Here we are, the second episode, where the fun begins! I dragged Hussein out on his rest day (thanks Hussein), and we put this together quickly, so excuse the relatively poor sound quality and some of the ad libbed content, which always sounds funny when you hear it again! One thing we learnt from this exercise is that it must take a lot of practice for people who do it so well on the radio and TV! I decided to post the recording despite the fact it may need some improvement. Although not perfect, we will not postpone until perfection, which will never be reached and if we keep postponing, the project will never start. We will try to improve inshala, esp. with your support and feedback. We pray that Allah gives us guidance.
Below I posted some related material and references related to the podcast. I hope you find it useful.
Ahmed (Email: Libyamedcast at gmail . com)
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In this podcast we talked about the Emergency department. Everyone may and will eventually need this vital service some day makes it essential that it should be run efficiently, scientifically and ethically in order for it to provide a life saving service. Any complacency here means lives. As an example of this, in a very small study of 29 deaths in an emergency department, it was found that 20 people would have survived and could have had a chance for long term survival if they received STANDARD care*. Failure in the care chain leads to deaths and permanent disability. We should focus in improving our skills on detecting the common and dangerous conditions, the biggest killers, the rest will follow with increased experience.
The main take home messages from Episode two are:
-Inappropriate Action Costs Lives.
-Classification of medical emergencies:
- Cardiac 29%
- Respiratory 26%
- Neurological 21%
- Gastro 13%
–Common reasons for admission:
- Myocardial Infarction.
- Stroke.
- Cardiac Failure.
- Acute exacerbation of asthma.
- Acute exacerbation of COPD.
- Deliberate Self harm.
-Common Mistakes:
- Failure to recognise and treat serious illness and infection.
- Error in investigating-acute headache, acute breathlessness, epilepsy.
- Misinterpreting of investigations.
- Inadequate assessment of Abdominal symptoms.
-Errors in patient assessment:
- Available clinical evidence incorrectly interpreted.
- Failure to identify and focus on very sick patients.
- Investigations misread or ignored.
- Radiological evidence missed.
- Standard procedures, guidelines/protocols not followed.
- Inadequate assessment or treatment.
- Discharge from hospital without proper assessment.
In the emergency department, doctors should always assess patients in a structured and a focused way. Its very important to seek a second opinion if doubt exists NO MATTER how senior some one is, EGO COSTS LIVES.
Key Principles:
- Do no (further) harm.
- Focused knowledge and basic skills are essential.
- A structured approach will identify problems and prioritise management.
- Prompt accurate assessment improves patient outcome.
References: *Acute Medical Emergencies: The practical approach.
Useful website for Evidence based care: Evidence-Based On-call.
LibyaMedCast 
I think you did a good job. You touched on many points.
1. Basic medical ethics. You should not release the patient prior to reaching a verdict on what is wrong with him or her.
2. Follow standard procedures to the end.
3. Talk and communicate with your colleagues. Make sure you do that before you leave your shift.
4. Do not hesitate to get a second opinion from colleagues (senior or junior) to avoid causing harm to patients due to lack of knowledge and fear of asking others.
5. Always check on the results of lab or radiological orders.
Good job.
salaam
Elmahdi Elkhammas
Thank you Dr. Elkhammas for your advice and comment. We are planning to prepare an episode on ethics, your advice is very useful and inshala will be included in the episode.
Kind regards,
Ahmed.
Thank you Dr. Elkhammas for you support and your valuable advice.
Hussein.
Nice edpisode, informative, and the way you presented it in simple and Libyan chat (hadraza) style was a great chioce, after your permission I will be writing a post on the podcast on my blog, so that more people know about it. keep blogging keep podcasting.
Ghazi
imtidad.blogspot.com
Thank you Ghazi for your kind words and support. I am a big fan of your blog and podcast. The future success of the podcast will depend on all of us and any contribution from your part will be a huge asset, thank you and will look forward to your input inshala.
Ahmed
Dear Dr.Ahmed and Dr.Hussein
Assalamu-3alaikum
Describing your project as “humble” is a modesty. Initiatives are always the greatest steps in each path, not just a “humble”.
