MedWorm: Emergency Medicine Doctors

Gender Equality in Unnecessary Testing

WhiteCoat's Call Room — Tue, 07 Feb 2012 10:00:18 +0100

I admire this lady’s chutzpah. If Virginia wants to make an unnecessary ultrasound necessary before a woman can have an abortion, Virginia Senator Janet Howell wants to make unnecessary rectal exams and stress tests a prerequisite before men can receive Viagra prescriptions. I bookmarked this link from Instapundit which is one of my favorite news aggregator blogs. However, I disagree with Glenn Reynolds’ opinion that the Virginia senator’s rider to the initial bill is “kindergarten payback” and that it is “sad” that Senator Howell is being lauded for her cleverness. OK. Maybe it is kindergarten payback. The bottom line is that the state wants to make an expensive and unnecessary medical procedure a prerequsite to a woman being able to obtain an abortion. The proposed bill sta...

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FBI warns of threat from anti-government extremists | Reuters

GruntDoc — Tue, 07 Feb 2012 03:29:49 +0100

A fisking of a grossly awful article. (Reuters) – Anti-government extremists opposed to taxes and regulations pose a growing threat to local law enforcement officers in the United States, the FBI warned on Monday. These extremists, sometimes known as “sovereign citizens,” believe they can live outside any type of government authority, FBI agents said at a news conference. Well, no! Nobody’s above the law (unless they’re elected). The extremists may refuse to pay taxes, defy government environmental regulations and believe the United States went bankrupt by going off the gold standard. Wait, defy environmental regs? Like not exactly calculating the amount of fertilizer per hectare to put on their lawn? I can see how that’s an FBI concern. Routine encounte...

Interactive: Who Are the Uninsured in Texas?

GruntDoc — Tue, 07 Feb 2012 02:18:39 +0100

Nearly a quarter of the Texas population lacked health insurance in 2010, according to the most recent data released by the American Community Survey, which the U.S. Census Bureau conducted. That’s more than 5.7 million Texans.It’s likely that someone you know — and probably one you wouldn’t have guessed — doesn’t have health insurance. More than half of the uninsured are employed. More than a third have an annual household income above $50,000. And more than 1 million have college experience or post-secondary degrees. via Interactive: Who Are the Uninsured in Texas?. Very nicely done. If I get a lesson from this, it’s “Stay in School. kids!” (If you live that long). Related posts: Guest Column: Better Care, Thanks to Tort Reform — Health Reform and Texa...

How to give an unforgettable talk

Life in the Fast Lane — Tue, 07 Feb 2012 00:00:27 +0100

Life in the Fast Lane Medical Blog How to give an unforgettable talkBooks on how to give a great talk are dime a dozen. But how do you give a talk that will be impossible for your audience to forget?Rather than accept throw away epithets and sanctimonious dogma, I prefer to look for empirical evidence. This search led me to a talk given at the Urodynamics Society meeting in Las Vegas in 1983. Say what you will about the methods used, the talk given by British physiologist Professor G. S. Brindley at that conference will never be forgotten by those in attendance. Brindley later received a knighthood for his bioengineering research.What follows is based on account of this lecture by Laurence Klotz, who attended the meeting as senior resident hungry for knowledge. Klotz went to every lecture ...

Amanda Trujillo

WhiteCoat's Call Room — Mon, 06 Feb 2012 18:44:50 +0100

I finally took the time to read some other blogs today. One of the issues that I found disturbing was the case of Amanda Trujillo. There are a lot of bits and pieces out there about what actually happened in this case. This blog post was reportedly an e-mail from Amanda describing the events. A summary of the post follows. Amanda was a registered nurse of six years , specializing in cardiology, geriatrics, and end of life/palliative care. In April 2011, she was caring for a dying patient at Banner Del E. Webb Medical Center who had agreed to a major invasive surgery recommended by a staff surgeon. Amanda used materials from her hospital to educate the patient about the details of the surgery and the aftercare. The patient became upset, stating that the surgeon never explained details of th...

Choices: a physician and homeschooler rants

edwinleap.com — Mon, 06 Feb 2012 15:06:27 +0100

One of the unique things about emergency medicine in America is a law called the Emergency Medical Treatment and Active Labor Act, or EMTALA. Under this law, any facility that accepts Medicare cannot turn a patient away for financial reasons. I have said, in many columns, that the idea was reasonable…when first passed under Ronald Reagan. Very unstable patients were sometimes sent, without arrangements or stabilization, to county/city/charitable hospitals when they should have been initially treated at the for profit facilities where they arrived. Of course, like every ‘good idea’ from government, bad things arise. One of these is that people do the math and bring even the simplest of problems for free care. And another of these, in a struggling economy, is that...

