Happy New Year! I rung in the New Year shortly after taking off from the Addis Ababa Airport in Ethiopia on my way back to Thailand feeling grateful and fortunate that I could see my family over the holiday season. The two weeks went by quick with the first week spent with my family in Canada and the second week with my wife's family in South Africa.
Lake Nipissing, North Bay, Ontario
ECHO Course Implementation:
The few weeks in December following my last post were busy. We conducted the first MTC ECU ECHO course for a group of 4 Burmese physicians: two radiologists and two internal medicine doctors. The two Burmese radiologists will be the lead instructors for the overall ECU Medic Ultrasound course. Therefore, each lecture included a training of the trainer component to prepare the participants to be future course instructors. As mentioned in the previous post, Part I of the course covers basic ECHO views, the 5 E’s of ECHO, diagnosing pericardial effusions, normal size ratios (1:1:1 rule), and assessment of left ventricular systolic function by visualization and EPSS. Part II of the course is divided into three modules covering advanced ECHO techniques, including cardiac tamponade diagnosis, right heart function, methods of evaluating right heart strain, valve pathology, diastology, and endocarditis. All participants picked up the ECHO skills quickly, especially the radiologists who are already experts in performing other US studies.
As part of the US course, after each interactive lecture, we went to the MTC inpatient department (IPD) to practice the US skills taught that day. We reviewed patient cases with the IPD staff to determine which patients would benefit most from an ECHO. Demonstrating how important and applicable ECHO training is in the MTC context, during the practice scanning sessions after the pericardial effusion/cardiac tamponade and right heart strain lectures, we uncovered patients with a pericardial effusion and severe right heart strain with D-sign, respectively. Perhaps this should not have been surprising, given the extent of pathology seen at MTC.
Pericardial Effusion found by ECHO course participants during practice scanning
Right Heart strain (D-sign, enlarged right ventricle with Tricuspid Valve regurgitation found by ECHO course participants during practice scanning
I have also finished the additional modules for the initial MTC ECU Ultrasound Course for medics, including eFAST, Lung, and RUSH exams. Tomorrow we have a meeting scheduled with our core ECU clinical team and the two radiologists to review these lectures and the overall ECU Ultrasound curriculum to ensure the material is agreed upon by the ECU and radiology departments. Although there are additional ultrasound studies that are important for emergency medicine practitioners to know, our first ECU US course is designed to teach the most critical US skills before the opening of the ECU. Once the ECU is open, we plan to implement a longer 6-month to 1-year ECU training program that will also include expanded ultrasound skills.
MTC ECU Medic Ultrasound Curriculum
Singapore Health Team Visit:
During the week of December 11th we were visited by a team from Singapore consisting of emergency medicine, orthopedic, and an engineer specializing in hospital facility design/architecture to discuss the ongoing ECU project. We had several days to meet, tour the MTC campus, and review the ECU progress. One of the most helpful aspects of the Singapore team visit is the expertise of the engineer who has designed multiple emergency departments in Singapore. We were able to review our preliminary design and have a collaborative discussion on modifications while also sharing the unique challenges to our ECU design given the unique MTC needs and constraints. We have continued ongoing dialogue with a virtual follow up meeting scheduled for this week.
Next post...
The next post will discuss the pilot project of an emergency care needs assessment to be conducted along the Burma/Thai border, first aid training course for conflict areas, medical cases from the MTC IPD, and more. So stay tuned!
Finally.... a December Sunset in Mae Sot
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