Monday, July 27, 2015

LDS Youth Conference Medical Support Debriefing

Here is a review of medical issues during Youth Conference. I was called by the Augusta Stake to provide medical support for a 5-Stake, 3-day/2-night Youth Conference at the campus of Western Carolina University.  The conference accommodated approximately 750 youth and 50 adults.  Western Carolina University is about 4 hours away from Augusta which was a considerable distance (8-hour round trip) for any parent to drive and pick up their child if they suddenly got ill or injured.  Consequently, there was a bit more increased pressure to treat what we could at Youth Conference.  Also the kids were having a good time and preferred to stay at Conference if they could.  We were fortunate to have a Super-Walmart, CVS Pharmacy, and Urgent Care 10 minutes away and a Hospital with ED less than 20 minutes away.  Parents were contacted and permission obtained in each case to treat complex issues over what OTC medications could treat.

1. Mostly we had youth complaining of mild lightheadedness, queazy stomach, which was aided with fluids (mild dehydration), OTC Emetrol (nausea), and OTC Ibuprofen (aches and pains).  Most kids claimed they were drinking enough water but probably were not.  I went through 2-3 bottles of Emetrol during the 3 days which, together with rest in a cool place and fluids, seemed to help.

2. Second common issue was typical musculoskeletal aches and pains.  Useful items were instant cold packs (2 boxes), Velcro reusable ACE wraps, and an assortment of knee, ankle support braces and arm slings.  Next to Ibuprofen and Emetrol, instant ice packs were also a very popular item.

3. Third common issue was the usual mild stomach virus. Again, rest, fluids, OTC Emetrol, OTC Ibuprofen, and OTC Imodium (diarrhea) helped.

4. The other issues during the Conference were more individual issues:

Broken Arm: stabilized with SAM splint and ACE wrap and sent with adult leaders to Urgent Care or Emergency Department for proper XRay, Plaster Splint and Sling application.

Shoulder Dislocation: Treated with Valium and reduced at the Conference with closed reduction, Ibuprophen and arm sling application but would have otherwise required an Emergency Department visit.

Elbow Laceration: local anesthesia provided with Lidocaine and closed with skin staples.  This patient was up-to-date with her Tetanus immunizations.

Pneumonia/Bronchitis: treated with perscription Z-pack, steroids (dexamethasone), inhaler /w spacer and Ibuprofen. Perscriptions were filled at local CVS Pharmacy by mother who was also at the Conference.  I could provide the initial dose. 

Bee Sting: Treated with perscription hydroxyzine but OTC benedryl would have been adequate.

Allergic Rash: Treated with perscription hydroxyzine and dexamethasone but OTC benedryl and OTC topical steroid would have been adequate.   There was the consideration of scabies if the rash did not improve and an Elimite prescription was provided.

External Ear Infection: Ibuprofen, antibiotic drops provided and a perscription of Cortisporin OTIC given.

Preventative Considerations: Recommendation for illness and injury prevention are 1. Every child required to carry filled water bottle.  2. Adequate 8-hour sleep schedule especially on the first night with the 5K scheduled at 530 AM the next morning. Also, children can feel the spirit better when they are better rested. 3. No skateboards or other similar skate equipment permitted. 

Things I liked: Variety of indoor vs. Outdoor activities on Day 2 as opposed to manditory outdoor activity. Children were then able to self-regulate and choose an activity that would not overtax their energy- and/or fluid-status. 

How Summer Youth Conference differed from Winter Trek: While there were many similarities in terms of the popularity of Ibuprofen, ACE wraps, Emetrol, Instant Cold Packs; the differences were more seasonal and situational.  Winter Trek saw more coughs and colds and OTC cough medicine was a popular item. Also Trek naturally had more issues with blisters and chaffing, so Mole Skin and Zinc-barrier cream (Boudreaux Butt Paste) was essential.  Also Winter Trek had more cold-related issues than heat-related issues so evacuating children to the Headquarters cabin to warm up and even sleep and then transporting mildly injured or ill kids from activity to activity instead of walking was essential.

Impact on the Doctor: I was definitely tired out by the end of the trip.  Some of this may have been due to driving a van with energetic 11 youth to and from the venue.  I enjoyed participating in the activities of youth conference, so I was following the kids from dorms to activities to meals.  It may save energy to establish a central medical clinic than follow the kids from building to building and activity to activity. However, for me, participating in the activities was more fun than being stuck in one central area even if it was exhausting at times.  Another energy-saving strategy was to treat kids on initial evaluation and then send them with an additional dose of ibuprofen, Imodium, or cold pack for later.   I prefer using velcro ACE wraps over Coban (self-adhesive wrap) because the ACE wrap is reusable. 

Critical Medicines and Supplies:
Ibuprofen (500 count bottle)
Emetrol (3 bottles)
Diphenhydramine (benedryl)
Epi-Pen (2 injectors) 
Albuterol MDI Inhaler with Spacer

ACE wraps (20)
Instant cold packs (20)
Knee brace (2)
Ankle brace (2)
Shoulder sling (2)
SAM Splints (2)
4x4 gauze (large pack)
Coban wrap (multi pack)
Antibiotic ointment
Anti-fungal cream
Steroid cream
Bandaids (various sizes)
Dermaplast Spray
Sunscreen 30 SPF
DEET Insect Repellent

Suture Closure Supplies (if qualified):
chlorohexadine scrub
nitrile gloves
1% Lidocaine
skin staple gun
skin glue
5 ml syringe 
23 g needle
4.0 Prolene Suture
Kelly Clamp Straight Forceps 

Airway Supplies:
Nasalpharyngeal Airways
Laredal CPR mask airway

Ability to Write Prescriptions for antibiotics, steroids, or Phone Number of Personal Physician who can call in a prescription.

Other Useful Medications: Pepcid, Zofran, Azithromycin, Gentamycin Ophthalmic, Cortisporin OTIC, Dexamethasone, Hydroxyzine, Meclizine.

Monday, July 20, 2015

Trump and Losing Faith

The current direction in America is one of losing faith.  America is economically, politically, and morally bankrupt. Seeing a report of Donald Trump leading in the polls can only serve to further decrease faith in America so that when there is a collapse, I suppose the majority will be ready to accept the next system put before us. 

Some doubt that Trump is a real candidate and has any chance of winning.  But with electronic voting and controlled media, any system that can get Schwatznegger elected in California, Ventura elected in Minnesota, and Obama elected in 2008 and 2012, can get anyone elected.  I'm not saying I know that Trump will win the 2016?presidential election, but if the system is set up to get the US and the world to lose faith in America, I can't think of a better candidate.

However, others think that Trump is serving as a media distraction.  4 years ago, numerous candidates dropped out of the race after saying something ill-advised. This year we seem to be seeing less gaffs in the media because no one off-the-cuff comments could possibly be more ill-advised than Trumps.

The Nephites in the Book of Mormon lost faith just prior to their division into tribes. Will history repeat?