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Healthcare Update — 02-06-2012

WhiteCoat's Call Room — Mon, 06 Feb 2012 10:00:31 +0100

See more news stories at this week’s Satellite Edition over at ER Stories.net. Pfizer may be in legal trouble after some lots of its oral contraceptives had the wrong medications. Now women who took the mislabeled medications have an increased chance of becoming pregnant. Plaintiff attorneys wonder whether there will be class action lawsuits with hordes of women with unwanted pregnancies demanding justice. The simple solution is that every person who files a lawsuit but who has not made arrangements to give their child up for adoption immediately upon birth should have their lawsuit dismissed. Adoption fees can go to the hospital to cover delivery costs. None of this horsepuckey about how Pfizer should pay every pregnant patient the costs of raising their children until the children ...

Emergency Medicine Update Febuary 2012

Life in the Fast Lane — Mon, 06 Feb 2012 00:00:06 +0100

This study showed that they do not cause more cervical spine injury ( JACS 212 (3) 295 ). The problem is that this is a retrospective study that looked for cervical spine injuries in a data base and found that helmeted riders had less C spine injuries than non helmet wearers. This doesn’t take in to account how serious the traumas were, and what type of trauma they were. So yes, it doesn’t prove anything. Then again, how did opponents convince anyone that it did cause more injury? And American football players have perhaps the worst designed helmet and these do not seem to increase the incidence of neck trauma. Indeed a study in the Asian Pacific Journal of Public Health 23 (4) 608 (We’ll use the old Sid Cesar line “Stop me if you have heard this one before”) ...

US Army: Brigadier general has died in Afghanistan

GruntDoc — Sat, 04 Feb 2012 19:46:34 +0100

Natural causes. FORT HOOD, Texas (AP) – A 49-year-old brigadier general who died Friday in Afghanistan of apparent natural causes is likely the highest-ranking military officer to die in that conflict, according to military records. via US Army: Brigadier general has died in Afghanistan. At 49. Wow. Condolences to his family. Related posts: Army seeking troops bitten by stray animals following rabies death – Army – Stripes Wow, that is awful beyond belief. Army seeking troops bitten... Truman CO dies after collapsing – Navy News | News from Afghanistan & Iraq – Navy Times Carrier Command. On the path to Stars. Died at age... Wish comes true for cancer-stricken 10-year-old inducted into Army – Yahoo! News Most kids might hope to get an Xbox or...

Worker Trapped Under Boeing 787 Tires

GruntDoc — Sat, 04 Feb 2012 19:44:19 +0100

EVERETT, Wash. – Officials say emergency crews have rescued a worker who was temporarily trapped beneath the tires of a Boeing 787 jetliner at an Everett, Wash., airfield. via Worker Trapped Under Boeing 787 Tires Is Rescued. Yikes. Best wishes. via Drudge. Related posts: Boeing Providing Facebook Fan With the ‘Opportunity of a Lifetime’ — CHICAGO, Feb. 9, 2011 /PRNewswire/ – This weekend, Dr. Jeremy Hampton, an aviation enthusiast and amateur... Related posts brought to you by Yet Another Related Posts Plugin. (Source: GruntDoc)

The Best Super Bowl ad you won’t see

GruntDoc — Fri, 03 Feb 2012 22:00:05 +0100

It’s only on in Canada (eh). It’s good. Yeah, it’s a Budwiser ad, but since they paid for the stunt (I guess), so they get a lot of credit from me. via SFGate Related posts: Volkswagen rolls out full Super Bowl ad – Autoweek Volkswagen rolls out full Super Bowl ad – Autoweek. ... Announcing Guess-a-Nobel 2011 MedGadget has an interesting contest going on: Six days from... Related posts brought to you by Yet Another Related Posts Plugin. (Source: GruntDoc)

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Intercostal Antidote to Hubris

Life in the Fast Lane — Fri, 03 Feb 2012 16:57:51 +0100

Life in the Fast Lane Medical Blog Intercostal Antidote to HubrisNext time you get ready to Own the Chest Tube, think about these 2 angiography images of the course of the intercostal arteries.No Ethel, the intercostals aren’t stuck firmly to the inferior margin of the rib.They wander all over creation. Perhaps, they intentionally wiggle and try to impale themselves on the tip of your needle. I believe that one vessel in the second image crosses the equator into northern Queensland.Yoneyama H, Arahata M, Temaru R, Ishizaka S, Minami S. Evaluation of the risk of intercostal artery laceration during thoracentesis in elderly patients by using 3D-CT angiography. Intern Med. 2010;49(4):289-92. Epub 2010 Feb 15. PMID: 20154433.Here’s the free fulltext link for you: http://www.jstage....

