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Zimbabwe is a country with a strong foundation of medical care and education, a history of economic distress, and recent steps towards recovery. Emergency medicine is not a specialty within this country. The purpose of the study is to establish the current needs of Zimbabwean physicians in emergency medical care training. Methods: An anonymous online survey was distributed to physicians through the College of Primary Care Physicians of Zimbabwe (CPCPZ) listserv. This instrument was designed and hosted on the surveymonkey.com website. Thirteen questions included multiple choice/selection, rank order using a Likert scale and free text. Physicians were asked to complete the survey on three different occasions, but did not receive any remuneration. Results: Fifteen respondents completed at least a part of the survey out of approximately 50 on the primary care physician listserv. Six of 15 respondents (40%) currently consider themselves as working in an acute care setting; 12 (86%) of the respondents report having Basic Life Support training and 8 (57%) report Advanced Cardiac Life Support training. Two of respondents (14%) have had Paediatric Advanced Life Support level training, and two (14%) have had Advanced Trauma Life Support training. Skills that greater than 85% of respondents felt emergency care physicians should receive include: bedside ultrasound, central venous access, cardioversion/defibrillation, chest tube insertion, intubation and lumbar puncture. Greater than 50% of the respondents saw current emergency medicine technician provider’s skills to be insufficient in cardioversion/defibrillation. Challenges to the development of emergency medical care identified include: balancing acute care needs with the burden of chronic disease including HIV and tuberculosis, funding emergency medical systems, and convincing the medical establishment that emergency medical care providers can be more than “casualty officers”. Suggestions offered for development include: involvement of the undergraduate training programs in medicine and nursing, and development of certification programs within the country to recognize specialized training in emergency care. Conclusion: Providers in Zimbabwe have identified some key areas of focus for emergency medicine development within Zimbabwe. Respondents have suggested a path forward: the provision of increased undergraduate medical training; official certifications of emergency medical care skills; and government recognition. The low number of respondents significantly limits this study and its conclusions.

Background: Impalement injury is an uncommon presentation in the emergency department (ED), and penetrating thoraco-abdominal injuries demand immediate life-saving measures and prompt care. Massive penetrating trauma by impalement in a pediatric case represents a particularly challenging presentation for emergency providers in non-trauma center settings., Case Presentation: We report a case of 10 year old male who presented in our ED with an alleged history of fall from an approximately 15 foot tall coconut tree, landing over an upright bamboo stake approximately 50 centimeter long, resulting in a trans-abdomino, trans-thoracic injury. In addition to prompt resuscitation and hospital transfer, assessment of damage to vital structures in conjunction with surgical specialty consultation was an immediate goal., Conclusion: This article describes a case study of an impalement injury, relevant review of the available literature, and highlights the peculiar strategies required in the setting of a resource limited ED.

We undertook a retrospective cohort study comparing infection in solid organ transplant recipients receiving alemtuzumab (n = 726) versus basiliximab (n = 215) or antithymocyte globulin (ATG) (n = 85). Eighty-one percent of patients had kidney transplants. Overall, 33% of patients in the alemtuzumab group (240/724) developed infection compared with 40% (87/215) in the basiliximab group (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.53-0.99; P = .04). The frequency of infection was similar in the alemtuzumab and ATG groups (33% versus 36%, respectively, P = .53). The frequency of fungal infections, most caused by Candida spp., was similar in the alemtuzumab and basiliximab groups (10% versus 9%); disseminated fungal infection occurred in 68% of the patients with fungal infection receiving alemtuzumab and in 30% of the patients with fungal infection receiving basiliximab (OR, 4.76; 95% CI, 1.58-14.28; P = .003). Basiliximab posed a higher risk than alemtuzumab for infection. Disseminated candidal infections were more common in patients receiving alemtuzumab.