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Published 2 papers and 1 video

mobile chain of survival
Just recently my colleague and I have published two research papers. I am very proud of the first one titled “Mobile phone in the Chain of Survival”, which was published after a lot of research in the Resuscitation journal. This short paper gives an overview of vast possibilities possessed by mobile phones to be of assistance in medical emergencies. It represents a continuation of my work with CPR mobile applications. I have also now published a video of the lecture I gave during the Resuscitation 2010 congress about the same subject. You can watch my 10 minute lecture here, and read our paper at the Resuscitation website.

The second paper we wrote appeared in the Croatian journal Lijecnicki Vjesnik (in English this would be something like Physician’s Newsletter). It is a case report demonstrating a patient with smell disorders, which we suspect were caused be lacidipine, a calcium channel blocker used to treat hypertension. So far this drug has not been linked with smell disorders, but other calcium channel blockers from the same group are well known to cause such problems. The paper is written in Croatian, but its abstracts is available in English – Can lacidipine cause smell disorders? A case report.

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Informed Pocket Guides for the iPhone

Informed Pocket Guide
I discovered Informed Pocket Guides almost two years ago and have been a huge fan ever since. The first product I got was the Emergency & Critical Care Pocket Guide. I believe the fact that I take extra care this little/big guide is always in my bag when I go to work, says it all. It is small, light and compact, yet it has all the necessary reference information you might need in medical emergencies. It is especially useful if you work in the field.
Informed Pocket Guide pages
Emergency & Critical Care Pocket Guide has almost 200 pages and covers the following topics:

  • Current ACLS Algorithms, Lab Values, Metrics, Notes
  • Emergency, ACLS Drugs & Top Prescription Drugs
  • IV Drips, Drug Infusions, Dosages
  • Poisons & Overdose / ‘Rave’ Drug
  • 12-Lead ECG Section & Acute MI
  • Medical Emergencies Section
  • Quick EMS Spanish Translations
  • Fibrinolytics for AMI & Stroke / CVA
  • Childbirth, Diabetic, Respiratory Distress
  • Pediatric Resuscitation, Drug Doses, Vitals
  • Trauma, Triage, MCI, Glasgow Coma Scales
  • Airway Management /RSI
  • Burn Charts, the ‘Rule of 9s’
  • Pulse Oximetry
  • Infectious Diseases

Well, ever since the first iPhone medical apps started appearing, I thought to myself… hmmm I would love to have my medical pocket guides on this great device. Obviously, it was just a matter of time when Informed would port them to this mobile platform, and yes they are here! The complete series of Informed Medical Pocket Guides are now available for the iPhone and iPod touch. Titles like the RN Pocket Guide™, EMS Field Guide® BLS & ALS edition, NIMS: Incident Command System Field Guide™, and of course the Emergency & Critical Care Pocket Guide™ are available for $9,99 USD via the iTunes store. In fact the Emergency & Critical Care Pocket Guide app has just recently been updated with many improvements, so now is the best time to present it to you.

Informed Pocket Guide and app
If we take a look at the content, the app is the same as the pocket guide. The basic difference is that on one side you have a physical pocket guide, and on the other an application for your iPhone. Now, bringing the guide to the iPhone has some advantages and some disadvantages. First of all, you no longer have to worry about forgetting the pocket guide. You have all the same information available on your mobile phone, which you carry everyday and everywhere you go. This all makes perfect sense, since the iPhone is by itself a great mobile phone for doctors and other medical workers. So having another great medical app running on it just makes it even more powerful. Furthermore, you can do things with the app which are impossible or difficult to do with the pocket guide. One such thing, and maybe the most important one, is finding information quickly. The pocket guide is not an encyclopedia, but still it has a lot of dense information on small pages, so finding exactly what you need can prove to be difficult. Sometimes I just know that I have seen a piece of information or a chart in the guide, but cannot find it unless I flip thru numerous pages. The app is the champion in this area. It is very easy to find information you need thanks to the great built in search function, but also other navigation features like the possibility to flick thru pages, go to a specific page, browse the table of contents and see thumbnails of pages. Other interesting features include bookmarks and notes which again are there to make the data you need and often use more accessible. On the down side, the iPhone screen is a little bit smaller that the pages of the pocket guide. Maybe this could be a problem for some, even though the resolution is high so you can simply zoom in and see all the details. Also, you might not like the idea of bringing your iPhone with you in the field out of the fear it might get damaged or other reasons. I also found that sometimes its touch screen does not work flawlessly if I wear protective gloves.