Not dead yet

GruntDoc — Fri, 03 Feb 2012 06:07:18 +0100

All, Sitemeter tells me people still visit this site. Probably from a sense of nostalgia, and I thank all of you for checking in here from time to time. I’m working a lot of shifts, going to a lot of meetings, and still trying to have a semblance of a life. This leaves no time for original writing here. The meetings: our Gigantic Corporate Overlord has graciously agreed to part with a Princely Sum of Cash, and in March we break ground on a new ED. Nice! (Figures off the top of my head: currently we have about 96 beds in 24K sq. feet and see 96K/yr, and we’re going to 81 rooms and 48K sq. ft.). In case you missed that, we’re not scheduled to get the same number of beds as rooms, but a bunch of our current beds are hall beds. I hate hall beds. And, many of the new rooms are...

Medical Malpractice on the Decline

Movin' Meat — Thu, 02 Feb 2012 21:55:00 +0100

Last Monday, as is so common, I got an email from one of the several medical organizations of which I am a member. This was a fundraising pitch, and I can't recall the details, but it contained the usual breathless rhetoric regarding how important their advocacy efforts are to fix the SGR, enact tort reform, save the practice of medicine, ensure domestic peace and tranquility, yadda yadda yadda...Honestly, I don't even read these things any more before I hit delete, and I have actually developed a blind spot over the text where they hysterically predict catastrophe and doom. But this caught my eye — tort reform? Who's still talking about that as a priority? Mostly because it's a pipe dream that couldn't get through a republican congress with a republican president. In this day and age it...

The Indestructible Man

Movin' Meat — Thu, 02 Feb 2012 13:30:00 +0100

You know, writing about poor old Boomerang Bill made me think of another notorious alcoholic we used to see on a regular basis when I was a resident. I seem to think that I've written about this guy before, but I can't find him in a quick scan of my archives.This fellow was another who was frequently found by EMS slumped on the ground under a bar stool. We knew him well. He was surprisingly high-functioning, though, in that he managed to maintain some semblance of a job and a stable social situation. He even had family that would sometimes come and get him from the ER, which is pretty rare for a hard-core alcoholic. He didn't talk much (a welcome trait in an alcoholic frequent flyer) so he got nicknamed "Silent Bob," after the character in Clerks.Like many heavy drinkers, Silent Bob was to...

Prevent Falls

Your ER Doc — Thu, 02 Feb 2012 03:13:42 +0100

What is this plague that causes numerous visits to the emergency department for young and old alike? One word: falls. And three-quarters of them happen at home. And unless your home is built out of bubble wrap, that could cause an injury–sometimes a devastating one. The best way to reduce the risk of falls is to keep our bodies in shape and our minds alert. But there are many practical things we can do to help prevent them around the house as well. For the younger set, here are some simple rules: Don’t leave babies unattended on beds, tables, or couches. Get rid of sharp corners. Block stairs. Secure area rugs, or get rid of them. For older folks: Remove area rugs. Eliminate electric wires and other trip hazards. Get rid of step stools and ladders so we are not tempted to get on th...

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R&R in the FASTLANE 009

Life in the Fast Lane — Thu, 02 Feb 2012 00:00:45 +0100

Life in the Fast Lane Medical Blog R&R in the FASTLANE 009The ninth edition of our weekly series of eminence-based evidence:A free weekly resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 8 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.This week’s ‘R&R Hall of FamerBatchvarov VN, Malik M, Camm AJ. Incorrect electrode cable connection during electrocardiographic recording. Europace. 2007 Nov;9(11):1081-90. Epub 2007 Oct 10. Review. PMID: 17932025.This paper is a thing of ...

Volkswagen rolls out full Super Bowl ad – Autoweek

GruntDoc — Wed, 01 Feb 2012 19:42:56 +0100

Volkswagen rolls out full Super Bowl ad – Autoweek. No related posts. Related posts brought to you by Yet Another Related Posts Plugin. (Source: GruntDoc)

What does planned parenthood actually do?

Movin' Meat — Wed, 01 Feb 2012 19:33:00 +0100

One thing which has long pissed me off about the christianist faction in US politics, with regard to their never-ending quest to impose their definition of "life" onto everybody else in the country, is the way they put their ideology and their theology above the actual health and lives of real, actual, living and breathing women. Their belief in a magical spirit force in a clump of nonsentient cells is important enough they they are willing to lay waste to the rights, privacy, and also the health of the women who sinfully misuse their ladyparts.For years, the symbol that women's health activists have used to communicate this was the coathanger -- the implication that if abortion is driven underground then women will die from back-alley botched septic abortions. I always thought that was a ...

Treating pain a little too well

edwinleap.com — Wed, 01 Feb 2012 14:09:50 +0100

(My column from this month’s EM News) Second Opinion: Treating Pain a Little Too Well Leap, Edwin MD Free Access The Centers for Disease Control and Prevention report that prescription pain medication abuse and deaths are at an all-time high in the United States. Image… Image Tools The numbers in the November issue of the CDC’s publication Vital Signs, are impressive. (See FastLinks.) Prescription pain medication deaths numbered 3,000 in 1999 but 15,000 in 2008. The CDC report is shocking … to everyone except physicians and nurses in the real world of the emergency department. How many of us in the day-to-day practice of medicine have been predicting this sort of cataclysm for years? We’ve seen too many young people die from accidental overdoses from abu...

