Fireworks Fun
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An oldie but a goodie. Ouch!
Source: Scalpel or Sword? - July 6, 2008 Tags: bad ideas
The White Hare
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Another long week... nights to follow; I swapped a while back, without realisation that this would lead to a 14 day stretch... I suppose our sins always find us out, and it could be worse... Too-Tall medical student is on with me tonight, and has promised not wear heels, so maybe I can play some part in furthering the education of the next generation. Or not...Many brave small folks this week. I think I've offered before on how the self-possession of some children just takes my breath away. I don't know whether his is because they've been brought up that way, or if they just are. This li'l fella let us straighten this with...
Source: The KnifeMan - July 4, 2008 Tags: Nights X-Rays Kung Fu Panda
Dance Like Nobody Is Watching
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ImpactED nurse is always worth reading; but occasionally unearths a real gem. There's hope for us all...
Source: The KnifeMan - July 4, 2008 Tags: Dancin'
Mea Maxima Culpa
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Continuing the missed X-Ray series.I thought the second radiograph was o.k; so I fell back on the age old staple of serial observation. The patient settled, so no CT. 3 weeks later she called to say the pain had not settled, and returned for a review...I apologise for the limited quality of the images thusfar; but I think the abnormalities are visible on this one; sadly my colleague, who reviewed the patient, didn't...
Source: The KnifeMan - July 4, 2008 Tags: Mea Culpa
Your Eye Is Not Your Fingernail
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In a sense, every doctor’s birthday is July 1st. This is the day our training begins, with each subsequent first of July marking another step up the residency food chain. I’m now entering my sixth year with MD after my name and my third since finishing residency. Literally tens of thousands of patients seen, and yet stuff still walks through the door that I’ve never seen before. As an old attending once told me, the variety is a curse at the beginning of your career and a blessing at the end.
So not too long ago I saw for the first time a lady who had glued her eye shut. For the record if...
Source: Ten out of Ten - July 4, 2008 Authors: Ten out of Ten Tags: ER Life Medicine Glued Eye Shut
Happy Independence Day
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The US Declaration of Independence
Source: Scalpel or Sword? - July 4, 2008
The Delta P
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Treating our patients' pain is a priority in the ER, but it isn't our highest priority. And of course all pain isn't created equal. When the waiting room is full and everyone has 10/10 pain, we have to distinguish them somehow. One consideration is the mechanism of pain: an obvious injury like a broken wrist is more convincing than some of the "mystery pain" syndromes like migraine or fibromyalgia. But of course some conditions cause excruciating pain without an immediately apparent source, and all pain deserves to be treated. But in what order?One philosophy is to consider the change in pain from baseline, a function that...
Source: Scalpel or Sword? - July 1, 2008 Tags: perception pain
Scalpel's Theory of Relativity
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I try to see really old patients and those with terminal diseases as quickly as possible, because when someone doesn't have long to live, every minute counts. A 10 minute wait to them is like hours for us.I also try to see screaming babies as quickly as possible, because I don't like listening to screaming babies. I prefer that they scream at home, where hopefully their parents love them enough to tolerate their screaming. A screaming baby does not necessarily represent an emergency. To me, however, it does.
Source: Scalpel or Sword? - July 1, 2008 Tags: perception time
MindBullet: Take 2 Aspirin and We'll Google You in the Morning...
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Excellent MindBullet from MindBullets.net. They're weekly doses of futurism - health related in this instance...SA Doc's analysis. It could happen - give it a couple of years. In South Africa, we're in a little bit of a pickle though. No online consultations are allowed - HPCSA law dictates you have to "touch" a patient in order to provide a medical service.
Source: All Scrubbed Up - June 30, 2008 Tags: mindbullet google health surgery
Two Years in the Making
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Every fall I have added new bulbs to the existing ones slumbering in the flowerbeds around my house. I often forget where and what I have buried. For the past year, there have been prominent green leaves next to the front steps. I could not remember what kind of flower they were, but given the size of the leaves, I had great expectations.