Here are some of the photos of the Emergency & Critical Care app and the pocket guide:

Both the pocket guide and the app have things going for them, so you will have to choose which one better suites your work flow and style. I like them both so much and cannot decide. It seams that the pocket guide will remain in my bag and the app on my iPhone. I am really looking forward to new updates of the app, and hope that in the future it will incorporate more interactive content, so it could maybe replace some of the other apps I have installed on my iPhone, like various medical calculators.

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Year in Review 2008: Best in Health by WorldChanging

WorldChangingWorldChanging brings stories of the most important and innovative new tools, models and ideas for building a bright green future. Their articles are just amazing, and for the end of 2008 they decided to rediscovered some of the great events, innovations, interviews and debates that they covered in the previous year. They wrote a series of articles titled Year in Review, which was divided into several categories like best in climate change, energy, and of course best in health, food and society.

Here are the summaries of their best health stories from 2008.

Facebook, Coca-Cola and Medical Aid in Africa

Simon Berry has an idea. Why not persuade Coca-Cola to dedicate a fraction of its distribution network to carry medicines for simple, widespread and life-threatening ailments like diarrhea. Why Coca Cola? Because even the most remote African communities have limitless access to bottles of Coca-Cola.

Making Social Equity an Issue of Public Health

This article discusses the issue of health equity. How is it possible that there is a 28 year difference in life expectancy between the most and least fortunate residents of Glasgow, Scotland?

The Transformative 120: Text Messages Prove a South African HIV Lifeline

Six million South Africans are infected with the HIV, but just one in ten are currently in treatment. Project Masiluleke sends mobile customers texts pointing them to the National AIDS Helpline (0800-012-322) and HIV911 (0860-448-911).

Worldchanging Interview: Dr. Sanjay Gupta on Health Solutions

Interview with Dr. Sanjay Gupta, chief medical correspondent at CNN. He is a practicing neurosurgeon and award-winning journalist who is dedicated to helping improve public health and spreading awareness of health-related environmental issues.

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Access life-saving information in the field using iPhone

I came across a press release which further strengthened my belief that iPhone is perfect for doctors. The whole project is so exciting that I just didn’t want to leave anything out. That’s why I decided to include the complete press release here.

iPhone and new technology enables health providers to access key life-saving information

BLACK DIAMOND, AB, Oct. 3 /CNW/ – When Foothills Regional Emergency Medical Technician (EMT) Mike Anderson recently arrived at the scene of a car accident and found a person unconscious, he assessed the patient’s condition and realizing he had little patient information, activated an iPhone to obtain necessary health data on the person’s allergies and current medications.

Since April, the Calgary Rural Primary Care Network (PCN) has conducted a pilot project using iPhones and unique software to provide secure access to patient data to physicians and other health providers outside of health facilities.

At the Foothills Family Medical Centre, Dr. Tim Dowdall and the nine other family physicians volunteered to pilot and manage the iPhone initiative funded by the Primary Care Network. The iPhones have been modified to increase security of patient data with protocols that exceed those of banking machines and other secure networks. Also, even if an iPhone is lost or misplaced
somewhere, no patient information resides in the phone. As well, a Patient Impact Assessment, a standard security review done by the Primary Care Network when new health technology was introduced, validates the company’s security safeguards.

The iPhones are linked with a state of the art software program that allows physicians and other designated health providers to pull information from the local electronic medical records in the Foothills Clinic to the point of care.

“The iPhone and support software,” says Dowdall, “improves the quality of care and access to necessary patient information for those of us who are working outside of our clinics and need data to make a clinical decision.” This is the kind of information sharing required to serve patients living in a
community with increasingly complex health issues.

Theresia Berry, a Paramedic with Foothills Regional Emergency Services in Black Diamond, south of Calgary, believes the iPhone has become an invaluable tool for accessing necessary patient data. “Often before we even arrive at the scene, we can use the iPhone, find out the patient’s past medical history, and just have a better idea of what we’re dealing with so we’re prepared,” she says.