Unintended Super Bowl consequences

edwinleap.com — Wed, 01 Feb 2012 14:03:57 +0100

I never thought about this consequence of the Super Bowl… http://www.charismanews.com/us/32737-super-bowl-brings-sex-traffickers-to-indianapolis Thanks for checking it out! Edwin (Source: edwinleap.com)

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American Airlines, this is a problem

GruntDoc — Wed, 01 Feb 2012 05:31:54 +0100

Dear AA, I appreciate all the good to great service over the years, so this is why, in the spirit of improving our relationship, I offer this constructive criticism: For those unfamiliar with DFW, the gates are always related to the terminal. So the terminal being B and the gate starting with D, that’s a disconnect. I figured it out, but only after asking a terminal B curbside bag fellow which was real, and the answer was that the Terminal B was incorrect, it was supposed to be D. No harm, no foul. A learning experience. From a friend. Related posts: My first medical checklist Laugh if you want, this helps my life, at least... Royal wedding’s lone American will guard Queen on horseback – CNN.com Good for him. London (CNN) — Growing up on the... Related posts broug...

When politics trump health care

Movin' Meat — Wed, 01 Feb 2012 01:21:00 +0100

Seriously, this is bullshit:Susan Komen Foundation halts grants to Planned ParenthoodNEW YORK – The nation's leading breast-cancer charity, Susan G. Komen for the Cure, is halting its financial partnerships with numerous Planned Parenthood affiliates. Komen says the key reason is that Planned Parenthood is under investigation in Congress - a probe launched by a conservative Republican who was urged to act by anti-abortion groups.The result is a bitter rift, linked to the national abortion debate, between two iconic organizations that have assisted millions of women. Planned Parenthood says the cutoff, affecting grants for breast exams, results from Komen bowing to pressure from anti-abortion groups. Komen says the key reason is that Planned Parenthood is under investigation in ...

Doc Fix Just Got More Expensive

GruntDoc — Tue, 31 Jan 2012 15:38:01 +0100

This article and its graph (from the NEJM), and its... Related posts brought to you by Yet Another Related Posts Plugin. (Source: GruntDoc)

Boomerang Bill

Movin' Meat — Tue, 31 Jan 2012 13:00:00 +0100

One perk, or drawback, of working in the ER is that there are no shortages of interesting characters we see. Many of them we see over and over, and get to know very well. There was the old guy with the pacemaker who we saw >500 times for chest pain over a three year period. And the asthmatic who every doc in our group has intubated at least once. And the brittle diabetic who could somehow survive with a bicarb of five. They stick in your minds.One guy we will never forget around here was the alcoholic we called "Boomerang Bill." As his name implied, he was in the ER pretty damned regularly. He had money, and was actually rumored to be independently wealthy. (A repellent figure, he once confided to me that he spent all his money on "booze, hookers, and taxis.") He was routinely fou...

The LITFL Review 055

Life in the Fast Lane — Tue, 31 Jan 2012 00:00:43 +0100

Life in the Fast Lane Medical Blog The LITFL Review 055Welcome to the splendid 55th edition!The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team will cast the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle.The Most Fair Dinkum Ripper Beaut of the WeekSMART EMThe uber geek’s of emergency medicine are back with a lengthy look at Stress Testing: A Moment of Clarity - the SMARTEM team dives down through 40,000 leagues of medical literature on the utility of using the exercise stress testing in the emergency department. Congratulations...

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Things that are not at all surprising, part 26

Movin' Meat — Mon, 30 Jan 2012 18:06:00 +0100

I remember way back in the paleolithic era when the debate was actually going on over what health care reform would look like (before we settled on "greatest threat to liberty ever," that is) and my comment section was deluged with folks who railed against the very concept of universality in healthcare insurance. They, further, denied that such a thing as involuntary uninsurance existed, or that underinsurance was a problem at all. These commenters tended to be the rugged individualists of our great nation, and their testimonies were along the lines of: "I have type 1 diabetes and I've had three limbs amputated and I do just fine with my catastrophic health insurance plan" or "I have chosen not to buy health insurance and I'm just so badass that if I ever get sick I will go off onto an ice...

