Tag Archives | technology

EZIO Skills

Intra-osseous access to the intravascular space has fast been developed for more general and adult use over the last five years.  Innovation has been sped up by the experienced gained from military settings, including Afghanistan.

Whether you’ve become a seasoned EZIO user, or haven’t seen this before, the following videos may be handy to review/refresh what can make IO access more attractive than persevering for IV access.  Having been issued with one of these myself, and had the occasion to use it on several occasions, it’s clear the the initial fear felt (including those watching who are unfamiliar with the process) is rapidly dissipated by the ease of use in severe cases, such as trauma or cardiac arrest situations.

BASICS Scotland responders are lucky to have the continuing support from the Sandpiper Trust, and if you are a regular responder for  the Scottish Ambulance Service, you can apply to add one of these to your kit.

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

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

 

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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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dot.rural

Dot.rural aims to bring together researchers from a wide range of disciplines, in order to explore the digital challenges and opportunities for rural communities across the UK.  Based at Aberdeen University, they have focused on five channels: Accessibility & Mobilities, Healthcare, Enterprise & Culture, and Natural Resource Conservation.

They have recorded presentations and documents from their seminars and made them available as videos – worth a look.

One particular presentation from their Healthcare channel has a very direct relevance for future remote and rural medicine.  Alasdair Mort, Healthcare Research Fellow, has been working on ways of using technology to improve the prehospital emergency response, and seems to have a very pragmatic view of the challenges experienced in this field.

His presentation is available on the Dot.Rural website here (turn the volume up and fastforward a minute)… plus there is a YouTube video below with further information.

httpv://www.youtube.com/watch?v=ukrjhIM0JhU&feature=mfu_in_order&playnext=1&videos=ZiseKXuj2Vw

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Portable Head CT Scanning

Access to CT scanning has risen in importance, particularly with the tight timescales for stroke thrombolysis.  However, scanners still have a relatively high cost, in many cases too much for smaller community hospitals to justify (or have space for). This means that stroke patients can only achieve thrombolysis if rapid identification, assessment and transport to mainland facilities are available.

Yet rural populations often have a larger proportion of patients who are at risk of cerebroembolic events, to the extent that such presentations can be considered common.  The challenges of accessing CT facilities were raised in a recent article in the Scottish Medical Journal (Todd & Anderson, 2009)

So it’s interesting that the Summer edition of the Canadian Journal of Rural Medicine includes an article about the use of portable CT head scanners.  These are lower in cost, require less space and – as the article highlights – potentially more feasible for the community hospital setting.

So what does it look like?  There are various videos on YouTube but most are quite dated.  The best I could find was this video about similar scanners which are used for paediatric imaging in the USA.

If/when we emerge from the current cutbacks, perhaps this is on the horizon for our rural hospitals, stored next to the portable Xray machine?!

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