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Aunque pueda contener afirmaciones, datos o apuntes procedentes de instituciones o profesionales sanitarios, la información contenida en el blog EMS Solutions International está editada y elaborada por profesionales de la salud. Recomendamos al lector que cualquier duda relacionada con la salud sea consultada con un profesional del ámbito sanitario. by Dr. Ramon REYES, MD

Aspectos Destacados de la actualización de las Guias de la AHA para RCP y ACE de 2020

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martes, 15 de marzo de 2022

REMOTE MEDICINE: Field Laboratory for Remote Medics

REMOTE MEDICINE: Field Laboratory for Remote Medics 


Why do you need lab skills? I am a lazy medic. Why would I want to carry more lightweight kit? You add enough ‘lightweight’ kit and eventually, you are jumping out of an aircraft with a 110-pound rucksack full of ‘lightweight’ kit. For the remote and austere medic, it is important to find the perfect balance of what kit to bring for the mission at hand. Having a small microbiology lab with you adds fundamental abilities that will help you diagnose your casualty's ailments. This could be the difference between an expensive or mission ending medevac vs keeping your casualty on site. Here is a beginning list of what you can have in your Field Laboratory Kit.


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Patient Monitor (SPO2, BP, 3 Lead ECG, Temp)

Ultrasound

Microscope

Rapid Diagnostic Tests (RDTs)

Micro Haematocrit

ePOC/iSTAT blood analyser



The skills you need. As a remote medic, you need to have a fundamental understanding of microbiology and how to perform lab diagnosis for malaria, dengue, tuberculosis, skin fungus using KOH scrapings and to perform a Giemsa stain for the presence of blood parasites. You need to know how to find a blood group and rhesus typing using an Eldon card. This is mandatory for buddy transfusions. 


Using a smartphone microscope, you can perform a complete blood count from a blood smear. These devices can detect and identify living organisms in your drinking water. They can see helminths in a blood smear as well as other infectious diseases. Using the smartphone microscope with Geimsa staining can find bacteria in sputum samples. And finally, with tape and a couple of coloured sharpies, you can turn your smartphone into a Woods lamp for detecting skin fungus.


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Other lab skills that you need are more common such as urinalysis dipsticks, glucometer, pregnancy test kits, and rapid diagnostic tests for malaria, TB, lactate (for determining sepsis), and troponin. If you can get a point-of-care testing device such as the iStat or ePOC it would enhance your diagnostic capabilities. Unfortunately, the iStat requires refrigeration for their very expensive cartridges. That is a complete show-stopper for most of us. For that reason, we use the ePOC in our classroom training in Malta.


Any field laboratory should have a handheld ECG with three leads and a portable ultrasound machine. Both of these devices are cheap enough to have in your team house or clinic. We have the IQButterfly ultrasound in the classroom as well as other smartphone-based options. In the picture above, you can see a handheld ECG that is 3 lead capable. It comes with a BP cuff, thermometer and an SPO2 monitor. Both of these devices are small enough that you should have them in your medical bergen. Make sure that you buy a shock-resistant case for both of them.


You can get your casualty's haematocrit using a spinning paperfuge using a heparinised pipette with 550 cord and a small pipe. We have tested several variations of this technique with some good success. Additionally, there are quite a few rapid diagnostic tests (RDT) that are available: Malaria, TB, HcG, Troponin, Lactate, Guaiac cards and of course blood glucose.



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Microscopes. You will need a microscope in order to provide the lab skills mentioned above. We don’t have the capacity to carry around a large desktop microscope so we have two portable options. On the right is the Newton NM-1 Microscope that can see up to 960x. That is enough magnification to see malaria on thick and thin blood smear. Another option is the Nurugo smartphone microscope. As a 400x scope, it is good for macro views of blood smears and it is an excellent option for helminths or giardia in pond water and all of the larger jobs. We will have a few of these scopes for you to play with at our exhibition table during the Special Operations Medical Association Symposium in June in Charlotte, NC.


Where can you learn these skills? First, take a free microbiology course. You should also be spending a lot of time on the Prolonged Field Care website. But in order to understand field laboratory capabilities, you need to have some hands-on experience. Enrol in our Tropical, Travel and Expedition Medical Skills (TTEMS) and Intensive Care for Austere and Resource-limited Environments (iCARE) courses. Both of them are part of the BSc Remote Paramedic Practice programme. You can take the online module called Austere Clinical Laboratory Diagnosis.



Keep learning. Every day is a school day. Your patients deserve this.


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#MSPInfectología | Para la organización Mundial de la Salud (OMS) la incidencia del virus del dengue va aumentando a pasos agigantados a nivel mundial. Según las estimaciones, cada año se reportan alrededor de 390 millones de casos.

La prevención de este virus se puede hacer mediante el manejo adecuado de los desechos sólidos, limpiar y vaciar cada semana los recipientes donde se almacena agua para el uso doméstico y fumigar las zonas estancables y los productos susceptibles de traer el mosquito.

Aprende más sobre este virus con esta infografía o en https://lnkd.in/dSunwEi

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LIBROS GRATIS #PDF solo dirígete al enlace de las fotos y allí tienes el enlace en donde puedes descargar de forma legal y sin trucos tu libro. Dr. Ramon Reyes, MD @DrRamonReyesMD https://lnkd.in/eVpFyzZ #DrRamonReyesMD

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