Official 2012 Honda CR-V Game Day Commercial – “Matthew’s Day Off” Extended Version – YouTube

GruntDoc — Mon, 30 Jan 2012 17:23:35 +0100

Laugh, and enjoy! Official 2012 Honda CR-V Game Day Commercial – “Matthew’s Day Off” Extended Version – YouTube. Related posts: The Canada Party Okay, it’s got an Fword in it, so if you’re... Doctors decry poor ER conditions via YouTube – FierceHealthcare Doctors at LaSalle Hospital in Montreal have turned the cameras... Compression Only CPR video Okay, it’s kind of amusing, and I hope it induces... Related posts brought to you by Yet Another Related Posts Plugin. (Source: GruntDoc)

The Value of Education

edwinleap.com — Mon, 30 Jan 2012 14:26:40 +0100

This is my column in yesterday’s Greenville News. Thanks! One of the great things about my work in an emergency room is that I get to talk to people with every variety of educational and work experience. I especially enjoy talking with college students. While the intoxicated ones are less engaging (though equally entertaining) conversationalists, most are genuinely delightful. In speaking to them I can gauge their passions, ask about their dreams and explore how they view their educational experiences. It’s fun. I well remember the lovely young student who told me her plans after graduation. I might have expected many answers, from law school to business. But she answered, ‘I’m joining the Diplomatic Security Service.’ ‘Do you like guns?’ I aske...

Healthcare Update — 01-30-2012

WhiteCoat's Call Room — Mon, 30 Jan 2012 10:00:38 +0100

See more medical news from around the web at the Satellite Edition of this week’s update on ER Stories.net Meth heads do the “shake and bake” … on their face. New process for making methamphetamines in a 2 liter soda bottle often backfires, causing explosion and burns to the junior chemist. Because most people suffering these burns don’t have insurance and because the mandated care from this activity averages $130,000 per person (60% more than other burn patients), the financial strains are contributing to the closure of several burn units across the country – leaving fewer resources available for everyone. Correlation or causation? Study shows that elderly patients who visit the emergency department are almost four times as likely to develop a respiratory or gastrointe...

Emergency Medicine Update January 2012

Life in the Fast Lane — Sun, 29 Jan 2012 08:12:27 +0100

This article describes on going research which will interest me only when the article is finally published, but the statistics were important. Intracranial aneurysms occur in 0.4-0.6% of the general population; the total risk of rupture may be about 2% for all aneurysms, but indeed if they are less than 7 mm in diameter, the risk is only 0.1%. This is important for us to know because often we do CT’s for headaches, and find aneurysms that are not leaking-and it appears we do not need to do much for them. Surgical treatment for aneurysms cares a 1 in six morbidity rate and a mortality rate of 2.6% to 15.7% – probably a wide range due to location of the aneurysms. Coiling is much safer but has an incomplete occlusion rate in 40% and aneurysms recur in 34%. Risks for rupture inclu...

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Open Mic Weekend

WhiteCoat's Call Room — Sat, 28 Jan 2012 23:22:24 +0100

Haven’t had an Open Mic in a couple of months. Leave questions, opinions, and any other medically-related comments below and I will try to get to them Monday night. Remember, no personal attacks. (Source: WhiteCoat's Call Room)

Selling the ACA, 2 years too late

Movin' Meat — Fri, 27 Jan 2012 13:30:00 +0100

This is a cute and informative video about the health care reform act:My favorite drawing is this, of economist Jon Gruber about to be crushed by the ogre of uncontrolled health care spending:In fact, I think this will be my new twitter avatar.Still, it would have been nice to have seen more of this sort of education and messaging two years ago when public opinion regarding the ACA was more malleable. Now people's ideas are pretty well set, hardened in part by their partisan stances. I was shocked to see that 55% of Americans now think that the individual mandate is unconstitutional. This is evidence, I think, of how effective the impassioned rhetoric from the opponents of the ACA has been in shifting the way the law is viewed. I don't think that many people have done a deep dive...

I’m Glad I’m A Doctor

WhiteCoat's Call Room — Fri, 27 Jan 2012 10:00:50 +0100

I made the statement that “I’m glad I’m a doctor” in one of my posts, but when I went back to link to the story behind the statement, I couldn’t find it anywhere. So I pulled up the story from the archives and have posted it below. Still holds true today. When I was a student, one of the attendings on my ICU rotation told me a story that I still have not forgotten. When I was in your position, I thought it was cool to be a doctor because you got to have a pager. Everyone wanted you. You were the “go to” guy. If someone needed help, they called you. Then I wore a pager for a couple of days and found out that being wanted 24 hours a day wasn’t very much fun. In fact it caused me so much stress that I didn’t want the pager any more. But by then, it was to...

Funtabulously Frivolous Friday Five 074

Life in the Fast Lane — Fri, 27 Jan 2012 00:00:42 +0100

Life in the Fast Lane Medical Blog Funtabulously Frivolous Friday Five 074What do you get when you combine salted pork, a full moon, William the Conqueror, Stendhal and a swollen labia majora?The 74th edition of the FFFF of course!Question 1What underlying condition might make you want to treat a patient’s nose bleed by inserting nasal tampons made of salted pork?From Humphreys et al (2011)Reveal the funtabulous answer!expand(document.getElementById('ddet95330696'));expand(document.getElementById('ddetlink95330696'))Glanzmann thrombasthaeniaPatients with this condition have defects in their gpIIb/IIIa receptors that prevent their platelets from aggregating. As a result they are prone to bleeding complications, including epistaxis (nose bleeds). Various blood products or surgical proc...