A few weeks ago, giant iris blooms appeared out of
Source: Collective Contemplations - June 30, 2008 Authors: Kate
The Gathering Dark
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Some shifts you just want to go home and stand under a hot shower...La Belle Fille has been away this weekend, living it up in the country. I have missed her, perhaps more than I expected. Which I actually think is a good sign, at least for our future. We seem well suited, despite the fact that what I intend as gentle teasing oft emerges as slightly insensitive / poor humour. My boss thinks she's to good fro me, and she might be right. Still, I am assured that she acquitted herself admirably both on guitar and vocals (in Rock Band.)I am proud.The Department was generally quiet today; but the BatPhone trilled its urgent cal...
Source: The KnifeMan - June 29, 2008
Mea Culpa (2)
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No dissection; and indeed I have the luxury of digital X-rays. An advantage that I did not use to it's fullest; indeed it seems slightly unfair to ask you all to comment, given the poor quality of the images... but it's only light hearted.I was worried about the bases, and not entirely happy with the supine film, so repeated it, with patient sat up.Here it is:(I have tried to make the image bigger, but to little avail...)
Source: The KnifeMan - June 29, 2008 Tags: Mea Culpa X-Rays
Do I work in a Circus?
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I rounded the nurses station to drop off a chart only to by confronted by a clown.
I did a double take…yes, it was a clown, sitting in a wheelchair. A Pink curly wig donned his head and billowing teal pants with red and pink polka dots spilled through the spokes of the wheels.
He sat staring straight ahead. The droop on one side of his face pulled his make-up over to one side and made his painted red nose even more prominent. But it didn’t make me laugh.
I quickly examined the clown from head to toe and added some new parts to my neurologic examination.
“Raise your eyebrows for me,” I said.
His rain...
Source: Mr. Hassle's Long Underpants - June 29, 2008 Authors: Doc Shazam Tags: Uncategorized
The Missed X-Rays of Uncle Shroom
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Part of the 'mea culpa' series. Hopefully, a very occasional series. In several parts.Young woman, blunt force trauma to head and right chest. Primary survey unremarkable. Supine chest as follows. (Reported as normal by Radiology... and myself of course)Comments?
Source: The KnifeMan - June 29, 2008 Tags: Mea Culpa X-Rays
Practice Tips For New EM Grads
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Shadowfax already posted a really nice list but I have some ideas I’d like to share too, in particular some practice tips I have picked up in the now two years since I finished residency. Many of you may have discovered these things long ago, I don’t know what to tell you except that I’ve always been ahead of the curve when it comes to being kind of slow. On with the list…
Find out why your patient came to the ER.
I saw a young woman awhile back who had a bunch of vague subacute complaints that didn’t seem to add up. Finally I managed to figure out that she was worried about possibly being p...
Source: Ten out of Ten - June 27, 2008 Authors: Ten out of Ten Tags: ER Life Medicine
красные победили
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The SCOTUS hath rendered it's decision and opinion. When I heard the news, the words above (pronounced "krasniye pobyedili") went through my mind. It's what russians say when the good guys win in movies or stories. Roughly translate
Source: Latest entries from bloodletting.blog-city.com - June 26, 2008 Authors: doc Russia
On Top, Doggy And Normal
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A Tale Of Three...You came first; reluctant, disgruntled. A familiar ale, of a rough struggle in the night, steel toe-capped boots leaving their angry retort. A litany of complaints, of your head, your neck, your chest and your shakes. We saw you immediately. You argued with us then, unhappy at your confinement, unwilling to see the necessity... we explained, cajoled. You swore and threatened. We hoped it was your head injury... it was just you. We cleared your neck, offered pain relief, albeit not the opiates you wanted, eased your shakes. It wasn't enough. We were too slow to bring you the coffee and sandwiches you wante...
Source: The KnifeMan - June 26, 2008 Tags: On the Floor Trauma
How rude!
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From a recent complaint letter:"Dr. Scalpel stared at me when I talked."Maybe I should learn how to type into the computer while taking a history like some of the younger docs. It might even save a couple of minutes per patient and allow me to see a couple of extra patients per shift.But it just doesn't seem natural.I wonder if those docs get letters complaining that the doctor never looked at them?
