Use of Seizure Prophylaxis in Traumatic Brain Injury, India

As global health fellow for Kids Care Everywhere (KCE), I had the privilege of working with talented physicians, residents, and medical students in Amritsar, India. During my first few days in Amritsar I noticed that smartphones were ubiquitous. Virtually all medical professionals had access to either an iPhone or an android smartphone. While these devices provided an incredible portal to the latest medical information, the medical professionals rarely used the devices in their clinical practice. Most physicians still relied on text books as their primary source of information. When KCE introduced PEMSoft, I was anxious and not entirely sure how the local medical professionals would receive PEMSoft.

Any doubts I had were quickly laid to rest when nearly 500 medical professionals joined the training sessions for PEMSoft. Interest in free access to PEMSoft was just incredible and unlike anything I could have anticipated. Tech savvy students / medical staff had the software downloaded on their smartphones, navigated it with ease, and appeared keen to use it in clinical practice. Faculty and residents at Government Medical College of Amritsar and Sri Guru Ramdas Medical College were confident that PEMSoft would improve medical care for underserved children seen in these hospitals. Faculty were particularly excited to have access to most current medical information through a phone that they already owned. Professors at both medical colleges also thought that PEMSoft would provide a great learning resource for the young physicians in training.

After witnessing the incredible energy among physicians during training, I was excited to see how PEMSoft could be utilized at the bedside. As I joined faculty and residents in their clinical rounds, I was impressed by impressive fund of knowledge and expertise of the local physicians. Joining the bedside teaching sessions of the expert local physicians provided an incredible insight into how PEMSoft was being utilized in a manner that seamlessly fit into the normal ritual of clinical rounds.

Clinical teaching rounds commenced in the morning around 10 AM with a pediatrics resident presenting a patient who was admitted overnight. On one of these clinical teaching rounds I trailed a group of 15-20 local physicians at various stages of their training. Traditionally in clinical rounds, faculty physician leading the group listens to patient’s presenting history, asks clarifying historical questions, reviews the management decisions made by the overnight resident, identifies teaching points, and recommends any additional treatment deemed necessary.

During this clinical rounds’ session, we stopped at the bedside of a 5-year-old male child who fell from the roof of his house while flying a kite. He sustained a traumatic intracranial hemorrhage (bleeding inside the skull) and presented with altered mental status. The overnight team managed his care in an expert manner performing critical steps of obtaining necessary CT scans, Intubating patient, and giving appropriate medications to decrease the high pressures building up inside his skull. The faculty physician asked clarifying questions regarding the various management steps and proceeded to teach the important steps in treatment of traumatic brain injury. From background, I witnessed young physicians in training looking through PEMSoft to follow along and learn the doses of medications and treatment options for patients with traumatic brain injury. After concluding his teaching points, the faculty physician asked the overnight senior resident if he had used PEMSoft in his clinical decision making. I was ecstatic to hear that PEMSoft was consulted by the senior resident in providing great care to this patient.

Being an expert, the faculty physician identified that this child had developed seizures after his traumatic brain injury and during rounds asked his team whether this child would benefit from antiepileptic medications (medicines that prevent seizures). The local resident physicians and I used PEMSoft and quickly ascertained that this child would likely benefit from seizure prophylaxis. The rounding team and I learned that seizure prophylaxis in traumatic brain injury tends to decrease early seizures (< 7 days from injury) but not late seizures.

PEMSoft helped us answer a clinically relevant question that changed care for this child who was immediately started on seizure prophylaxis to prevent further seizures. The ease and quickness with which PEMSoft answered our clinical questions was impressive to the entire team.

As we moved to the next patient, the teaching faculty physician identified more teaching points and I witnessed resident physicians answering questions and learning using the incredible database that was now at their fingertips thanks to the mobile version of PEMSoft.

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