The Great Disruptor: Covid-19

Covid-19 will be long remembered by this generation. This low lethality but high impact event has left a scar not only on medical fields but theplanet itself. Thoough suffering from a second wave currently, Singapore has a well documented way of dealing with this and our ED/hospital "positives" can be summarised into:
  • Good command and control from the beginning
  • One source of Information/dissemination + Updated info passed onto the floor daily
  • Swab & Go protocols 
  • Segregation of fever & non fever areas in the ED
    • Fever area - PPE is gown / gloves /N95 / face goggles or shield
    • Resus - PPE is N95 / gloves
    • Resus (intubating and arrests) - PAPR with N95
    • Non fever areas - Surgical mask and gloves

Other good resources:

The original article of the index cases

Handbook by Chinese hospitals

Covid calculators

Johns Hopkins datacentre


Probably the best video you can get on the subject is this detailed look into the pathophysiology and management by ESICM:




And finally when to ECMO:



Syncope guide 2019

A new guide on our site on Syncope! Often overly investigated and common pitfalls abound.

See our guide section here - https://singem.blogspot.com/p/downloads.html

Link is here for pdf.

Comments and edits of course welcome.




Nul pointes..... the zero point survey?

Cliff Reid surmises that preparing yourself BEFORE the stress and immediacy of critical care tasks. Zen achieved via zero points...  survey that is.
Not just for pre-hospital teams but also for ED situations.

Ventilation guide Ver. 2

An update of our ventilation guide is now available here (pdf).
Version 2 includes nods to new techniques as well as ventilation strategies for difficult or rarer conditions. As always this is free for download and replication/alteration for your purposes.





Essential # management

Excellent self explanatory talk.
Essentials indeed.


Teaming in the real world / work

Been away for a while but we will still be posting EM related content intermittently. Here's a teamwork demonstration like no other which is applicable in complex environments like ours. 

Moral injury, not burnout




Dr Zubin Damania does great parody songs but his rants are equally engaging.
This call to arms denounces the odious habit of blaming people rather than systems/institutions. A different viewpoint indeed but well thought out and has evidence at its core.

Other very good links on this topic:

How you perceive these challenges (in the ED setting) depends on your world view however your perspective might be influenced by the following; 
  1. Stepping into a non metropolis resource limited setting
  2. Being a patient or having a loved one be a patient
  3. Talk with an "old timer" ED Doc. If they're still in this challenging environment after decades, they must be doing something right.
Systems inherently lack pathos so our efforts must be channeled into doing what best for patients and peer monitoring/support for ourselves/nurses/students.

As always... fight the power!