Episode 4: The Practical approach to assessing and managing an acutely ill patient [Part 2]

Assalamo Alikum.

This is Episode 4 and part two of the previous topic: “The Practical approach to assessing and managing an acutely ill patient”.

It is a long episode, just under an hour!   I will hopefully try make the next episodes much shorter and I will aim for the them to be 20 minutes or less.

Remember to read the PDF file that accompanies episodes 3 and 4 which I previously posted.

As mentioned in my last episode: “Whilst I try my best to make sure everything that is mentioned in all the podcasts is correct, I nonetheless urge any listeners to use the podcasts as a stimulus to seek further knowledge and to read around the topics mentioned and to make sure everything is correct, safe  and up to date”.

Please leave a comment or email me if you need to add anything. I hope you find the episodes useful.

Episode 3: Practical approach to assessing and managing an acutely ill patient [Part 1]

Assalamo Alikum, this is the long overdue third episode of Libyamedcast. I apologise for the long absence, as they say, better late than never! I think I fell into the trap I tried to avoid in the first place, which is to be so fearful of how the episodes will turn out to the extent that I constantly avoid doing anything. I finally got some courage and managed to restart the project. The recording is from a while back.

Unfortunately I am alone in this and the next episode, I hope you can bare with me and don’t sleep while listening! I also hope brother Hussein and others can contribute soon. I am trying to convince some people to try this out, but it will take time. If anyone is interested in contributing please let me know and I’ll be very happy to hear from you. The podcast belongs to anyone who wants to contribute to health care, I am here merely to facilitate the process through this humble project.

The topic I discuss in this episode is divided into two parts. This episode is an introduction and in Episode Four I will discuss the management of acutely unwell patients in more detail.

Again, I am sorry for the poor quality sound, the constants umms and aahs I say and the silly language mixture!
Please feel free to leave any comments or concerns regarding the podcast or the embedded document and also let me know if anything needs correction.

Whilst I try my best to make sure everything that is mentioned in all the podcasts is correct, I nonetheless urge any listeners to use the podcasts as a stimulus to seek further knowledge and to read around the topics mentioned and to make sure everything is correct, safe  and up to date.

I have embedded a PDF document below which has a brief outline of Episodes 3 and 4, as well as the references I used. Please take sometime to go through it.

I am also pleased to say that you can listen to and download Libyamedcast on i-Tunes. This website in English and this in Arabic explains how to use i-Tunes to listen to and download podcasts. You could also see this video which will explain how to use i-Tunes to listen and subscribe to podcasts (click here to watch video).

Thank you for listening and I hope all of us can contribute to the betterment of our countries health care inshala.

Episode 2: The Emergency Department: The Pitfalls

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.