Resource Limited Environment

Aka: Resource Limited Environment, Acute Healthcare in Low and Middle Income Countries, LMIC Healthcare

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II. Definitions

  1. LMIC
    1. Low and Middle Income Country

III. Types: LMIC Facilities and their resources (including monitoring, sedation and analgesia)

  1. Health Clinic
    1. No Running water, electricity or oxygen
    2. Vital Sign monitoring (pulse, Temperature)
    3. Local Anesthesia (Lignocaine)
  2. Rural Hospital 1
    1. Running water and intermittent electricity, but no oxygen
    2. Vital Sign monitoring (pulse, Temperature, Blood Pressure) AND stethoscope
    3. Local Anesthesia AND sedation (Ketamine, Diazepam, Midazolam)
  3. Rural Hospital 2
    1. Running water and continuous electricity (with some interruptions), but no oxygen
    2. Pulse, Temperature, Blood Pressure, stethoscope AND Oxygen Saturation
    3. Local Anesthesia and sedation (as above) AND Ephedrine, Analgesics, spinal Anesthetic
  4. First Referral Hospital
    1. Running water, reliable electricity, and oxygen is often available
    2. Pulse, Temperature, Blood Pressure, stethoscope, Oxygen Saturation AND EKG
    3. Local Anesthesia, sedation, Analgesics, spinal Anesthetic AND Drawover (Halothane), induction (Propofol), paralytic
  5. Regional Hospital (level 2 facility)
    1. Running water, reliable electricity, and oxygen
    2. Pulse, Temperature, Blood Pressure, stethoscope, O2 Sat, EKG, AND mechanical Ventilator, ET-CO2
    3. Local Anesthesia, sedation, Analgesics, spinal Anesthetic AND Drawover (Halothane), induction (Propofol), paralytic

IV. Preparations: Equipment that may better allow for care of sick patients in resource poor environments

  1. End-Tidal CO2
    1. Typical uses
      1. Procedural Sedation (apnea monitoring)
      2. Cardiac Arrest (e.g. CPR adequacy, Return of Spontaneous Circulation)
    2. Other uses
      1. Ketoacidosis (monitor Metabolic Acidosis)
        1. Agus (2006) Diabetes 7(4): 196-200 +PMID:16911005 [PubMed]
  2. Ketone Meter (or combined Glucometer/Ketone meter)
    1. Test strips for Ketones are different than test strips for Glucose
    2. Meter is much more accurate than Urine Dipstick values
    3. Kuru (2016) Turk J Emerg Med 14(2): 47-52 +PMID:27331169 [PubMed]

V. Resources

  1. WHO Essential Medicines
    1. http://www.who.int/topics/essential_medicines/en/

VI. References

  1. McQueen (2015) World J Surg 39:2153-60

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