suggestions, please leave a comment at the foot of this page.

Key to cost: free, £ is <£1, ££ is £1-5, ££££ is >£10

  • MedCalc (£).  This longrunning ever-increasing collection of useful medical calculations is a stalwart for daily practice.  You probably won’t need the APACHE score nor the paediatric ET tube sizes, but how about the opioid & steroid conversion tool, abbreviated mental test (AMT) and dermatome map?  Highly recommended.
  • LabTests (££). Background info, as well as useful clinical interpretation guide to nearly every lab test, and certainly all the ones I’ve come across in daily practice.  Whilst sitting in front of DocMan, do you ever get inquisitive about what fibrinogen is actually for, or when to get concerned about a slightly raised Alk Phos?  This app, costing a couple of quid, can give you a quick reference to find out those answers for next time.
  • 3D4 Medical (££).  A number of apps cover different body systems, revealed in stunning 3D and some animated images.  I like to use it to demonstrate the cause of muscular pain, or explain fractures on x-ray.  Sometimes slow to load up, but this is because of the high-resolution images which can be easily manipulated to view from different angles.  Can take a good chunk of your memory too.
  • Paeds Drugs (££).  For any GP on call for a local A&E unit, one of the most worrying calls is for an unconscious child.  Preparation can be key to good clinical management, hence the use of Breslow tapes and acronyms such as WET FLAG.  However, this app – from experienced paediatric critical care colleagues in London – offers to do all this with minimal fuss and input.  All you need is the child’s age, or even better their weight.  Drug doses for all the emergency drugs imaginable then appear in an easy-to-use format, uncluttered and logically laid out.  As a bonus, it even provides normal ranges for vital signs.  Recommended.
  • EMS Tracker (free).  BASICS responders will like this one, but perhaps also those who are involved in emergency hospital care.  This is a log of activity – from call-out and arrival times, to observations, procedures and drug delivery.  Again this is a well thought-out app, with events recorded in a single tap.  Useful for keeping track of events at scene, as well as being able to document and report times accurately, this is well worth having in your iPhone especially if you respond to prehospital incidents.  It even allows you to email or text the full log for your records.
  • Oxford Handbook of General Practice (££££).  The bible comes to iPhone – but at a price.  More expensive than the print version, it’s difficult to justify the expense.  However, the prospect of being able to dip into this no matter where I am – when covering our local hospital, in satellite surgeries or on home visits – persuaded me that this would be worthwhile, and I haven’t looked back.  I hope that OUP see sense and come up with better pricing (note that future updates are NOT covered), but for now I have very easy access to this very thorough companion.  The OH of Emergency Medicine is also available, but I can keep that in the back of the car for now.
  • A2Z of Dermatology (££).  A useful atlas of dermatological conditions – the range is adequate for most GP presentations, and if it’s not for your reference, it is useful for reassuring/explaining to patients or parents about the diagnosis.
  • Pocket ECG (free).  Particularly useful if you’re teaching students or colleagues… this is a useful reference for all the ECG changes that you’re likely to come across – there’s a quiz too so if you’re feeling the need to test yourself this free app is a great addition.
  • DropBox (free).  Installing this on your iphone and home computer, allows files to be stored within a “cloud” which is easily accessible by both.  This is useful for rotas, guidelines and local protocols – but be aware that you need to open each file from your iPhone to ensure that it exists in the phone’s memory.  If you don’t do this, and you move out of a 3G area (like the majority of rural areas at present), you won’t be able to access the file.
  • STAT Depression Screener (free).  This is designed for patients to self-test, but it can come in very handy if you want to do a PHQ9 screen but don’t have the questions with you.  Perhaps a home visit, or a branch surgery when the computer isn’t connecting well.
  • Flashlight+ (free).  There are loads of apps to make use of the LED camera flash.  This one seems to work well, and from a medical point of view, can be a great way to quickly check pupillary reflexes when on home visits.

Can you recommend any others?  If so, please add it via the comments box below.

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Tranexamic Acid in Major Haemorrhage

The CRASH-2 trial was published in the Lancet in June 2010, and presents strong evidence for the use of tranexamic to reduce haemorrhage in the context of major trauma.  The fact that tranexamic is cheap, seems to be safe, and is easy to obtain & administer makes it an attractive drug for general use. The study used a 1g IV bolus over 10 minutes (within 8 hours of injury), followed by 1g IV infusion over eight hours.

It would seem that tranexamic acid may have the particular potential to benefit patients who have suffered major trauma in rural areas, where the logistics of transfer/retrieval can result in prolonged time to definitive surgical care.  Permissive hypotension is standard practice, with a similar rationale to avoid destabilising clot formation that has already occurred.  The question now is whether it can be used routinely in rural community hospitals, or even by emergency responders such as  BASICS GPs, or is there a need to wait until more specific guidance?  In a bid to gauge its current use, a discussion has been start on the RuralGPNetwork, and any relevant updates will be posted here.  In the meantime comments are welcomed below too.

  • The original article (PDF;  The Lancet).  CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with signifi cant  haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; published online June 15. DOI:10.1016/S0140-6736(10)60835-5.
  • The associated editorial (PDF; The Lancet) by J Levy.

Dr Levy has also issued a YouTube video on this paper:

httpv://www.youtube.com/watch?v=YXPU_MEd5vg

… and The Lancet has recorded its press conference when the paper was published: you can listen to it here.

[podcast]http://download.thelancet.com/flatcontentassets/audio/lancet/2010/crash2.mp3[/podcast]

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