Migration of education materials

 Have decided to use this blog for personal reflections and have migrated all educational materials to:

https://emeducationportal.wordpress.com

Do visit here for more updated Emergency Medicine related resources. Thank you!

Peaberry Coffee bean... the 'only child'

Peaberry Coffee bean... the 'only child'

From quora.com

Coffee bean develops in the fruit... which is like a cherry. Usually there is are 2 beans inside the fruit. Hence these seeds have a flattened side (where the seeds are in contact with each other) and a curved side.  However, in 5% of the fruits, only 1 bean develops and hence the seed is less flat and rounder. It is supposed to be denser and smaller and the taste is supposed to be sweeter and more flavourful. This is called the Peaberry Coffee bean and is sold separately as the work involved in harvesting it is much more.

https://procaffeination.com/the-many-types-of-coffee-beans/

Burnout, stress and resilience

A collection of quotes and videos for our mental wellness.

Recgonising and preventing burnout

• NEJM article

Stress is your friend

Stress is not always bad. The physiological effects of stress actually help us to perform better in certain situations. Found this talk particularly useful...

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My very own inspiration from home- my husband Kumaran Rasappan. His 1 year stint to climb was an inspiration for many, especially for the Mithras in prison. How he inspired the prisoners was a story that left tears in my eyes. (3rd video)

Kumaran Rasappan's videos

Do you see the step between failure and success: 

https://www.youtube.com/watch?v=ASvmKPpW5Rs

Failures in Success

https://www.youtube.com/watch?v=PUchb6JwGAY

Singapore Youth award video- motivation to the Hindu Mithras

https://www.youtube.com/watch?v=SQa3HmggPm0

Its not just about the summit

https://www.youtube.com/watch?v=YbFcTJoPyn0

Testimony of courage

https://www.youtube.com/watch?v=-PDp7OXh68k

Take me to Everest

https://www.youtube.com/watch?v=ABHwgqEJWzs

Emergency Room MSK module on backslab application

Here are some videos that we have created as aid memoire for the junior doctors to learn how to apply plaster backslab:

Videos created in our department demonstrating the application of backslab

There is no one correct way....and there is no one size fits all. The most important thing to remember are the principles behind why and how we apply a backslab:

Why we apply?
1) It acts as a splint to immobilise the limb, allowing for good opposition of the ends of the broken bones
2) By acting as a splint, it prevents movement and hence reduces the pain from a broken limb

Types of material for splinting
Since splinting refers to immobilising the limbs, there are many methods of splinting which can range from using tree branches in the wild, to the SAM (Structural Aluminium Malleable) splint or splints made up of either Plaster of Paris or fibreglass.

Important principles

1. Backslab (non circumferential) splint is to be placed in an acute setting to allow for limb swelling to take place without placing the limb at risk of compartment syndrome
2. It is important to check and document the neurovascular status of the limb prior to and after placing a backslab
3. When placing a splint, it is important to keep the limb in an anatomically appropriate position to allow for healing without causing joint stiffening or deformity
4. It is important to have cotton gauze acting as a barrier between the plaster and the skin to prevent skin burns from happening
5. The pressure points are often forgotten and may require additional padding. Similarly, the plaster needs to be smoothen to ensure it doesn't exert excessive pressure on the skin and damage it

In a haste to help the patient, let's not cause the patient more harm!!!!

Dare CPR training in the Sikh community- Age is not a barrier to learn CPR

It was an honour to have the opportunity to liase with the Sikh community and introduce the Dare team to train them in CPR and the AED. What was even more impressive was the number of people who turned up and the age range of the audience!

It was also an eye-opening experience- working with them gave me a chance to better understand their community and culture. Most importantly, I discovered the strong support system they have for their people, especially the elderly.

Mdm Amarjit and her SIWEC Eldercare committee organises weekly activities for the elderly within a 12 week program block. The activities ranges from art & craft classes, to music classes to visits to various places in Singapore. Learning CPR and AED was one of the activities. We conducted it in the Silat Road Sikh temple and will be following up with another session at the Towner Road Sikh temple

Those who were physically not able to kneel down and perform chest compressions were equally keen to learn and even suggested that their role may be to instruct others to help and even get the AED during a cardiac arrest.