They might receive a call because a person is in distress, but it could be one health condition or several medical issues. Sometimes even when they arrive at the scene, the person or family members may not be aware or under too much stress to explain clearly the medications and health conditions of the person affected.

“The iPhone gives us immediate and accurate clarification of the person’s health status,” she explains. Dr. Dowdall gives a unique example of taking the health iPhone and going
on vacation in Banff, Alberta. He received a call from his clinic about a patient and unlike in the past, when a non-urgent decision would be deferred until his return, he activated the iPhone, looked at the patient data, and made a decision.

This information sharing project and the use of technology supports the type of collaborative practice required among health professionals to coordinate and improve medical care. Homecare nurses in their offices can currently use the solution in linking patient electronic data from the Foothills Clinic. There are huge benefits in accessing information when visiting clients’ homes. Frequently people with complex health needs are confused regarding their conditions and various drugs and treatments that are being employed. Having one shared “source of truth” in the electronic record is extremely beneficial to get the care team on the same page.

Berry does admit there is one challenge in sometimes using the iPhone, especially in a more rural location. Cell phone reception is occasionally not good. However, Berry says she and her partner, EMT Mike Anderson, are aware of those locations and are usually able to obtain the necessary patient data before entering those areas.

Response to date from all physicians involved in the iPhone pilot project has been positive, says Dowdall. What makes the technology unique is that physicians can input into the software program the level of patient information other health providers require to do their jobs while restricting
access to any other information. This collaboration, and providing iPhone access to patient medical records, is likely a first in Canada and represents a significant step forward in having all health professionals working as a team to provide better health care to patients in Alberta.

Primary Care Networks (PCNs) are a made-in-Alberta approach to improve the delivery of primary care. A Primary Care Network is formed when a group of physicians and Alberta Health Services agree to work together to provide enhanced primary care services. In addition to physicians, other health professionals are key partners in delivering PCN services. Alberta Health and Wellness, Alberta Medical Association and Alberta Health Services are partners in the development of Primary Care Networks.

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Why is iPhone perfect for doctors

I purchased my iPhone about six months ago and it has in many ways changed my life for the better. This is especially true regarding my work as a medical doctor. I believe that iPhone is a perfect gadget and that it can improve any physician’s performance. That is way I decided to present some of many useful ways you can utilize iPhone in your practice.

Access your Electronic Medical Record

Life Record is a company which produces Life Record Electronic Medical Record (EMR) software. What is interesting about it is that you can access your records form an iPhone. You can also make updates and even write prescriptions.

View medical images

To view your radiology images remotely you can use the Mobile MIM iPhone Application. This application provides multi-planar reconstruction of data sets from modalities including CT, PET, MRI and SPECT, as well as multi-modality image fusion. Using the multi-touch interface, users can change image sets and planes; adjust zoom, fusion blending, and window/level.

Calculate, compute, add, subtract, multiply, divide

Medical Calculator gives quick access to calculations that are too hard to memorize or perform in your head. There are around 50 clinical calculations that you can do with it right now, and more are coming. To not get lost, favorite those you use often.

Medical calculator

Access drug information

Epocrates Rx software for iPhone puts continually updated peer-reviewed drug information at your fingertips. This can improve patient care and safety, save time, reduce administrative burden and enable confident clinical decisions.

Take notes

There are many powerful note taking apps for iPhone out there. But let me just present the two most interesting, Evernote and Jott.

Evernote allows you to take text, snapshot, saved photo and voice notes. When you take for example a voice note, you can add a title to it, some description and tags. The interesting thing happens after you have taken your notes. They synchronize with your online account and what this means is that you can access them from anywhere. From your computer using a desktop application or from any other computer in the World with an Internet connection via the web interface. Everything is always synchronized across all of your devices. One cool thing that Evernote can do is transcribe images, meaning that it is capable to find text inside an image and make it searchable. It doesn’t yet transcribe your voice notes to text, but I believe this feature will be coming in the near future.

There are some advices on how to use Evernote on The Efficient MD blog, but I am sure you can think of many more ways to utilize this app. For example you could take snapshots of your patient’s injuries in the ER or record interviews with your patients.

Well, this other application, Jott is capable of doing what Evernote still can’t. It can capture your to-dos and transcribe your voice into text and place the resulting notes in your lists.

