The aim of the SATG was to produce a triage scale for use throughout South Africa. The group was multi-disciplinary and comprised doctors, nurses and paramedics. The result
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of the SATG’s activities is the South African Triage Scale (SATS), a physiology and symptom based scale which prioritises into one of four colours and can be used in hospital Emergency Centres as well as in the pre-hospital setting. The SATS has been validated in the public, private health care setting as well as pre-hospital.
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Welcome to the World Health Organization pulse oximeter training manual. In many countries pulse
oximetry is mandatory for monitoring patients during anaesthesia. Although pulse oximetry is a simple and reliable technology that can detect low levels of
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oxygen in the blood, it is only effective if the anaesthesia provider understands how an oximeter works and what to do when hypoxia is detected. This manual describes a simple plan to respond to this situation, and explains how oximeters work and how to use them. The manual contains essential information for all anaesthesia providers who are not experienced in using pulse oximetry and would be useful reading for all members of the theatre team.
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DOI:https://doi.org/10.1016/S2213-2600(20)30316-7
The Lancet Respiratory Medicine
The IMCI chart booklet is for use by doctors, nurses and other health professionals who see young infants and children less than five years old. It facilitates the use
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of the IMCI case management process in practice and describes a series of all the case management steps in a form of IMCI charts.
These charts show the sequence of steps and provide information for performing them. The IMCI chart booklet should be used by all health professionals providing care to sick children to help them apply the IMCI case management guidelines. Health professionals should always use the chart booklet for easy reference.The chart booklet is divided into two main parts because clinical signs in sick young infants and older children are somewhat different and because case management procedures also differ between these age groups.
Sick child aged 2 months to 5 years
This part contains all the necessary clinical algorithms, information and instructions on how to provide care to sick children aged 2 months to 5 years.
Sick young infant aged up to 2 months
This part includes case management clinical algorithms for the care of a young infant aged up to 2 months.
Each of these parts contains IMCI charts corresponding to the main steps of the IMCI case management process.
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Most of the global burden of sepsis occurs in low- and middle-income countries (LMICs), but the prevalence and etiology of sepsis in LMICs are not
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well understood. In particular, the lack of laboratory infrastructure in many LMICs has historically precluded an assessment of the pathogens leading to sepsis. A recent systematic review found that data describing antimicrobial resistance were absent for 43% of countries in Africa, and only two countries have national antimicrobial resistance plans. In addition, small studies have identified indiscriminate antibiotic use both in and out of hospital settings in sub-Saharan Africa. The absence of microbiological data and lack of antibiotic stewardship complicate sepsis management and almost certainly worsens outcomes, particularly in low-resource systems. The purpose of this study was to examine the prevalence, etiology, and outcomes of sepsis among a cohort of critically ill patients in a referral hospital of Malawi, with a focus on the prevalence of culture-confirmed bacteremia and urinary tract infections.
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Wearing a face mask can help reduce the spread of COVID-19 in the community by reducing the release of respiratory droplets from asymptomatic / pre-symptomatic individuals or those with mild non-spe
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cific symptoms. The use of face masks for this purpose may be adopted to reduce the societal impact associated with absence from work or healthcare pressures due to infection, or to protect vulnerable individuals in particular settings.
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A guidebook intended for use by first responders
during the initial phase of a transportation incident
involving dangerous goods/hazardous materials
The cardiovascular disease continuum begins with risk factors such as diabetes mellitus (DM), progresses to vasculopathy and myocardial dysfunction, and finally ends with cardiovascular death. Diabetes is associated with a 2- to 4-fold increased risk for heart failure (HF). Moreover, HF patients wit
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h DM have a worse prognosis than those without DM. Diabetes can cause myocardial ischemia via micro- and macrovasculopathy and can directly exert deleterious effects on the myocardium. Hyperglycemia, hyperinsulinemia, and insulin resistance can cause alterations in vascular homeostasis. Then, reduced nitric oxide and increased reactive oxygen species levels favor inflammation leading to atherothrombotic progression and myocardial dysfunction. The classification, diagnosis, and treatment of HF for a patient with and without DM remain the same. Until now, drugs targeting neurohumoral and metabolic pathways improved mortality and morbidity in HF with reduced ejection fraction (HFrEF). Therefore, all HFrEF patients should receive guideline-directed medical therapy. By contrast, drugs modulating neurohumoral activity did not improve survival in HF with preserved ejection fraction (HFpEF) patients. Trials investigating whether sodium-glucose cotransporter-2 inhibitors are effective in HFpEF are on-going. This review will summarize the epidemiology, pathophysiology, and treatment of HF in diabetes.