Source: Scalpel or Sword? - June 26, 2008 Tags: perception patients
Humble Pie
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It has been a rough week for me procedure-wise. The other day I saw a septic patient. He had a fever, diarrhea, a heart-rate twice normal, and a soft blood pressure. So, we did all of the usual things, and then I got called to his room because there was a problem getting IV access. No problem-- time to put in a central line (an IV placed into one of the larger veins in the body- internal jugular,
Source: Collective Contemplations - June 26, 2008 Authors: Kate
Quote of the Day
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Neil Entwistle was convicted in Massachusetts today of murdering his wife and 9 month old baby daughter. He faces a sentence of life in prison without the possibility of parole.Prosecutors had argued that Entwistle was deeply in debt and unhappy with his sex life."I wonder how he'll like it now?"- Shepard Smith, Fox News Anchor
Source: Scalpel or Sword? - June 25, 2008 Tags: karma justice
Lose-Lose
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An old woman had some chest pain and shortness of breath, or at least that’s what she told the staff at her nursing home. Saying things like that leads to a predictable series of events. The supervising doc was notified, a trip to the ER was approved, and the patient was loaded up into an ambulance and transported next door to us.
Who knows if she was really experiencing these things — she had fairly advanced dementia and the validity of anything she said was questionable at best. Just a few weeks prior, however, she was brought to the ER and ultimately admitted for what turned out to be a small...
Source: Ten out of Ten - June 23, 2008 Authors: Ten out of Ten Tags: ER Life Medicine
On Treating Tigers
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Tiger Woods won the 2008 US Open golf championship despite playing with a torn ACL and two stress fractures of his left tibia. He earned $1.35 million in prize money for that heroic effort, which will also probably increase his already stratospheric endorsement income next year (in 2007, he pocketed an estimated $100 million in endorsement deals alone). Now he's about to undergo surgery to repair his injuries.When a 32 year old soon-to-be billionaire superstar seeks medical treatment, I doubt he has to get a referral from his PCP or approval from an HMO pencil-pusher. But as the John Ritter case revealed, when a rich celeb...
Source: Scalpel or Sword? - June 22, 2008 Tags: ER
Quote of the Weekend
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Courtesy of a commenter on Malkin's blog:“We in Germany cannot figure out why you are even bothering to hold an election.On one side, you have a bitch (Hillary) who is a lawyer, married to a lawyer.Alternatively, you have a lawyer (Obama) who is married to a bitch, who is also a lawyer.On the other side, you have a war hero (McCain) who is married to a good looking woman, who owns a beer company.Where is the contest here?”Danke schön!
Source: Scalpel or Sword? - June 21, 2008 Tags: beer politics
Neurotics and Psychotics
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The difference between a neurotic and a psychotic is that, while a psychotic thinks that 2 + 2 = 5, a neurotic knows the answer is 4, but it worries him.Thanks to Medical Jokes on Geocities.
Source: All Scrubbed Up - June 21, 2008 Tags: just joking
I'm A Mr, Too
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Belligerent Shroom; Brief post; Apologies.Nights have been and gone, surprisingly quietly. The only evidence they were ever there are a few straightened ankles, and the disruption to my body clock.One of Shroom's good friends has found her life goin' a little bit sour. Through no fault of her own, but because one of her housemates lacks social integration skills. I can't pretend to be in his head, and it's true that every story has two sides, but he seems to have a crush, for want of a better word, on her. And is having trouble adjusting to the fact that his feelings are not reciprocated.I know how that feels, so feel I ca...
Source: The KnifeMan - June 21, 2008 Tags: La Belle Fille Non-Medical Jib
Ionising Radiation
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Nice to know that even eminent colleagues, like Dr Schwab, get odd visitors too.A few pictures, I think. My night is slow, or was until I jinxed my self by writing that...A personal triumphThe cast is perhaps not as well molded as it might have been, but I enjoyed the reduction.An oddity:Fell off the sofa apparently; was advised, over the phone, to ice it...And lastly, a little sadness...The images show CT of the brain, with the upper view showing a monstrous intra-parenchymal bleed - the white area inside the grey. An blood clot of truly epic proportions, within the very substance of the brain, and forcing its way into al...
Source: The KnifeMan - June 18, 2008
An ambulance crashes, and I'm not surprised
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I'm surprised we don't see this more often.
During the year that I drove an ambulance, I had to deal with a) oblivious drivers, for whom my lights and sirens were like the sound of falling golf clubs to Tiger Woods, and b) crazy-ass Denver Health paramedics who drove like nutjobs.