It was mainly an elderly audience, where Punjabi is the main language spoken. They leant fast and by the end of the session, seem more willing to perform CPR and use the AED.

Despite language barriers, they were enthusiastic and engaging and asked many questions at the end of the session. It was a wonderful way to spend the afternoon. It is also prove that age is not a barrier to learning how to perform chest compressions and using the AED.

Here is a slideshow from the session...

Aging is not a disease

Aging is not a disease. There are age related illnesses and a better understanding of these can help up prepare for the future.https://t.co/irNdC7bWsB #agehappily #happyagers #agingisnotadisease pic.twitter.com/jtxxO7IjJs

— Happy Agers (@happyagers_sg) June 2, 2018

Reflections on dementia

As an Emergency Physician, we deal with patients of all ages. One of the groups that repeatedly evoke deep thoughts about life and death, the Evolution of Medicine and what it truly means to be healthy is the group of elderly patients I see every day.

Furthermore, I had the unfortunate personal experience of seeing a love one being diagnosed with dementia and going through the process of helping my family understand what dementia is. Dementia is a word we so commonly use in our workplace that sometimes we forget that most of the world may not truly understand what it means... and the impact it can have on ones life. I learnt that:

• What may seem so obvious to us from the medical world may not be so obvious to the rest

The signs and symptoms of dementia in my aunt was obvious. But to the rest of my family it wasn't. For many years, my aunt would claim that people were entering her house and stealing her belongings. And at times, she would call us to her house as she 'Felt unwell' and when we arrive, we would find her looking perfectly well. I realise that she was making these accusations as she couldn't remember where she left her things... and was in denial that she was becoming increasingly forgetful. Hence her defence mechanism was to make these accusations. She also forgot how to express herself especially when she was ill such as when she was having a fever. Hence, though she looked well.... she was usually brewing an infection when she told us she wasn't feeling well.

• Denial and lack of insight makes it challenging

• A sense of purpose keeps them mentally active and appears to slow down the cognitive decline (the slowing of the mental state)

• People who do not understand dementia or the process of an illness can get frustrated, angry and can lead to misunderstandings and disgruntlement within the family

• People can understand illnesses like stroke, heart attack and cancer but not conditions like dementia, depression or anxiety. If someone said they had chest pain, one would take it seriously. But if one became increasingly forgetful or depressed, we get frustrated with them, without realising this is a symptom of their illness

• One has to look out for signs of stress in the caregiver as they can burn out easily.

I saw this when my mother first understood learnt about the diagnosis of dementia (through the youtube videos I showed her and through the nurses from Touch Home Services)... it took her a while to understand, during which, the stress of her sister's condition was taking a toil on her wellbeing. It was after many conversations, videos and sessions with the Touch nurses that she learnt how to handle her sister's dementia. After which, she came up with innovative ways to help her sister remember things and function independently.

• It is hard to find help for the in-betweeners (eg: those who do not have severe dementia and with no insight; hence still appearing normal but slowly deteriorating) Help in the form of resources for equipment and services for the elderly is equally challenging. What is most challenging is finding for activities and events to engage these group of people to keep them active as well as prevent mental deterioration

• Medicine, especially doctors can be a hindrance to healthy and happy aging... by wanting to find an answer and treat everything without taking into account what the psychosocial environment and the personal desires of the individual. 

For example, giving multiple appointment for minor ailments, which may be natural in the aging process. This 'medicalises' normal aging changes and creates a "I have to see the doctor; hence I am sick" mindset. Furthermore, each clinic appointment involves the waiting time for registration, to see the doctor and obtain medications, which means spending half a day in the hospital, which can take a toil on the individual and their caregiver.
Another example is wanting to investigate everything because the protocol or guidelines dictate as such. This is inevitable in today's climate, where there is a fear of legal actions in the healthcare industry or the fear of 'missing something'. However, the solution for this can be a hear-to-heart honest discussion with the inividual and family rather than subjecting them to every possible tests. Sometimes it is not the answer that matters... but the reassurance and a discussion on the implications on one's life may be what is needed.

There are many challenges and they are going to get worse with our ageing population. Perhaps we have to think out of the box for new solutions....