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9 April 2020
WHO has published the guidance “Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected” This document is intended for clinicians taking care o
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f hospitalized adult and paediatric patients with severe acute respiratory infection (SARI) when COVID-19 infection is suspected. Optimized supportive care should be provided to ensure the best possible chance for survival of COVID-19 patients as described in the WHO guidance:
1. Management of severe COVID-19 requires oxygen therapy and monitoring. Supplemental oxygen therapy should be given immediately to patients with SARI and respiratory distress, hypoxaemia or shock.
2. Management of critical COVID-19 (acute respiratory distress syndrome (ARDS)) requires advanced oxygen/ventilatory support.
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The design of anaesthesia equipment for use in hospitals in the developing world must take intoaccount the local conditions, particularly whether reliable supplies
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of compressed oxygen andelectricity are available. Designs should ensure that maintenance is feasible locally. Internationalstandards should encourage the design of suitable equipment to ensure safe anaesthesia for patientsworldwide
Anaesthesia, 2007,62(Suppl. 1), pages 54–60
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4 April 2020
This interim guidance on oxygen sources and distribution strategies for COVID-19 treatment has been adapted from WHO and UNICEF’s technical specifications and guidance for oxygen the
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rapy devices, which is part of the WHO medical device technical series. This guidance is intended for health facility administrators, clinical decision-makers, procurement officers, planning officers, biomedical engineers, infrastructure engineers and policy-makers. It describes how to quantify oxygen demand, identify oxygen sources that are available, and select appropriate surge sources to best respond to COVID-19 patients’ needs, especially in low-and-middle income countries.
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For patients on NIPPV or HFNO with persistent hypoxaemia or respiratory distress:
• Check the equipment: inspect the exterior of the machine, the tubing (circuit), the mask for any sign of mechan
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ical damage, confirm it fits securely without leak (if CPAP/BiPAP) and the filters are in place. Ensure the settings are appropriate and flow is maximized.
• Check the oxygen source: there is sufficient oxygen available and flowing through the device. If FiO2 > 50% of oxygen is needed, the ventilator must have a blender.
• Check there is no obstruction with secretions: patients with COVID-19 may have very thick secretions which may block small and large airways and cause sudden respiratory deterioration.
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WHO recommends prompt recognition of progressive acute hypoxaemic respiratory failure when a patient with respiratory distress is failing to respond to standard oxygen therapy and adequate preparati
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on to provide advanced oxygen/ventilatory support.
Hypoxaemic respiratory failure in ARDS commonly results from intrapulmonary ventilation-perfusion mismatch or shunt and usually requires mechanical ventilation.
At any time, if there are urgent or emergent indications for intubation, do not delay.
WHO suggests that hospitalized patients with severe or critical COVID-19 with acute hypoxaemic respiratory failure that do not require emergent intubation be treated with HFNO, or CPAP or NIV (BiPAP) rather than standard oxygen therapy.
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This collection of posters are intended for health care workers, biomedical engineers and staff of health facilities in charge of caring, cleaning,
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decontaminating and sterilizing respiratory medical equipment in hospitals and health facilities. They include checklists to ensure the optimal infection prevention and control during their use and between patients.
They describe the procedures to follow (Checklists) to clean, decontaminate and sterilize different respiratory devices:
Oxygen concentrators,
Non-invasive mechanical ventilation equipment: High flow nasal cannula, BiPAP/CPAP,
Mechanical ventilators,
Pulse oximeters and monitors.
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Safe excreta disposal is a top priority in an emergency, but one that takes time and extensive resources to implement. This Technical Briefing Note examines the use of poo bags for safe excreta cont
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ainment and disposal in urban emergency settings. The Brief also explores ways of building more complete excreta management systems to ensure not only safe disposal, but also to ensure the dignity and safety of users.
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Oxygen is an essential medicine required at all levels of the health care system; only high quality, medical-grade oxygen should be given to patien
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ts. Pressure swing adsorption (PSA) oxygen generating plants are a source of medical-grade oxygen. This document provides technical specifications as the minimum requirements that a PSA Oxygen Plant must meet for use for the administration of medical-grade oxygen.
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For patients on HFNO with persistent hypoxaemia or respiratory distress:
• Check the equipment: inspect the exterior of the machine, the tubing (circuit), the prong for any sign of mechanical dam
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age, confirm it fits and the filters are in place. Ensure the settings are appropriate and flow is maximized.
• Check the oxygen source: there is sufficient oxygen available and flowing through the device. If FiO2 > 50% of oxygen is needed, the device must have a blender.
• Check there is no obstruction with secretions: patients with COVID-19 may have very thick secretions which may block small and large airways and cause sudden respiratory deterioration.
more