Needless to say, I wouldn't be surprised if either vehicle was at fault for this crash.
Source: Glorfindel of Gondolin - June 18, 2008 Tags: Grab Bag o ' Goodies
13.1
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Thirteen miles is a long way to run. I ran a half marathon last Sunday (Yes, I also called my father!). I ended up finishing much better than I thought, at 2:30. For some reason, I had it in my head that it would take me 3 hours to finish. I did walk about a quarter of a mile of the race because I got a bit overheated, but overall I'm pretty happy with how I did.
This particular race has only
Source: Collective Contemplations - June 18, 2008 Authors: Kate
The Singer Sings His Song
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Another one down.Did not exacly distinguish myself during my assessment today. Organisation evidently not my strongpoint. Something to learn from, I guess...The Department was, surprisingly, quiet. We're one down tonight, so it'll undoubtedly be carnage. Most of my time was occupied trying to sooth the tortured mind of a young fella in the throes of mental collapse; for a while he did a good job of trying to scare us into thinking he was a 'terror suspect'. Paranoia strikes deep...Is there hope for him? I'm not sure, but it does worry me that we started to see him in turns of what he looked like, what 'profile' he fitted, ...
Source: The KnifeMan - June 17, 2008
Advice to Interns
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This column was originally posted in July of 2007.For the benefit of the new interns, I'll now present my own perspective on internship.I like to think that my own internship was more like this guy's than the type being advocated amongst some of my fellow medbloggers these days. I was a mediocre medical student, smack dab in the middle of the bell curve, but I ultimately became the best intern in my large program. "How could that be?" you might ask. Simple...I worked harder than anyone else. If you finished medical school at the top of your class, you are ahead of the game and you probably are already anticipating your cus...
Source: Scalpel or Sword? - June 17, 2008 Tags: internship tips
A Bug Crawled Into A Guy’s Ear
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A guy came in because he thought a bug had crawled into his ear while he was sleeping and sure enough looking through the otoscope I saw the unmistakable hard backing of some beetle-like thing.
Just seeing it made me feel a little repulsed. Blood, pus, poop, sweat, discharge, vomit whatever the usual healthcare stuff gives me no problem but I don’t like bugs. It’s not pathological or anything, it just kind of creeps me out to have a spider running up my arm or hear a roach crunching under my shoe.
I wanted that thing dead, for both the patient’s sake and mine, so I squirted some lidocaine into his ear...
Source: Ten out of Ten - June 17, 2008 Authors: Ten out of Ten Tags: ER Life Medicine
I'm Sorry?
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In trying to post more frequently, while lacking the intellectual prowess to hold forth in a meaningful way about the big stories of the day, one runs the risk of running short of inspiration.While casting about, I elected to see from whence my visitors come...Most unusual referrer goes to whomever elected to use Google Australia to answer the query 'How is knee fucking done?'.I have no idea why you'd wanna know, or indeed how they ended up here.Food for thought? Nights await, so maybe some more laughs to share tomorrow.
Source: The KnifeMan - June 16, 2008 Tags: Non-Medical Jib
A Little Lesion Causes A Big Problem
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Tim Russert’s death was yet another reminder that life can be snatched away from us at any time — and in a hurry.
Mr. Russert’s physician revealed he had asymptomatic coronary artery disease, asymptomatic at least until the time of his death. Within a large artery supplying his heart was a very small cholesterol-containing plaque. This gave him no trouble whatsoever until a blood clot formed on top of it, blocking all blood flow to a large portion of his heart, disrupting its electrical system and ultimately causing it to stop beating.
Ironically, these small lesions can be more dangerous tha...
Source: Ten out of Ten - June 16, 2008 Authors: Ten out of Ten Tags: ER Life Medicine
The Dreaded Hand Tissue
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An unfortunately common practice around these parts is for patients to hold onto a Kleenex for a prolonged period of time. Not a thin, billowy pristine one fresh out of the box, nor one carefully folded for convenient storage just in case it's required. No, I'm talking about the dreaded hand tissue, molded into a crusty tubular shape by the combination of absorbing various bodily secretions and applying what's left of Grandma's grip strength.Now I don't know about you, but when I'm done with a Kleenex I throw it away immediately. The sole purpose of such tissue is to use it to collect stuff that you don't want to get on yo...
