Sharadh Garach

Emergency physician in a rural ED in a still amazing South Africa, with a penchant for gadgets, tech and innovative EM.. #FOAMed #NgwelezED

[Sharadh Garach @ED_NGH]

@ruralBell Every day man.. every day. Stay safe!

[Sharadh Garach @ED_NGH]

@ChristoffBell 😳

[Sharadh Garach @ED_NGH]

@ChristoffBell @ketaminh @vemadoc @geoff_isbister Food for thought.. recombinant antivenom offers the prospect of reduced adverse events, easier administration and faster response if reduced need for transfer due to AEs.. https://t.co/2ttcdmYD7i
Also ?cost effective vs SAIMR..
https://t.co/QxLi1Q01L2

[Sharadh Garach @ED_NGH]

@ChristoffBell the best place to spend an on call weekend.. in hospital with a 7yo cytotoxic envenomation with RPS.. 🐍😁 thankfully our quota of anaphylaxis has been met, none with this infusion!

[Sharadh Garach @ED_NGH]

@ChristoffBell @ketaminh @vemadoc @geoff_isbister Local experience suggests high incidence of reactions, anaphylactoid and anaphylactic.. https://t.co/KpkokrXIKM and https://t.co/GgphGn65xP
Prep and awareness must factor into AV admin, alongside clinical decision. Agree more local work is needed.

[Sharadh Garach @ED_NGH]

@ChristoffBell Going 2 for 2 for this month, let's see if it lasts! 🙈 always been prepared for full on anaphylaxis.. AV admin still is a consultant led intervention at NGH though, for exactly that reason. Kid doing fine, no progression further, avoided compartment being opened.

[Sharadh Garach @ED_NGH]

@mjslabbert Combination of both I think.. rural Natal has angry snakes and silly humans, chasing said angry snakes.. it's a seasonal surge from November to March-ish, coincides with the townies coming home to the farm.. spot the recipe! 😄 expanding settlements also encroach vegetation more

[Sharadh Garach @ED_NGH]

Ladies and gentlemen.. Mamba No 5! Been an interesting few months, 5th antivenom administration for neurotoxic bites since Jan, similar for cytotoxics.. at least the team are getting better at managing the envenomations! #NgwelezED #KZNEM

[Sharadh Garach @ED_NGH]

@ketaminh @vemadoc @ChristoffBell @geoff_isbister @ToxTalks Excellent work! Reading through briefly, the lower dose in Aus looks like a reduction from previous for coag problems.. low incidence of neurotox. Your PV AV reflects same.. SA PV is Cyto&neuro specific, no haemo AV. Same regime in SA for haem/coag bites, 1-2 vials initial dose

[Sharadh Garach @ED_NGH]

@vemadoc @ketaminh @ChristoffBell @geoff_isbister @ToxTalks Loving the discussion.. 🐍 brief look at Indian experience is similar, high initial dose cf Aus, both haemo & cytotoxics.. variations in dose look like regional AV composition, trying to find out exact composition of SA AV. What is current Aus practice and SE profile with NT AV?

[Sharadh Garach @ED_NGH]

@ketaminh @geoff_isbister @ToxTalks @ChristoffBell Clinically, AV reverses NT effect in ED, rpt doses required with more severe presentations.. locals present with high venom loads, culture is to catch the snake for identification, hence multiple bites. We assume is AV is not enough (ps. AV manuf recommends min 2 vial start dose)

[Sharadh Garach @ED_NGH]

@ToxTalks @ChristoffBell @ketaminh @geoff_isbister Bedside experience is in keeping with @ChristoffBell says, 2-4 doesn't stop neurotoxic effects, 8-10 vials usually starting point. Mamba bites show little to no haem/cytotoxic envenomation.. may be room for similar studies re:venom/antivenom 🤔

[Sharadh Garach @ED_NGH]

@ChristoffBell This one was early, 10 vials did the job, he's having breakfast as I type, making jokes about snakes.. I think he'll be fine.. up to 15-20 vials previously for the neurotoxics, 5-10 usually works for rapidly progressing cytotoxic bites. Still learning 😄

[Sharadh Garach @ED_NGH]

@drlaragoldstein My shop has changed a bit since then 🤔 some for the better, some not so better.. still an adventure every day 🐍🐾🐾

[mande toubkin @mtoubkin]

@StrokeAngelsSA @mtoubkin @EMSSA2017 @grobler2603 @bad__EM stroke care is a huge discussion point today at Angels steering committee

[Sharadh Garach @ED_NGH]

@StrokeAngelsSA steering committee meeting.. moving forward on accessible and effective stroke care across the country and across the public private divide

[Sharadh Garach @ED_NGH]

@TelkomZA Waits patiently... (30/12)

[Sharadh Garach @ED_NGH]

@TelkomZA Waits patiently.. (30/12)

[Sharadh Garach @ED_NGH]

@TelkomZA
Hi, fault 62ANK111217 currently being tested & will be assigned aferwards. ^Lebo (27/12)
Me: waits patiently
Telkom: technician is fixing (28/12)
Me: waits patiently
Telkom: ... (29/12)
Me: still not working
1. Fix it
2. Refund my last months subs

[Sharadh Garach @ED_NGH]

@TelkomZA almost a month, no internet connection, and I'm still getting a bill??? It's your policy not to charge for lack of service, still waiting for you lot to solve the initial, problem.. let's round it off to 3 weeks sans connection, and you adjust accordingly, ok? 😡