PALS
Santa Rosa de Copan
Central American Medical Outreach
CAMO
Hospital Regional de Occidente
February 25-28, 2008
PALS
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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
Map of Honduras
The Hospital
Classrooms were housed in the
Hospital Regional de Occidente
Class list Group A
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Clara Lainez, MD
Instituto Hondureno
Seguro Social (IHSS)
Thunia Fancinily, MD
IHSS
Alma Rodriguez, MD
Hospital Regional
Occidente ( HRO)
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Yadira Carcamo, MD
Hospital Gracias
Nelson Penman, MD
HRO
Jorge Madunado, MD
HRO
Hector Sandoval, MD
HRO
Class list Group B
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Jeanette Flores, MD
Cesamo San Jose Copan
Gloria Cacenes, MD
Cesamo San Jose Copan
Claudia Calix, MD
Hospital Gracias
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Sonia Delattibodier, MD
HRO
Marisabel Rivera, MD
HRO
Marco Rodriguez,
Paramedico, Santa Rosa
de Copan
Map of Honduras
SRDC,
Gracias,
Tegucigalpa
The Faculty
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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 Children’s Hospital,
St. Petersburg, Florida
The Faculty
Faculty
The Course
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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
Skills Stations
Skills stations
Skills Stations
Skills stations
 BLS
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1 person 30:2
2 Person 15:2
AED
Airway
Defibrillator
Dysrhythmias
Presenting the Video
Intra-osseous Lecture
Intra-osseous station
Where to decompress a
pneumothorax?
Defibrillator Station
Guest Lecturer
Natalie
(Anesthesiologist at Hospital Occidente)
DOPE Pneumonic
En Espangnol
 Desplazamiento
 Obstruccion
 Pneumotorax
 Equipo
Shock Lecture
Assess-Categorize-Decide-Act
Testing Scenarios
Las Drogas
Teaching
The Broselow Tape
Working the Megacode
Megacode
Clinical Testing
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All participants passed the megacode.
A few clinical deficiencies were identified and
corrected.
Thanks to the CAMO support staff
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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
CAMO Organization of Equipment
CAMO Support Staff
Lunch and Snacks
The Written Test
Written Testing
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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)
Remediation
Remediation
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Tests were graded and key points were reviewed
without answering the actual questions on the
test.
Participants were re-tested and all passed
successfully
Lunch post testing
Graduation
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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
Success!
Faculty Organization
Accomplishments
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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.
In kind course donations
Central American Medical Outreach
About CAMO
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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.
CAMO
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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 CAMO’s Central
American counterpart –Fundación CAMO.
Fundación CAMO serves as CAMO USA’s local
partner and conduit to the community.
Equipment
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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.
Sustainability
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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.
CAMO Programs
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Capital Improvements in
Medical Facilities
Dental Program
Wheelchair Repair and
Distribution
Surgical Development:
Orthopedics, Plastics, Eye,
and Urology
Prosthetic Lab
MMERV Program
Medical Education
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Technical School
Research and
Development
Community Center/Gym
Audiometry
Multidisciplinary Breast
Clinic
Eye Clinic
Day Care Center
Medical Education
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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
Accountability
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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.
Volunteer Costs – Time and $$
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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
Hospital Grounds
Surgery and Women’s Surgery
Emergency Room
Ambulance Area
Old Pediatric Area
Outside Old Pediatric Ward
Current Pediatric Ward
Nursing Station
Pharmacy
Enfermera Preparing Meds
Penicillin Test Dose
Rounding with the Pediatricians
Radiology and Chart Filing System
in the Patients Bedspace (Chair)
Reviewing X-rays
Chest X Ray
? Pneumothorax
Femoral Cutdown
Femoral Cutdown
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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.
Intubated in General Pediatric
Ward
Mother with Ventilated Child
Hospital Occidente
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18 month old female
with a history of one
week of eye swelling.
No fever
No history of trauma
No pertinent past
medical history
Hospital Occidente
?
Bot Fly Pathology
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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. 1986;93:1225-1227.
2. Wilhelmus KR. Myiasis palpebrarum. Am J Ophthalmol. 1986;101:496-498.
ambergriscaye.com/pages/town/botfly2.html
The Bot Fly
Scientific classification
Kingdom: Animalia
Phylum: Arthropoda
Class: Insecta
Order: Diptera
Suborder: Brachycera
Infraorder: Muscomorpha
Section: Schizophora
Subsection: Calyptratae
Superfamily: Oestroidea
Family: Oestridae
http://en.wikipedia.org/wiki/Botfly
The Human Bot Fly
Bot Fly Pathology
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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
Bot Fly Pathology
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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. 1987;12:40-45.
4. Elgart ML. Flies and myiasis. Dermatol Clin. 1990;8:237-244.
ambergriscaye.com/pages/town/botfly2.html
Human Bot Fly
ambergriscaye.com/pages/town/botfly2.html
Human Bot Fly
ambergriscaye.com/pages/town/botfly2.html
NICU
Pediatric Interns in the NICU
Premature Infant
Hospital Occidente
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Macrosomia
Edema
Respiratory Failure
Shock
Breathing over ventilator
NICU Flowsheet
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Dobutamine
Albumin
Furosemide
Hydrocortisone
Ciprofloxacin
Clindamycin
Fluconazole
Midazolam
Fentanyl
Albuterol/Atrovent
D10 NS
Delayed Capillary Refill Time
Post Bolus Improvement in CRT
Delivery Room
Resuscitation Equipment
Delivery Room
Delivery Area - Nursery
ONLY Breast Feed!
Breast Feeding Teaching Area
Lecture to Pediatric Housestaff
Benefits
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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