Source: Scalpel or Sword? - June 16, 2008 Tags: bad ideas general interest
Jedi Mind Trick
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She was a pretty typical drug seeker, or so it seemed. There were multiple visits to our ER over the past few weeks, including one on the previous day. Fortunately she'd already had quite an extensive workup, and she had been given adequate prescriptions for powerful narcotics and even a few alternative analgesics. Her husband had called triage looking for her, and he told us that she had been going around to various ERs to obtain narcotics and that she'd just left another hospital across town. It seemed that there really wasn't going to be much that I could do for her except to have an unpleasant discussion.I asked her th...
Source: Scalpel or Sword? - June 15, 2008 Tags: perception patients drug-seekers
Happy Fathers Day
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photo credit
Source: Scalpel or Sword? - June 15, 2008 Tags: pictures photochops links to greatness
The Rustling Beneath The Sheets
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“Sean, you have a new patient in Room 8…and there is something moving under the sheets,” stated the Nurse. I noticed she looked quite pale. I paused…”Okaaaay…..did you say something moving beneath the sheets?” “Yes,” she replied. “Do you know what it was,” I asked? “No but they were large, there were a lot of them, and they were moving….” “Did you look,” I asked with a look of bewilderment, and...
Source: Straight Talk from the Stanford ER - June 15, 2008 Authors: Sean Donahue, DO
'There's A Weasel Chomping On His Privates'
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Apparently, anything can be made funnier by the addition of the word 'weasel'. I'm told this is especially true if it can be shoe-horned into joke punchlines.During the Annual Parade, Lt Col Smithers noticed some odd behaviour among the men of 1st Battalion. he asked his adjutant: 'What's wrong with Major Sharpe's men? They all seem to be jigging up and down as they march?'. 'Oh that', replied the aide, 'Well, apparently...'
Source: The KnifeMan - June 14, 2008 Tags: Humour Weasels
The Cross Is In The Ballpark
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There are very few moments in my job when I feel real fear; I see a lot of unpleasant things. I see a lot of sick people, and many of them make me anxious, because I'm always thinking the worst. But that's what I'm there for. Get on and treat.But sometimes, something will happen that makes me pause, that sucks the breath right out of me. A time when you begin to think you might not have whistled loud enough on your way past the graveyard.Perhaps this will clarify:Last night began humourously enough; I forgot my scrubs, so borrowed a set from Sister. Dressed as I was in blue, everyone took the opportunity to look askance at...
Source: The KnifeMan - June 14, 2008 Tags: Squeakers On the Floor
They Seek Him Here...
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Christ. I really have been away for a few weeks. I, again, resolve to try to post more often, which, if you're still reading probably counts as good news.For a certain value of 'good'.And 'news'.Anyway... one of my erstwhile readers, a proper doctor, not an honourary schmuck like me, has suggested a link between my real life and post frequency. He's more or less right. Sometimes, life just gets in the way.So; an update. Non-clinical flail first.Spent my time off NOT doing the hundred things I'd promised myself I would, so my car remains unserviced, and the kitchen unpainted. I did however spend some grand times in Wales, f...
Source: The KnifeMan - June 14, 2008 Tags: Lemons Non-Medical Jib La Belle Fille; Assessment
Hard slogging
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I am sorry that I have not been blogging much as of late. The fact of the matter is that I have tons of stuff to do, and there are some tough times ahead. All together things seem to have conspired against me to keep Domestic-6 and myself from enjoyi
Source: Latest entries from bloodletting.blog-city.com - June 13, 2008 Authors: doc Russia
Sneaky Disgusting
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There is plenty of stuff in this world that is inherently recognized as disgusting and as such avoided. Not too many of us I don’t believe would be interested in chewing on a piece of used gum offered from the mouth of a coworker. Yet there are many other equally germy scenerios that we ritually engage in without so much as a second thought.
So without further ado, here is my official Top 5 list of Sneaky Disgusting Things.
Honorable Mention
Payphones
It is my understanding that there was a time when everyone and their cousin did not have a cell phone. To make a phone call in public one allegedly ...
Source: Ten out of Ten - June 13, 2008 Authors: Ten out of Ten Tags: ER Life Medicine
A second penis?
