Saturday, 24 October 2020

The 32nd WACEM-ACAIM Weekly Summit: Week 4 of e-EMINDIA2020

 








Surviving the Pandemic with Empathy, Passion and Music

Dr. Prabath Nanayakkara, MD, PhD
Professor and Head
Acute Internal Medicine and Pharmacotherapy
Department of Internal Medicine
Amsterdam UMC, Netherlands

In this brilliant presentation, Dr. Prabath serenaded us with his tunes. He talked about his journey toward becoming a professor in a foreign country. His story of feeling at first like an outsider to finding his way, his niche and his place in a foreign country and medical system serves as an inspiration to us all. In his journey, he dreamt of publishing in the internationally acclaimed journal, The Lancet, and made that dream happen. Even Grey's anatomy recognized his important publication about prehospital antibiotic use in the ambulance (link: https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(17)30469-1.pdf). His latest work involves a publication on the use of lung ultrasound in diagnosis and prognostication of COVID-19. During all of this, he continued to create and share his incredible music - a lesson to us all, not to forget ourselves outside of our work. Dr. Prabath's songs are available on Spotify, under artist: SERENDIB.

Kempegowda Institute of Medical Sciences, Begaluru


Convalescent Plasma Therapy in COVID-19 Patients

Dr. Bharat K, MD,
Assistant professor,
Department of Emergency Medicine

Dr. Bharat's comprehensive presentation began with reminding us of the past uses of convalescent plasma therapy in SARS, MERS, and H1N1. The theory is that plasma from donors who have recovered from COVID-19 infection, may contain antibodies to SARS-COV2 that may help suppress the virus and modify the inflammatory response in the recipient. Presently there isn't a good evidence base talking about the effectiveness of convalescent plasma therapy in COVID-19 patients, however, as we are struggling with finding the perfect antiviral therapy, Dr. Bharat thinks convalescent plasma ought to remain a contender in choosing treatment modalities, and encourages scientists, doctors, students to conduct more studies in hopes that we learn more and add to our evidence base.

Clinical Presentation of COVID-19 Patients at Tertiary Care Centres

Dr. Abheer Khan,
Post-graduate Resident
Department of Emergency Medicine

Dr. Abheer shared a study from her department which was conducted to recognize the mild to moderate symptomatology, prevent progression to severe disease, and to help contain the spread and appropriately triage cases. The study collected data from 56 patients over the age of 18 years, who were lab-confirmed COVID-19 positive, with mild to moderate symptoms. A lot of their results compared to other national and international studies, for instance, majority of patients belonged to the age group of 41-50 years, with a male preponderance. Fever was the most common presenting symptom, followed by cough. Gastrointestinal symptoms can be present in mild illness, even without URTI symptoms. She emphasized a point of note from the study that shortness of breath and chest pain can be treated as cause for concern. 

Acuity and Volume of Emergency Department Cases Before and During COVID-19

Dr. Sujay S,
Post-graduate Resident,
Department of Emergency Medicine

Dr. Sujay started his presentation with two interesting bits of information. First, an urban hospital in the US that reported a 35% decline in emergency department visits compared to the previous year, and second a multi-centre study from Qatar observing a 20-40% reduction in ED visits compared to the pre-COVID era. The study by his department, which looked at a total of 7,296 ED visits in a period of a month between 2019 and 2020, revealed 13.4-20.9% drop in ED visits. The decline in overall attendances and increase in proportion of severely ill patients, raised concerns that patients may not be seeking timely care during the initial presentation of any illness and presenting in critical condition can put a strain on the resources available to treat such patients. The study suggests an expected late surge. 

Vydehi Institute of Medical Sciences and Research Centre, Bengaluru

Lessons in Administrative Modifications in the COVID-19 Pandemic: Challenges in Surge Capacity - Oxygen Supply

Dr. Rajith Kumar K, MD,
Senior Resident,
Department of Emergency Medicine

Oxygen, an essential gas for survival of all things living, an important element on the periodic table, and an important element in our management of illnesses, not the least of which includes COVID-19, and yet we could do with learning more about it. Dr. Rajith emphasized the importance of meticulous planning needed in the prevention of major mishaps in case of failure in supply. COVID-19 has put a spotlight on the role of medical oxygen as a life-saving medical therapy. The Manifold Department is responsible in securing an adequate supply of oxygen 24x7. Apart from in-wall supplies to flowmeters, there are also various cylinders available to deliver ambulatory oxygen. Supply of oxygen should be included in disaster preparedness efforts since it is ultimately fundamental in our management across illnesses.

A Curious Case of Abdominal Pain

Dr. Dhruva P.V,
Post-graduate Resident, 
Department of Emergency Medicine

Dr. Dhruva described her case of a male in his 60s who attended the emergency department with abdominal pain, which had began 4 days before presentation, was diffuse in nature, and associated with nausea, vomiting, and loose stools. His vitals were remarkable for a heart rate of 188 per minute which was further revealed to be atrial fibrillation on his ECG, however he was stable with a BP of 140/74mmHg and was well perfused peripherally. He was lab-confirmed COVID-19 positive. The patient was given a dose of amiodarone to treat his tachyrrhythmia, which improved his ventricular rate to 160 per minute. Point of care ultrasound was performed at the bedside, and investigations conducted. A contrast enhanced CT revealed the diagnosis of superior mesenteric artery thrombosis with mesenteric ischaemia. The cardiology team were involved in deciding further management of the tachyarrhythmia and surgical team for treating the cause. Anticoagulation, antiplatelets, steroids, and antiarrhythmics were initiated and patient transferred to the critical care unit. Dr. Dhruva's case reminds us of the need for early consideration of anticoagulation in battling the thrombogenic disease state of COVID-19.

Tune in for more next week.

Check out http://www.indusem.org/ for various publications, information, affiliate links.


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