Emergency Medicine Society of South Africa guidelines for the training and credentialing in emergency point-of-care ultrasound.

This is the second guideline from the Emergency Medicine Society of South Africa (EMSSA) on the use of emergency point-of-care ultrasound in South Africa. It supersedes and replaces the guidelines produced in 2009. This document contains information on the changes from the 2009 guidelines and details of the training and credentialing processes recommended by EMSSA. It also contains detailed information on the curricula of the Core Emergency Point-of-Care Ultrasound and Advanced Emergency Point-of-Care Ultrasound courses.

Let's get physical: A prospective pedometer study of doctors working in a South African emergency department.

BACKGROUND: The positive impact of physical activity and exercise on health is well known. Individuals who walk at least 10 000 steps per day are likely to meet recommended physical activity guidelines. Very little is known about the physical activity levels of doctors at work, in particular those working in emergency departments (EDs). OBJECTIVES: To determine how many steps per shift were taken by doctors in a South African (SA) ED. Secondary objectives were to assess what factors influenced the number of steps taken. METHODS: This was a prospective observational cohort study in a tertiary academic teaching hospital ED in Johannesburg over a 1-month period. Doctors wore pedometers during their day shifts in the ED and the number of steps taken during their shifts was measured, as well as the number and triage category of patients seen and whether cardiopulmonary resuscitation (CPR) was performed. RESULTS: The median (interquartile range) number of steps taken per shift was 6 328 (4 646 - 8 409). The number of steps taken exceeded the 10 000-step target in only 11.7% of shifts. The overall mean (standard deviation (SD)) number of steps per hour was 744 (490). Factors that significantly increased the number of steps taken included shift duration, number of patients seen who were triaged yellow, and performance of CPR in a shift. Each additional hour of shift led to a mean (SD) increase of 575 (115) steps. Each additional yellow patient seen led to a mean (SD) increase of 118 (108) steps. The mean (SD) number of steps for a shift with CPR was significantly higher (8 309 (850) steps) than for a shift without CPR (6 496 (384) steps). CONCLUSIONS: Doctors working in an SA ED are not achieving the daily recommended number of steps while at work. The increased risk of ill health and burnout in an already high-risk specialty heightens the importance of exercise and physical activity that needs to be achieved outside the workplace.

The quick machine--a mathematical model for the extrinsic activation of coagulation.

The present paper describes a mathematical model of the kinetics of the extrinsic coagulation cascade in vitro. The coagulation factors FI, FII, FV, FVII, FX, heparin and antithrombin III (ATIII) as well as soluble fibrin polymers are considered. The effect of single-factor deficiencies of the factors II, V, VII and X, diseases like hypo- and dysfibrinogenaemia, hepatic insufficiency, inhibited polymerisation by degradation products, heparin therapy with and without ATIII deficiency and coumarin therapy on prothrombin time can be portrayed. Physiology of coagulation is represented in a dynamic mathematical model as a differential equation system. The model is based on three reaction types: enzymatic cleavage, complex formation and polymerisation. The model was implemented in a continuous simulation program on a personal computer using the Pascal programming language. Unknown rate constants were estimated by chi 2 fit. Prothrombin time calculated by the model was compared to the training set of 20 plasma samples. In most but not all cases the model harmonized quite well with the coagulometric data.