My name is Temesgen Beyene, resident in emergency medicine, Ethiopia and this is how I became a researcher
I am a chief resident in the Emergency Medicine and Critical Care residency and lecturer at Addis Ababa University. As an Emergency Medicine resident, I am committed not only to developing my clinical skills in the Emergency Department but also to developing my skills in clinical research. Emergency Medicine (EM) is a completely new specialty in Ethiopia; thus far not much research base exists to support our practice. Clinical research done elsewhere is rarely relevant here and many of the research questions asked elsewhere do not apply in our setting. As the practice of EM develops in Ethiopia, research to support that practice must develop also. I would like to become expert in the field of clinical research so I can lead that development.
Following seven years of a highly successful, dual language policy in publication, the African journal of Emergency Medicine (AfJEM) will cease to include French translations in publication from the September 2017 issue. Instead we will be taking it online to our newly created family of blogs.
From the outset our policy has always been towards inclusivity – no-one with a great research idea should be excluded from disseminating their work through publication, and no-one hoping to access research should be excluded from doing so either. Fully subsidised by the African Federation for Emergency Medicine, the AfJEM charges no processing or accessing fees, provides free author assistance and up until this issue published all titles and abstracts in both English and French. Oddly enough this did not make us as inclusive as we had hoped. Perhaps through ignorance we neglected to acknowledge Africa’s diverse, regional language culture, one that cannot simply be described through English and French.
I have to say off the cuff that I was simply blown away by the local Rwandan faculty and the quality of this conference. In retrospect I do not know why I expected things to be different. I mean I knew most of the faculty, the journal has published a number of their papers and I have seen many of the trainees present elsewhere. I was really hoping it would be great, but worried that I’d be disappointed. The Rwandans easily exceeded expectations.
I caught up with Prof Tim Rainer who will be presenting a keynote at the Rwanda Emergency Care Association’s conference this May. Tim is Professor of Emergency Medicine at the Cardiff University School of Medicine. I asked Prof Rainer for a sneak peek into his keynote topic on permissive hypotension in the context of major trauma
What is Permissive Hypotension and why is it important?
Permissive hypotension, in its simplest form, is the use of restrictive fluid therapy that increases systemic blood pressure without reaching normal pressures. The aim is to achieve a mean arterial pressure of 40 to 50 mmHg, which is generally equivalent to a systolic blood pressure of ≤ 80mmHg, or the presence of a just palpable radial pulse.
There is a more complex definition, which is the use of restrictive fluid therapy and/or inotropes and/or vasopressors as appropriate to increase systemic blood pressure without reaching normal pressures. This definition is important practically as hypotension is not always due to hypovolaemia (or reduced preload) but may also be due to altered cardiac inotropy and/or peripheral vasodilatation.
The subject is important because there is considerable uncertainty regarding whether permissive hypotension is more or less appropriate than normotensive resuscitation, and whether this might impact on patient survival.
About the author
Stevan is the editor-in-chief for AfJEM. Providing access to resource appropriate research for those working in low and middle income settings is one of his passions. Others include keeping his four chickens out of the family veg patch.