PALS Santa Rosa de Copan

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PALSSanta Rosa de Copan

• Central American Medical Outreach
• CAMO
• Hospital Regional de Occidente
• February 25-28, 2008

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PALS

• Objective To teach Pediatric Advanced Life
  Support to a group of medical professionals in
  Santa Rosa de Copan
• Students came from many areas of Honduras
  including Tegucigalpa, Gracias, Santa Rosa de
  Copan, and Cesamo San Jose Copan

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Map of Honduras
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The Hospital
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Classrooms were housed in the Hospital Regional
de Occidente
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Class list Group A

• Clara Lainez, MD Instituto Hondureno Seguro
  Social (IHSS)
• Thunia Fancinily, MD IHSS
• Alma Rodriguez, MD Hospital Regional Occidente (
  HRO)

• Yadira Carcamo, MD Hospital Gracias
• Nelson Penman, MD HRO
• Jorge Madunado, MD HRO
• Hector Sandoval, MD HRO

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Class list Group B

• Jeanette Flores, MD Cesamo San Jose Copan
• Gloria Cacenes, MD Cesamo San Jose Copan
• Claudia Calix, MD Hospital Gracias

• Sonia Delattibodier, MD HRO
• Marisabel Rivera, MD HRO
• Marco Rodriguez, Paramedico, Santa Rosa de Copan

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Map of Honduras
SRDC, Gracias, Tegucigalpa
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The Faculty

• Carlos Delgado, MD Emory University, Atlanta,
  Georgia
• David Goo, MD - Emory University, Atlanta,
  Georgia
• Alex Rogers, MD - University of Michigan, Ann
  Arbor, Michigan
• Ricardo Jimenez, MD All Childrens Hospital, St.
  Petersburg, Florida

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The Faculty
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Faculty
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The Course

• The PALS video was shown and translated into
  Spanish, pausing the video while discussion and
  translation occurred
• Skills station checklists were checked off and
  signed by the instructors
• Shock lecture was given in Spanish
• Dysrhythmia lecture was translated into Spanish

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Skills Stations
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Skills stations
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Skills Stations

• Skills stations
• BLS
• 1 person 302
• 2 Person 152
• AED
• Airway
• Defibrillator
• Dysrhythmias

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Presenting the Video
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Intra-osseous Lecture
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Intra-osseous station
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Where to decompress a pneumothorax?
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Defibrillator Station
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Guest LecturerNatalie (Anesthesiologist at
Hospital Occidente)
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DOPE Pneumonic En Espangnol

• Desplazamiento
• Obstruccion
• Pneumotorax
• Equipo

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Shock Lecture
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Assess-Categorize-Decide-Act
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Testing Scenarios
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Las Drogas
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Teaching
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The Broselow Tape
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Working the Megacode
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Megacode
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Clinical Testing

• All participants passed the megacode.
• A few clinical deficiencies were identified and
  corrected.

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Thanks to the CAMO support staff

• Organization of participants
• Course Manuals
• Preparation of mannequins and all the many
  supplies for airway, BLS, AED, etc
• Copies of materials and tests
• Snacks, coffee, lunch
• Chicken legs for the intr-osseus skills station

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CAMO Organization of Equipment
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CAMO Support Staff
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Lunch and Snacks
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The Written Test
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Written Testing

• Pre-test and discussion were translated into
  Spanish
• Actual test was in Spanish
• 7 out of the 13 passed on the first try (Passing
  grade of 84)
• 2 missed just one extra question (80)
• Most were with in two questions (76)

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Remediation
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Remediation

• Tests were graded and key points were reviewed
  without answering the actual questions on the
  test.
• Participants were re-tested and all passed
  successfully

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Lunch post testing
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Graduation

• 13 Medical Professionals successfully finished
  the new PALS course
• Continued objectives will be to return and in
  time teach instructors and have a sustainable
  PALS class here in Santa Rosa de Copan

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Success!
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Faculty Organization
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Accomplishments

• Four pediatric emergency medicine attendings from
  3 different hospitals around the US successfully
  put on a PALS course in Spanish
• The trip was self funded with the cooperation of
  CAMO a large non-profit group in Honduras
• Faculty preparation and teaching time as well as
  some equipment were donated to the course and
  hospital.

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In kind course donations
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Central American Medical Outreach
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About CAMO

• CAMO has been serving Central America since 1993.
  
• CAMO's founder, Kathryn Tschiegg, RN served as a
  Peace Corps volunteer in Honduras.      
• Kathy returned to Honduras with a team of
  physicians and technicians from the United States
  in early 1992. 
• In 1993 she founded CAMO to provide medical
  supplies, equipment and education to hospitals
  and clinics in Central America. 

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CAMO

• At present, CAMO serves over 67,000 people a year
  in Central America
• Receives over 2million dollars in donated
  supplies, time and financial contributions.   
• A distribution center was built in Honduras in
  2003 and is now operated by CAMOs Central
  American counterpart Fundación CAMO. 
• Fundación CAMO serves as CAMO USAs local partner
  and conduit to the community. 

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Equipment

• Each year has seen an increase in the size and
  the number of specialty teams and an increase in
  the amount of medical equipment integrated into
  the public health system.
• All equipment provided by CAMO is technically
  sound and in good working order.  This equipment
  would be or has been discarded in the United
  States. 

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Sustainability

• CAMO trains Honduran public health staff to use
  the donated equipment through the efforts of
  licensed medical professionals from the United
  States who donate their time and services to 
  Central American hospitals and clinics. 
• These medical teams travel with the sole purpose
  of integrating medical equipment and technology
  into the daily workings of these facilities and
  training the Central American staff to use their
  new skills after the U.S. teams leave.

