Christmas Update

Hey!

Since I posted this link on the bottom of my Christmas card figured I should update this with a quick synopsis of the year.

I finished residency at Wake Forest in Emergency Medicine in July and moved down to Augusta, GA to work at MCG (Georgia Health Sciences Univ) and now Augusta Regents University as a wilderness medicine fellow. I work attending shifts in the emergency dept - and then get to do a lot of wilderness medicine stuff which includes courses, conferences, trips, etc.
most of these adventures are chronicled here.

Next year I've accepted a position in the emergency department at Carilion in Roanoke Virginia. I'm hoping to eventually help contribute to wilderness medicine opportunities for in Roanoke.

I'm also a co-founder of blue ridge adventure medicine llc which is a new organization designed to offer hands on scenario based wilderness medicine education.

Interesting ingestion

Patient ingested all of these substances in a suicide attempt! Pretty much covers most toxic ingestions. Hydrocarbon, alcohol, alkali, acid, Tylenol, surfactant...

Updates:

Its sort of been a while since I've posted anything. Just a quick summary of the past month or so.

I took EM written boards November 12th. I'm glad its over.

I spent Thanksgiving at home in Charlotte with my family!

Liz came down Nov 23-25th and we hung out, compared war stories and did lots of mountain biking. We accomplished my goal of riding all the FATs trails in one day :) Somewhere in the ball park of 37 miles.

The next weekend I headed up to Winston-Salem and did the mistletoe half marathon. Nothing about my performance was impressive - but it was the furthest by 6 miles I've ever run in my life - and I sort of never trained for it - so I was just happy I managed to run the whole way.

The weather has been mild, which has allowed me to continue to get in some good mtn biking. Rich and I have gone night riding twice this week at FATs. The trails are even more fun in the dark.

Work in the ED over the past month has been busy. Plenty of critical patients - and plenty of the flu to keep me and the residents very busy!

Today (Thursday) I went to an ultrasound course for the critical care docs. Its awesome to work in a place where you can learn so much!

My upcoming projects include: MedWARs on April 20th and the 6th Annual Southeastern Student Wilderness Medicine Conference on April 13-14.
This spring it looks like a Wilderness EMS director course, WMS conference in Park City, Med support for racing the planet in Chile, and the completion of the WMS DiMM course at Rainier!

I've also got some research projects cooking...

Test rides at fats

Had a great Sunday testing out some fun bikes at fats!!

Peru day 8

Today is the last day of class. Matt Lyon gave us an excellent lecture on us in shock.

We did some review cases and then headed to the wards to scan. We scanned one gentleman who was intubated and as there wasn't a ventilator his family had to take turns squeezing the ambu bag to breath for him until he got better. His family was his ventilator. His prognosis was very poor.

We also went to ultrasound someone in the hospital next door. It was nicer than some US hospitals. It is crazy the disparities in care. You have patients lining hallways with no privacy and several hundred yards away another patient lies in a private room with a flat screen tv. I know disparity exists in the us system - but it's never been that glaring to me.

We have a big final dinner tonight at a restaurant over the ocean. Should be fun!!

Peru day 7

Had a good night last night. We ate dinner in barranco. I had lasagna as ive had my fill of lomo Saltado now.
Afterwards we headed back to loco mar and had hot chocolate and dessert.

I've finally mastered making coffee or atleast am getting used to it. Basically you mix about 1/2 glass hot water with 3/8 coffee 1/8 milk and 2 packets of sugar.

Today we learned about lung ultrasound and ocular ultrasound.

Saw some sad cases. HIV, karposi sarcoma, tb meningitis... And HIV, cryptococcal meningitis.
Interesting one of the patients was intubated for airway protection - but wasn't hooked to a ventilator - just had blow by oxygen. Both of the patients were in regular floor beds without monitors. Crazy how different healthcare is down here...

Went to the inca market after class and had an awesome dinner at San Antonio's.