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Founds this on Truemors.comA baby boy was born with a second penis — on his back. The rare condition is called fetus in fetu. He was rushed to Tianjin Children’s Hospital in China’s Henan province on May 27. The second penis has been surgically removed.What!?
Source: All Scrubbed Up - June 13, 2008 Tags: penis
FISA "compromise" bill a Democratic surrender to George W. Bush
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As is often the case, Glenn Greenwald's latest blog post must be read:The New York Times' Eric Lichtblau has a long, prominent article today on the pending debate over FISA and telecom amnesty -- headlined: "Return to Old Spy Rules Is Seen as Deadline Nears" -- that features (and endorses) virtually every blatant falsehood that has distorted these spying issues from the beginning, and which is built on every shoddy journalistic practice that has made clear debate over these issues almost impossible. The article strongly suggests that a so-called "compromise" is imminent, a "compromise" which will deliver to the President v...
Source: Glorfindel of Gondolin - June 12, 2008
Playin' with your food like it's some kind of game
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CONCLUSION. Our observations suggest that successful speed eaters expand the stomach to form an enormous flaccid sac capable of accommodating huge amounts of food. We speculate that professional speed eaters eventually may develop morbid obesity, profound gastroparesis, intractable nausea and vomiting, and even the need for a gastrectomy. Despite its growing popularity, competitive speed eating is a potentially self-destructive form of behavior.Not Totally Rad's got a nice discussion of the paper, as well as some personal perspective:After a few preliminary tests, these two subjects were asked to eat as many hot dogs as th...
Source: Blogborygmi - June 12, 2008 Authors: blogborygmi
Washington DC Day 2
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Day 2 was another full day of walking, museums, and monuments.
International Spy Museum, which featured all sorts of mini cameras, a dog poo radio transmitter, a lipstick gun, and an emergency rectal tool kit (Unfortunately, I am not making that last one up!):
Recently built (2004) World War II Memorial:
The Washington Monument:
The Lincoln Memorial:
Korean War Memorial:
Statue next to Vietnam
Source: Collective Contemplations - June 12, 2008 Authors: Kate
Difficult Airway
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Last night I had this patient......He was a 45 yo Caucasian male with no significant past medical history who presented to the ER in the early evening c/o "I think I have something in my throat." After further questioning his story goes like this:When I went to bed last night, I felt fine. No cold or flu-like symptoms, no trouble breathing...nothing. When I woke up this morning I felt as though there was something in my throat. Not all the time, but when I swallowed, I felt...like it was hard for the saliva to go down. I tried drinking cold water, then hot coffee, I ate a banana, but nothing seems to "push it down." I deci...
Source: EM Physician - Backstage Pass - June 11, 2008 Tags: Emergency medicine
Just Go Ahead And Order The Scan
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Last post, I mentioned that we work in a system that can encourage unnecessary testing. I then went on to see a patient that really hammered this point home for me.
A young insured high schooler tripped and fell, hitting his head against a window sill and knocking himself unconscious with seizure-like activity for about ten seconds. His dad found out about it the next day, talked to his wife who had a friend who knew a nurse who told them he could have a brain bleed and that’s the story of how we ended up meeting.
It was now almost 24 hours after the fall. I talked to him and looked him over and decided tha...
Source: Ten out of Ten - June 10, 2008 Authors: Ten out of Ten Tags: ER Life Medicine
Academics and politics
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There's an excellent discussion going on over at Stanley Fish's NYT column about the role of political beliefs among college professors. I tend to agree with Fish. The University of Colorado's attempts to recruit conservative faculty members are misplaced and should embarrass all Coloradans.
In my own experience, I've found that a diversity of political views within the student body is far more important for a student's experience than that within the faculty. As Fish argues, most competent professors can and do bracket their own political views in the classroom. But students, in conversations outside of class, can't and ...
Source: Glorfindel of Gondolin - June 10, 2008
Washington DC Day 1
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Some traditional and not-so-traditional sights found walking around Washington D.C.
I am still not sure what they meant by "Kiss & Ride" at the Metro Station:
No clue what building this is:
The Capital:
J. Edgar Hoover FBI Building:
The White House:
This was at the Smithsonian Museum of Natural History. The title of the display was something along the lines of "Man Taming a Goat". It
Source: Collective Contemplations - June 10, 2008 Authors: Kate