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CAMO Programs

• Capital Improvements in Medical Facilities    
• Dental Program    
• Wheelchair Repair and Distribution    
• Surgical Development Orthopedics, Plastics, Eye,
  and Urology    
• Prosthetic Lab    
• MMERV Program    
• Medical Education    

• Technical School    
• Research and Development    
• Community Center/Gym    
• Audiometry    
• Multidisciplinary Breast Clinic    
• Eye Clinic    
• Day Care Center

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Medical Education

• Educational Programs Currently Running
  Respiratory care and equipment Neonatal care
  NALS ACLS CPR OB/GYN Laboratory and
  X-ray Emergency medical services Dentistry
  and orthodontics Mammography related areas
• Now PALS

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Accountability

• Where Does the Money Go? With the extensive
  network of volunteers and in-kind contributions
  CAMO is able to get 7 dollars worth of work and
  equipment out of very 1 donated enabling CAMO
  to give the money to those who need it most.

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Volunteer Costs Time and

• It costs about 1,000 per team member for a week
  in Honduras
• Medical professionals donate their time with the
  understanding that they participate in an ongoing
  program which might require  a commitment of 1 -2
  weeks per year for five years.
• PALS will probably take three to four trips to
  accomplish the goal of a self-sustaining course

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Hospital Grounds
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Surgery and Womens Surgery
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Emergency Room
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Ambulance Area
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Old Pediatric Area
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Outside Old Pediatric Ward
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Current Pediatric Ward
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Nursing Station
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Pharmacy
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Enfermera Preparing Meds
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Penicillin Test Dose
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Rounding with the Pediatricians
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Radiology and Chart Filing Systemin the Patients
Bedspace (Chair)
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Reviewing X-rays
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Chest X Ray? Pneumothorax
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Femoral Cutdown
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Femoral Cutdown

• Done at bedside
• Pediatrician on call, covers ER, Nursery, and
  Inpatient wards
• Used a 10 French feeding tube cut off at an acute
  angle and inserted into the femoral vein after
  nicking.
• Vessel then ligated and feeding tube tied in.

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Intubated in General PediatricWard
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Mother with Ventilated Child
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Hospital Occidente

• 18 month old female with a history of one week of
  eye swelling.
• No fever
• No history of trauma
• No pertinent past medical history

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Hospital Occidente

• ?

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Bot Fly Pathology

• Ophthalmomyiasis refers to the invasion of the
  lids, conjunctiva, cornea, and rarely the orbit
  or globe of the mammalian eye by fly larvae
  (order Diptera) .1
• The human botfly (D hominis) is the most common
  cause of cutaneous myiasis in Central and South
  America, but few cases of external
  ophthalmomyiasis and no previous case to our
  knowledge of orbital invasion have been
  reported.2

1. Savino DF, Margo CE, McCoy ED, Friedl FE.
Dermal myiasis of the eyelid. Ophthalmology.
1986931225-1227. 2. Wilhelmus KR. Myiasis
palpebrarum. Am J Ophthalmol. 1986101496-498.
ambergriscaye.com/pages/town/botfly2.html
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The Bot Fly

• Scientific classification
• Kingdom AnimaliaPhylum
  ArthropodaClass InsectaOrder
  DipteraSuborder BrachyceraInfraorder
  MuscomorphaSection SchizophoraSubsection
  CalyptrataeSuperfamily OestroideaFamily
  Oestridae

http//en.wikipedia.org/wiki/Botfly
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The Human Bot Fly
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Bot Fly Pathology

• The female botfly glues her eggs onto the abdomen
  of a captured mosquito or other common fly.
• When the carrier insect lands on a human, the
  larva, or bot, hatches, burrows into the skin,
  and positions itself "head down" to feed,
  breathing through caudal respiratory spiracles.

ambergriscaye.com/pages/town/botfly2.html
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Bot Fly Pathology

• The larva withdraws through a central punctum,
  falling to the ground and pupating before
  emerging as a mature botfly.3
• Chloroform or lidocaine to anesthetize the bot
  may facilitate surgical removal as does occluding
  the breathing hole with ointment, beeswax,
  chewing gum, or pork fat.4

3. Lane RP, Lowell CR, Griffiths WA, Sonnex TS.
Human cutaneous myiasis a review and report of
three cases due to Dermatobia hominis. Clin Exp
Dermatol. 19871240-45. 4. Elgart ML. Flies and
myiasis. Dermatol Clin. 19908237-244.
ambergriscaye.com/pages/town/botfly2.html
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Human Bot Fly
ambergriscaye.com/pages/town/botfly2.html
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Human Bot Fly
ambergriscaye.com/pages/town/botfly2.html
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NICU
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Pediatric Interns in the NICU
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Premature Infant
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Hospital Occidente

• Macrosomia
• Edema
• Respiratory Failure
• Shock
• Breathing over ventilator

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NICU Flowsheet

• Dobutamine
• Albumin
• Furosemide
• Hydrocortisone
• Ciprofloxacin
• Clindamycin
• Fluconazole
• Midazolam
• Fentanyl
• Albuterol/Atrovent
• D10 NS

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Delayed Capillary Refill Time
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Post Bolus Improvement in CRT
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Delivery Room
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Resuscitation Equipment Delivery Room
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Delivery Area - Nursery
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ONLY Breast Feed!
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Breast Feeding Teaching Area
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Lecture to Pediatric Housestaff
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Benefits

• Cultural exchange
• Teaching
• Potential collaboration in the future
• Exposes us to the limitations of medical practice
  in other parts of the world
• Enlightens us about how our counterparts work
  internationally