Doctor Cat

Movin' Meat — Thu, 26 Jan 2012 18:25:00 +0100

A friend alerted me to the existence of this:Unfortunately, the Doctor Cat cartoon seems to be on a bit of a hiatus for health reasons (here's hoping the author gets better soon). It works for me on a number of levels:1. Cats are cute (no explanation needed)2. Cats are like doctors in that they are variably narcissistic, imperious and inscrutable.3. Did I mention the cute factor?Reminds me of this brilliant series from Medium Large: (Source: Movin' Meat)

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Watching the watchers…evade their taxes

edwinleap.com — Thu, 26 Jan 2012 17:01:06 +0100

Fascinating indictment of the power, and arrogance, of the ruling class and its employees. http://news.investors.com/Article/599002/201201260818/obama-white-house-staff-back-taxes.htm Try not paying your taxes, peasant. See what happens! Edwin (Source: edwinleap.com)

Your Feet – Your Shoes

Your ER Doc — Thu, 26 Jan 2012 14:00:36 +0100

We all know you can’t judge people until you walk in their shoes. But should we be walking in other peoples’ shoes? Sounds painful. Our own feet are much too important. Consider that every foot is made of twenty-six bones, thirty-three joints, nineteen muscles, and one hundred and seven ligaments. Lots can happen! So take time, and care, when buying shoes. Here are some guidelines. Feet should be measured while standing. Measure both feet and fit the shoe to the largest one. Forget shoes that need to be “broken in.” They should be comfy now. Shop later in the day to account for swelling. Try on shoes while wearing the socks you’d normally wear. Make sure shoes fit the heel, the toes, and the sides of your feet and offer support. And ladies, you’re four times more likely...

The House Abuser

WhiteCoat's Call Room — Thu, 26 Jan 2012 10:00:46 +0100

Never finished describing what happened when we got back from our vacation … three weeks ago. Dang does time fly. When we walked in the house, the first thing we noticed was that it smelled like cleaning products. There were a mop and a bucket sitting in the wet room by the garage. The fishtank in the kitchen was a ruddy brown color. We could barely see the fish. One fish was floating. Half of a large can of fish food that we had just bought was gone. Instead of coming home to relax, we came home to a CSI scene. We began to explore further. One of the things that I noticed was that our coat rack had been moved. It was sitting to directly block the view through the windows by the front door. I also noticed that there was a piece of tape over the side of the kitchen window. Our neighbo...

The Myth of the Cost Sensitive Patient

Movin' Meat — Thu, 26 Jan 2012 07:50:00 +0100

It simply will not go away, and the fact that anyone who has ever interacted with the health care system thinks this will ever be more than a pipe dream is simply delusional. The offender (this week) is former CBO and OMB director Peter Orszag. (Disclosure: I once had a man-crush on him as the uber-wonk of health care reform, until he left government and cashed in at Citigroup.)Orszag writes in Bloomberg: To Shop Smart, Patients Need to Know Price of Care, in which he argues for greater price transparency "with the goal of helping people become smarter shoppers."Sweet baby zombie Jeebus help me.To his credit, Orszag notes that the extant experiments towards this goal "have not been overwhelmingly successful," in perhaps the same way that the captain of the Costa Concordia was "n...

Save 50% at XYScrubs.com

GruntDoc — Thu, 26 Jan 2012 02:00:22 +0100

I recommend these. They’re terrific. Get ‘em while they last. XY Scrubs, a premier provider of men’s scrubs and medical work apparel is having a 50% Off Sale on all Men’s Scrubs. Providing eco-friendly, anti- microbial, durable and fashion forward scrubs for Men, XY Scrubs (XYScrubs.com) has established itself as the New Leader in Men’s Scrubs, introducing three unique lines of medical apparel. … To take advantage of the 50% off sale enter the promotional code “HALFOFFSCRUBS” at the checkout window. via Save 50% at XYScrubs.com. I have some (Full disclosure, I got some gifted to me by their designer/owner, and I like ‘em. A lot.) Related posts: XY SCRUBS | Mens Scrubs – XY SCRUBS XY SCRUBS | Mens Scrubs – XY SCRUBS. A... Colorect...

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R&R in the FASTLANE 008

Life in the Fast Lane — Thu, 26 Jan 2012 00:00:48 +0100

Life in the Fast Lane Medical Blog R&R in the FASTLANE 008The eighth edition of our weekly series of eminence-based evidence:A free weekly resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 14 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.This week’s ‘R&R Hall of Famers’Abd-el-Maeboud KH, el-Naggar T, el-Hawi EM, Mahmoud SA, Abd-el-Hay S. Rectal suppository: commonsense and mode of insertion. Lancet. 1991 Sep 28;338(8770):798-800. PMID: 1681170This little known clas...