Listening to this episode helps making my life easier, that is in the middle of our chaotic health system and practice there are people who are thinking the right way.
You addressed the most important issues in organizing our approach to the emergency care and let me make this small contribution:
Our emergency departments, though are run by many good doctors (most of them juniors), are working out of system with no rules or policies…
To have an effective emergency department (ED) , organizational issues are important.
We should not use the ED as an outpatient clinic, this will overwhelm the ED with non-emergency cases and decreases the quality of emergency care to those who really need it…..Unfortunately, due to the lack of organized primary care and efficient referral systems, many of cases that we see in the ED have nothing to do with “emergency”…these should have been managed at primary care clinics by qualified GPs or family doctors.
However, even with good referral systems, we may have a flow of patients with self-referral, these should not be turned away without assessment and this is the function of triage nurse which we lack in most if not all our EDs…She/he can recognize the serious patients from those who can wait or simply can be referred to their GPs if they came with self-referral. She/he can also categorize patients and prioritize them according to their condition.
You addressed important points that we should implement in our EDs….having discharge policies…..giving the patient clear, preferably written, discharge instructions….having standard protocols of management…and sadly these thing do not exist in our EDs. They are the task of managers and team leaders but unfortunately they are busy with other things that they consider most important!! So I suggest that doctors working in EDs and those with past experience should take this task by themselves.
I also suggest making “templates” to document patient data…this is important not only in case of subsequent ED visit, but also in auditing our practice.
Doctors working in EDs should have basic standards, one of them is that they should have attended an ACLS course before getting into the ED.
Lastly sorry for my lengthy comment and I am grateful to both of you for this initiative and wish you all the success in your noble project and your career.
Dr. Albarsha,
Thank you very much for your comment and words of encouragement. You comment contains a wealth of information which is very pertinent to our aims.
The issue of health care in Libya is complex and a lot is needed. I totally agree with what you said regarding the lack of a primary health care system, which leads to more crowding and pressure on the already creaking ED’s.
ACLS and ATLS is hardly known, and if it’s known, its considered a luxury!
For example, the trauma department in Tripoli central hospital lacks basic equipment and more importantly training of their staff, the result is evident in on the ED floor. This is in Tripoli, imagine the situation in the district hospitals!
Things will change for the better inshala, I am very optimistic and hopefull, if the likes of you, Dr. Elkhammas, and countless others are trying to contribute, educate, raise awareness and I hope soon to train staff as well.
There are huge challenges, but every one of us has a duty to try help and change things for the better in our health care system.
I think a lot of people if they can get rid of the initial scepticism of improving health care in Libya and see past the many difficulties, opportunity does exist to make things better and immense satisfaction can be gained in seeing real improvements on the ED floor due to their simple input.
For example, if someone can introduce the concept of triage nurses, they can be trained fairly easily, placed on the ED floor and I’m sure their introduction will improve things immensely. The issue is convincing the authorities or hospital management. I think it can be done, if explained tactfully and diplomatically, the irony is, that I think this will be difficult in Tripoli, probably much easier to do in the district hospitals.
I’m sorry for the long reply, and thanks again for your input.
For all our listeners, I’m sorry I haven’t posted any more episodes, but I’m working on the next episode and I’ll try posting it very soon inshala.
Regards,
Ahmed
Dear brothers
Thank you for this nice job and big effort and I will be happy to join you to help Libyan patients and Libyan doctors to get best of education.And also i would like you to see my audio sessions at ibnosina health .org under primary care audio and tell me what you think
finaly thank you again and good luck for both of you.
NE
Dear Dr Nagah,
Thank you very much for your nice comment. We also commend you on your excellent work at the Ibnosina website, I have heard some of the files, and I will try to hear the rest soon inshala. Please continue on your efforts, we will keep listening and I hope you can contribute to our project as well.
I’m sorry I have not updated our podcast for some time, I am planning to make more episodes, I just need the time! But I will try to update it soon inshala, so please keep visiting.
Thank you,
Ahmed