Peru day 6

Today we learned about cardiac ultrasound in tropical diseases and ocular ultrasound. We went to the hospital and did some more scans. I'm amazed by the number of "sick" patients. Would be an overwhelming place to work. Saw one patient who was intubated but just on blow by oxygen. So different from what I'm used to!!

Tonight we are heading back to barranco.

I've managed to catch a pretty good cold - not sure if the guys are going to try to scan me or leave me in the Ed :). No worries. Pretty sure I got it on the plane not at the hospital and really just a runny nose and sore throat.

I attached a photo of Lucy's which is the hospital cafeteria and also of one of the EKG machines...

Peru day 5

Today we learned about ultrasound findings in HIV and ultrasounds of superficial structures like lymph nodes We spent some time on the medicine ward doing ultrasounds. We also had several PTs with tropical diseases come for scans. It's pretty sad to see the all of the people in the hospital.

Tonight we went to barranco and did some exploring and also had some dinner. My chicken Parmesan was pretty good. Afterwards we stopped by the grocery store and I bought some coffee.

Peru day 4

Today we had lectures on tropical ultrasound, liver and tropical diseases and echinococcus and PAIR.

We also spent a couple hours in the emergency department doing ultrasounds. We mostly did emergency type ultrasounds. We had 2 gunshot wounds to the buttocks, 1 car accident, a pregnant women with right abdominal pain, a guy with a dialysis catheter that had fallen out, and an older lady for a Dvt scan. We also saw several chest X-rays with tb.

I stuck with lomo sallado for lunch. It's a stir fry with beef, onions, peppers French fries which is served with rice.

Peru day 3 - ultrasound intro

Today we took a bus down to the hospital cayetano. The morning was spent brushing up on ultrasound basics. We did practice ultrasounds in the afternoon.

Had a banquet dinner tonight - and a good time afterwards...

Peru day 2

We started off the day with a buffet style breakfast at the hotel. Had some eggs and sweet bread type stuff. The coffee was the consistency of motor oil. It did taste better though :) then we headed down to see the pacific ocean and the walkway above the beach. There is a semi outdoor shopping mall there. Nothing seemed to open until 11 am. What a change from the us.

We then meandered back up to a plaza where we all enjoyed some much better coffee.

We then piled into a small cab - imagine 4 of us in the back of something the size of a Chevy cavilier and rode up to the Capitol building and the square where all the inquisitions were held. We ate lunch and had some inca soda at a rooftop cafe overlooking the presidential palace. We ordered a couple of dishes to share. One was a fried chicken breast with rice - the other was steak stir fried with vegetables and other was potatoes in a mild hot sauce. All were great!

We walked to another plaza through and outdoor shopping area and took a taxi back to the hotel. Next up is a short run next to the beach.

Beach was really nice. Lots of people were out with their families. There were numerous paragliders and surfers.

We had dinner at pescado capitale.
I had an excellent pork dish - and tried some others fish which was actually pretty good!
I also had pisco sours - a classic Peruvian drink - which was very good and strong :) Sunday morning came a bit early!

Peru - tropical medicine ultrasound

As a part of my fellowship I'm participating in a tropical medicine ultrasound course offered by the mcg faculty.

We all met at Dr kuhn's house this morning and carpooled to the Atlanta airport. It's about a 6-7 hour flight to Lima. We are staying at Jose Antonio hotel in miraflores. We have Saturday to do a bit of exploring before the course starts Sunday morning.

About 4 hours after getting to Lima we are finally at the hotel. 3 bags were lost and the ultrasounds didn't make it through customs.

Atleast my room is nice!

High Angle Rescue Conference

October 17th, 2012

After spending the morning lecturing (Mike spoke about high altitude and his everest experience) and I spoke about cold injuries (which luckily I have no personal experience with) we headed out to do some high angle rescue demonstration with the residents.

Laughing or Screaming?

