Sunday, 17 October 2021

83rd Saturday Summit: WACEM Weekly Global e-Grand Rounds - Point of Care Ultrasound in EM ~ The Water Bath Technique

 16th October 2021

Water Bath Technique for Extremity Injuries 


Professor Sanjeev Bhoi from AIIMS New Delhi.

The Water Bath Technique

Fill a Tub with Luke warm water. Place the patient extremity either foot or hand in the tub totally submerged. 

You can then take a Linear Probe with a Frequency of 7-10 MHz.

Run the probe along the surface of the water covering the part to be scanned adjusting the Sonography machine for depth as water will add to the interface and act as a contrast medium.

The Long Axis views get a better image of tendons, skin and bone while the transverse view helps evaluate multiple areas.

Water Contrast increases the diagnostic quality. 

This technique can diagnose: Fractures, Infection. Foreign Bodies and Tendon Tears. 

82nd Saturday Summit: WACEM Weekly Global e-Grand Rounds - Evidence Based Medicine


9th October 2021

 Neutrophil-lymphocyte ratio as predictor of outcome following traumatic brain injury Systematic review and Meta-analysis 


Speaker: Dr. Rakesh Mishra Assistant Professor Neurosurgery research and education at the Institute of Medical Sciences, Banaras Hindu University. 


Moderator: Dr Amit Agrawal on behalf of Neutrophil-lymphocyte ratio Research Group


Evidence-based medicine has revolutionized the decision-making process in different specialties of medicine. Systematic review and meta-analysis have been the
most important research tool for evidence synthesis and identifying the quality of evidence. Systematic review is an arduous task with iterative steps and requires extensive cooperative team work. In the talk the essential concepts, steps, philosophy and necessity of systematic review and meta-analysis was discussed using NLR in TBI as the model.


At the end of the session:


- Understand the concepts of systematic review and meta-analysis.


- Using NLR model the process of systematic review and meta-analysis was discussed into and all the individuals’ steps were deliberated upon. 


- Discuss on several research questions of importance to health care and emergency medicine and find the right approach for the evidence synthesis.


Friday, 8 October 2021

81st Saturday Summit: WACEM Weekly Global e-Grand Rounds - The Quaterly Resident Rumble : Evidence Based Wound Care in the ED

WACEM Quarterly Resident Rumble

2nd October 2021


Presenter: Dr. Courtney Kirkland, DO

                    PGY III

                    Florida State University

                    EM Residency Program, Sarasota, Florida.


Part I of the Presentation:

Journey of PGY III Resident and Status Today:

  • Description of Sarasota Memorial Hospital acuity and volumes

  • Responsibilities of an EM resident physician

  • A list of skillsets and procedures that we are proficient in.


Part II of the Presentation:

Evidence Based Wound Care:


  • Literature review with various data on controversial wound care management topics

  • Consensus on “time since wounding” for primary closure vs. delayed primary closure regarding clean wounds is 6-10 hours for extremity wounds and 10-12 hours or even more for wounds on the face and scalp

  • Contaminat4ed, infected or high-risk wounds should be closed by delayed primary closure

  • Always obtain an x-ray when concerned about a retained glass foreign body, physical examination alone is not enough to rule it out

  • Standard for wound irrigation consists of high-pressure irrigation with saline or water

  • Tap water is just as effective for irrigation as saline

  • Sterile gloves show no benefit over regular gloves for wound closure

  • Certain immunocompromised populations may require prophylactic antibiotics

  • Currently bite wounds above the clavicle are recommended to be closed with careful consideration of primary closure of bite wounds to the extremities

Saturday, 2 October 2021

80th Saturday Summit: WACEM Weekly Global e-Grand Rounds on Congnitive Theory in Simulation

25th September 2021

Speaker: Dr. Afrah Ali is an assistant professor with expertise in medical education and simulation at the University of Maryland School of Medicine. 

Topic: Cognitive load theory in Debriefing 
Debriefing is a complex skill that requires deliberate practice. The cognitive load theory when applied to debriefing helps to mitigate the various loads on the working memory. It helps enhance the debriefing experience for the learners and promote faculty development.

At the end of the session, the attendees were able to :

- Understand the concepts of cognitive load theory and its application in simulation.

- Categorize the many potential mental loads that can affect the faculty
debriefer as a learner. 
- Discuss mitigation strategies that can be considered by faculty development
programmed to enhance professional development of debriefing staff.

Monday, 20 September 2021

79th Saturday Summit: WACEM Weekly Global e-Grand Rounds on Situational Awarness in Crisis Situations

18th September 2021

The WACEM Grand Round was delivered by Professor Bonnie Arquilla from New York.

The Content Focused on a case scenario which brought to light perspectives of leaders from across the world.

It was very clear that many countries have a phenomenal preparedness plans which can be a benchmarks for others nations to follow.

Dr. Lateef (Singapore) emphasized that it is crucial that plans be optimized and followed and Dr. Michaelson (Israel) added that developing a plan and following it was extremely crucial in mass casualty situations.

Different leaders cited their opinions about importance of decision making when plans are exhausted and resources decline and physician burn out happens.

Plan for a Plan is key to contingency management and developing scenarios with options is key component of preparedness.

Without a plan failure is guaranteed and emotional decisions are never planned and are rarely agreeable as a standard.  


78th Saturday Summit: WACEM Weekly Global e-Grand Rounds on POCUS in Cervical Fractures

11th September 2021

VK, V., Bhoi, S., Aggarwal, P., Murmu, L., Agrawal, D., Kumar, A., Sinha, T.P. and Galwankar, S. (2021), Diagnostic utility of point of care ultrasound in identifying cervical spine injury in emergency settings. Australas J Ultrasound Med.

Online :

The Grand Round Focused on the Utility of POCUS in Identyfing  Cervical Fractures. It was a exploratory research model where initially training was imparted to the person doing the ultrasound and different probes were used to make the diagnosis.

Following Detailed Discussion Following Outcomes were comprehended:

1. More Study was needed on the subject

2. Proper Training Curriculum will need to be built

3. Creation of a  Ultrasound Compatible C-Collar could be a innovations Opportunity

4. Focus on MSK injuries beyond just bone injuries and also vascular assessment will be a great area of research.

Friday, 10 September 2021

77th Saturday Summit: WACEM Weekly Global e-Grand Rounds on Neutrophil Leucocyte Ratios in Traumatic Head Injury


4th September 2021

The NLR = Number of neutrophils divided by Number of lymphocytes.  In Inflammation the number of neutrophils increases, while the number of lymphocytes decreases.  

This Ratio was used to analyze large amounts of Data in Traumatic Brain Injury and Outcomes of that Data were discussed in Detail.

The Teams from The All India Institute of Medical Sciences, Bhopal presented their analysis in great detail followed by a very proactive discussion on importance of N/L Ratio in Emergency Medicine and Trauma. 4th September 2021.

The Discussion was led by Prof. Amit Agrawal Chief of Trauma at AIIMS, Bhopal. 

Some of the Latest Articles worth a read:

Djordjevic D, Rondovic G, Surbatovic M, et al. Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia?. Mediators Inflamm. 2018;2018:3758068. Published 2018 Jul 15. doi:10.1155/2018/3758068

Park JM. Neutrophil-to-lymphocyte ratio in trauma patients. J Trauma Acute Care Surg. 2017;82(1):225-226. doi:10.1097/TA.0000000000001266