Demanding Perfection?

WhiteCoat's Call Room — Wed, 25 Jan 2012 21:59:10 +0100

Want more evidence about how many people expect perfect outcomes in medical practice? Look no further than the Wall Street Journal: “What if the Doctor is Wrong?” by Laura Landro. As a substantive basis for the conclusion that initial treating physicians are “wrong” when they haven’t yet reached a diagnosis, Ms. Landro interviewed two patients who, in the midst of a workup, left the doctor who was trying to diagnose and treat their problems. Said patients then went to a “mecca” to have their workup completed where … amazingly … the problem is “discovered” and “properly” treated. Even though the initial provider in all likelihood would have done the same testing that the “mecca” performed after reviewing the results o...

More Adventures of Dick

WhiteCoat's Call Room — Wed, 25 Jan 2012 05:02:09 +0100

Daughter WhiteCoat’s reading is going well. In keeping with the previous posts on the topic, she continues to learn about the adventures of Dick and his family and she still can’t understand why mom and dad laugh at her as she reads her workbook. I bet the teacher sits in her class every morning just chortling away at this book. (Source: WhiteCoat's Call Room)

Crime Time: Juror arrested for trying to enter Fort Worth courthouse with loaded gun

GruntDoc — Wed, 25 Jan 2012 04:59:28 +0100

This isn’t the part that made me roll my eyes: FORT WORTH — A juror was arrested Tuesday morning as she attempted to enter a courthouse with a loaded handgun and after deputies saw the weapon during a screening, a Tarrant County official said.The incident occurred about 8:30 a.m. at the south entrance to the Tim Curry Criminal Justice Center. … This was: Authorities did not release any information on why she had a loaded 32-caliber handgun at the courthouse. via Crime Time: Juror arrested for trying to enter Fort Worth courthouse with loaded gun. A .32? Why? Related posts: In Fort Worth, MedStar’s Community Health Program cutting costs, improving patients’ well-being … Kudos to MedStar (our Fort Worth EMS provider) for their... Extra Credit: Fort Worth t...

The Registrar sits at the desk registering patients. Right?

Life in the Fast Lane — Wed, 25 Jan 2012 04:20:14 +0100

Life in the Fast Lane Medical Blog The Registrar sits at the desk registering patients. Right?aka American ER Doc Gone Walkabout… 009Arriving in Tassie, I had only the vaguest sense of how the intern-resident-registrar system compared to our US system. (OK, so planning ahead has never been my strong point. Works out amazingly well. Sometimes.)By the time I finished, I had concluded:The system doesn’t make much difference, we all figure it out and do pretty much the same things by the time we’re done training. Interns are interns, and they all look and function pretty similarly. The residents in Oz have a much greater knowledge base than interns, but not being into the ER track, don’t have quite the mindset of ER Docs – they’re doing inpatient workups –...

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Grand Rounds is at USA Today…today!

edwinleap.com — Tue, 24 Jan 2012 16:16:56 +0100

Hey folks, medical blogging champion Dr. Val Jones is hosting Grand Rounds today on the USA Today platform. They’ll release assorted topics every three hours, so check back from time to time. I’ll have one there at some point. http://yourlife.usatoday.com/health/healthyperspective/post/2012-01-23/grand-rounds-begins-health-tips/610723/1 Thanks! Edwin (Source: edwinleap.com)

At the end of the algorithm…Lortab

edwinleap.com — Tue, 24 Jan 2012 14:45:02 +0100

Sir, you appear to have a life-threatening aortic dissection, in which the large blood vessel in your chest has a tear. ‘Uh, yeah, so can I get a Lortab?’ Ma’am, I believe you have pneumonia and need antibiotics. ‘I figured. Can I have some Lortab or what?’ Miss, your child has a subtle break in his wrist. ‘I see. Can he get some Lortab or something?’ Headache….Lortab. Depression….out of Lortab. Anxiety….pain…Lortab. Abscess…Lortab. Cystitis…Lortab. At the end of every algorithm, Dear physicians, insert the word Lortab (or Percocet, or Methadone, or Oxycontin, or Dilaudid). You’ll be right about the underlying problem more than most of us care to admit. Edwin (Source: edwinleap.com)

Unaffected by suicide?

edwinleap.com — Tue, 24 Jan 2012 14:31:31 +0100

I cared for a suicide patient recently. Not an attempted suicide, a completed one. She was efficient, effective and successful. I pronounced her dead, filled out the appropriate forms, and went on with my shift. While I found it tragic, and while I was moved by the sorrow of her family, I was not particularly moved. What does that mean? Day in and day out, emergency departments like mine are bombarded with patients coming in the door, or via ambulance, who say, ‘ I’m thinking about killing myself.’ We evaluate them, admit them, commit them, see them weeks later for the same thing and round and round it goes. One becomes a little numb to the complaint, and to the almost hopeless cycle that our inadequate resources and dysfunctional populations produce. But a co...