 Mike rappelled down and got his fingers stuck, so I rigged another rapell line, came down to him, attached him to my ATC via a cows tail (sewn sling) and managed to get his finger free. We then tandem rapped down my line.

 In the next iteration I rapped down to the stuck climber. I attached him to my ATC again. This time I had to rig a 3:1 to untension his rope to get him off of it. I did this with a prussik above him with a 3:1 with a foot loop for me to stand in.

Who will make it to the top first?

We enjoyed climbing the rest of the afternoon!

ACWM Training Event: climbing

Sat Oct 13th: Crowder's climbing



Deb celebrating on the way down

One of my goals as part of the Appalachian Center for Wilderness Medicine was to plan some more group activities. The first one of these was a day of climbing at Crowders. Deb and I had a great time. She did some awesome climbing - 5.11b sport lead :) I couldn't even follow up that on top rope... maybe one day!

Hopefully the next events will grab a bigger crowd - or Deb and I can just have fun :)

Me struggling up

Mtn Biking Around Pisgah



View from Black Mtn

October 4-6th -Mtn Biking:  Brevard NC

I had a couple of fall days off so headed up to Pisgah with Matt and some of his friends. (Most of mine bailed...) We camped at the Davidson River campground and got in a lot of miles on the mtn bikes.
Thursday evening we rode Black Mtn. I rode this trail numerous times in college and probably once or twice since then. I was really disappointed after lugging my bike uphill (both riding and hike a bike) for almost 3 hours - to find the trail was in such poor condition (washed out waterbars, huge ruts) that a lot of it wasn't rideable (for me atleast). The view was still great from the top!



Matt on NC slickrock

On Friday and Saturday we rode at Dupont State Park. The trails there have great flow - and plenty of climbing and descending to keep me very happy (and tired). It helped to have a semi-local (Allen) ride with us on Saturday - as he was a lot more familar with the fun trails!



Great couple of days riding. Can't wait to get up there again. Won't be long until all the leaves are changing!

Resident Wilderness Day

Wilderness Medicine Day Oct 3, 2012:

Mike and I spent a couple day out on the Savannah River and on the trails around FATs setting up a medical adventure course which entailed the residents navigation on both water and land to answer a series of wilderness medicine related questions. They finished up the day with a series of land based stations including litter building, fishhook removal, intubating under and dock and dragging heavy mannequins from the water for resuscitation!

Overall an awesome experience for all involved!!

Mike paddles through the shallow water of the Savannah River

View from my kayak

 

Crane enjoys nature

Augusta Half Ironman

Sunday Sept 30th

I spent the afternoon out at the Augusta Half Ironman medical tent. Luckily there were no serious injuries on my watch - mainly exhaustion, cramping and some blisters. Powerade and bandaids were my medicine of choice for most of my patients. It was inspiring to see such a large group of motivated athletes! The triathalon was sold out with 3,400 participants!

Fishhooks in the ED

Impaled by a Fish Hook! Fish hooks are great at snagging fish and fingers. There are a number of novel techniques for their removal. In this situation after performing a digital block (numbing up the whole finger) we used the needle cover technique which is described below from the FPnotebook website. In this case as the fishhook was embedded fairly superficially and only had one barb it was very effective. We also up dated the patient's tetantus and washed out the wound throughly after removal!

Technique: Needle Cover Technique http://www.fpnotebook.com/surgery/der/fshkrmvl.htm

1. Indications
   1. Large hooks with single barbs
   2. Barb superficially embedded
2. Images
   1. Needle Cover Technique
      1. 
3. Technique
   1. See Preparation above
   2. Advance 18 gauge needle along entrance of fishhook
      1. Insert parallel to shank
      2. Bevel pointing toward inside curve of hook
      3. Longer edge of needle matches end of hook angle
   3. Disengage barb by advancing fishhook
   4. Pull and twist hook so hook point enters needle lumen
   5. Back the needle and hook together out of the wound