If you like Evernote, but desperately need for your voice notes to be transcribed to text, don’t worry. There is this great hack from Lifehacker that can help you.

Stay on top of your field

As a modern evidence based medicine physician you have to read and follow new developments in your field. Often you find interesting articles on the Internet, but don’t have time to read them. My advice is to save them for latter and read them on your iPhone during your breaks, when you are on call and have some free time or while waiting in some line. Perfect little app that can help you do just that is Instapaper and it is one of my favorite iPhone app ever. When you find something on your computer that you want to read later, simply click Read latter bookmark. Then when you have time, just open Instapaper app on your iPhone and read those articles. You would think that the iPhone’s screen is too small to read, but you would be wrong. It’s high resolution screen and zoom capabilities make reading enjoyable.

Of course you can read whole books on the iPhone too. Use Stanza to transfer and read all your important medical e-books.

Apart from reading, you can do a little bit of watching and listening, to thousands of podcasts in the medicine category. A podcast is a series of audio or video digital-media files which is distributed over the Internet and can be transfered to your iPhone. Listen and watch podcast from The Lancet, The New England Journal of Medicine and many others while you, let say, travel to work.
Podcast directory

Enhance your scientific research

You can use your iPhone to find scientific literature. Download PubSearch and search among the millions of research papers indexed in PubMed. This app has a simple user interface with fast access to the PubMed database, and it lets you concentrate on finding the research articles you need without getting in your way. PubSearch Plus is on the way and it will allow you to not only read abstracts, but full-text articles too.

Convert your iPhone into a wireless external disk, one with a lot of memory. This way you can carry around all the important documents for your undergoing scientific project. Come to a meeting with your colleagues and have all your excel and powerpoint files with you. Also bring some scientific articles in pdf, or other format, related to your research. All these files can easily be opened on your iPhone or access from any PC or Mac in the room. This is all done using AirSharing for iPhone.

Play games

You too deserve to have fun from time to time. There are numerous great games for iPhone and if nothing these can help you relax during an intensive and difficult shift. There have been some results published about video games and their ability to enhance surgeons’ performance. So before your next surgery why not try playing a game like Labyrinth to get you all warmed up and focused.

As you can see there are numerous useful ways you can utilize iPhone as a medical professional. This is not all of course, there are many other interesting apps coming up everyday and I did not mention the obvious things like reading email, surfing the web and contacting people via sms or IM services. I am looking forward to new medical apps that might appear in the future. Also, wouldn’t it be cool if somebody introduced some iPhone medical accessories. I would like to see some pulse oximeter sensors or ECG cables for iPhone. They could plugin-in to it’s 30-pin dock connector to input data which, I am sure, due to it’s processing power iPhone would not have a problem to analyze. Are we getting closer to those great all in one medical devices from Star Trek? 🙂
Star Trek

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Young man dies from tongue piercing

tounge piercingHaaretz Newspaper from Israel brings a story of an 18-year-old Israel Defense Forces soldier who died this Sunday from an infection he received from a tongue piercing.

The soldier had been hospitalized in serious condition for over a month in Rambam Hospital in Haifa after he developed 14 abscesses in his brain from bacteria that spread from the piercing in his tongue.

The manager of the emergency room at Rambam, Dr. Yaron Bar-Lavi said that during the course of the soldier’s treatment, he began taking medication to deal with spasms that had been caused by the abscesses.

Over the last two days, doctors discovered that the medicine had caused serious problems with the soldier’s liver and led to the decline in his condition and eventually his death.

Back in 2003, Richard Martinello and Elizabeth Cooney published a brief report in Clinical Infectious Diseases Journal entitled “Cerebellar Brain Abscess Associated with Tongue Piercing“. They presented a case of a previously healthy adult who had a solitary cerebellar brain abscess diagnosed. This infection occurred 4 weeks after the patient underwent a tongue piercing procedure that was complicated by an apparent local infection. The clinical history, abscess culture results, and lack of an alternative explanation suggest that infection of the tongue piercing site was the source of the cerebellar abscess.

While brain abcesses present a very rare tounge piercing complication, local infection, pain, bleeding, edema, inhalation, dental trauma, contact lesions, oral interferences and endocarditis are more common. So think twice before getting one.

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