A View of Emergency Medicine in Botswana

Life in the Fast Lane — Tue, 24 Jan 2012 00:00:29 +0100

Life in the Fast Lane Medical Blog A View of Emergency Medicine in Botswanaaka Postcards from the Edge 004This ‘postcard from the edge’ is by Swedish Emergency doctor Katrin Hruska (@akutdoktorn), who writes a predominantly Swedish language blog called akutdoktorn.I am a born optimist, which is why I have taken on the struggle to establish emergency medicine as a specialty in Sweden. Since EM is a supraspecialty I had to take the long way through an internal medicine residency, but now I am at least seeing the end of my EM training. I am also mildly adventurous. Not in the crazy, head-first, emergency physician way, but in a safe, Swedish way. Somehow I managed to convince my program director that a rotation abroad would make a great contribution to my education, so me and my f...

Healthcare Update — 01-23-2012

WhiteCoat's Call Room — Mon, 23 Jan 2012 14:46:49 +0100

See more medical news from around the web over at the Satellite Edition of this week’s Update at ER Stories. The story of “Dr. Douchebag” and why morale is declining in many of this country’s emergency departments. Even if you say “thank you, sir” for the abuse, your job may still be threatened because of bad Press Ganey scores. More than 80% of medical mistakes go unreported by hospitals. Let’s just get this out of the way: Doctors kill every single patient that they treat and plaintiff attorneys should be paid even more money to sue our way to better health care. That should do it. Indiana woman awarded $1.5 million after surgeon did not operate on abdomen soon enough. Two days after initial presentation, she required emergency surgery for ischemic bowel requiring that ...

Think Fast Engineering

GruntDoc — Mon, 23 Jan 2012 09:30:46 +0100

My brother (the Aerospace Genius) is branching out into race engineering consulting. Think Fast Engineering is his effort, and if you want to go fast, you’re looking for the right fellow. (If you are rolling your eyes in a ‘what’s he done’ mode, have a look at his ‘about page‘, and then pick your jaw up from your chest). I’m biased, but aside from my Dad he’s the best engineering brain I know. (Dad’s not for hire). “Speed is money: how fast do you want to go?” Related posts: How fast does a wildfire move? A picture’s worth a thousand words a second… via Ace.mu.nu... Related posts brought to you by Yet Another Related Posts Plugin. (Source: GruntDoc)

The Canada Party

GruntDoc — Mon, 23 Jan 2012 08:01:48 +0100

Okay, it’s got an Fword in it, so if you’re prone to the vapors, skip this one. The rest of you, laugh, and enjoy. Related posts: Paul, I Accept Your Resignation | TechCrunch Apparently, even an open handed slap can leave a mark.... Related posts brought to you by Yet Another Related Posts Plugin. (Source: GruntDoc)

The LITFL Review 054

Life in the Fast Lane — Mon, 23 Jan 2012 07:55:46 +0100

Life in the Fast Lane Medical Blog The LITFL Review 054Welcome to the mind-boggling 54th edition!The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team will cast the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle.The Most Fair Dinkum Ripper Beaut of the WeekEM BasicTop spot this week is taken out by someone new on the podcasting/blogging scene… Steve Carroll over at the simple yet extremely informative podcast EM Basic. This podcast covers all the pertinent topics in EM in a simplified, easy to follow format. To take out top spo...

Not Running a Hospital: Carrying a lot of baggage

GruntDoc — Sat, 21 Jan 2012 01:02:22 +0100

What he said… Query: Why hadn’t they notified me upon arrival — or even before arrival when I was aboard the plane? They knew what plane I was on. Why have me go through a long fruitless wait at the airport? If you have such a powerful information system, why not use it to the benefit of your patrons? Especially your so-called “priority” customers.Indeed, why can’t all customers gain access to the baggage information system on their computers or iPhones? Sounds like that would be better service and possibly save money for those companies, too. via Not Running a Hospital: Carrying a lot of baggage. Related posts: Former Winkler County Hospital Administrator Pleads Guilty, Must Serve Jail Time From Texas Attorney General Greg Abbott ODESSA – Former Winkl...

Too Many CT Scans … or Not Enough?

WhiteCoat's Call Room — Fri, 20 Jan 2012 14:40:29 +0100

Scary findings. Patients using Coumadin who have any head injury need repeat CT scans. The study looked at 116 patients who were taking Coumadin and who had any head injury with a GCS of 14 or 15 – regardless of loss of consciousness (patients with lower GCS were presumably at higher risk of intracranial bleeding). CT scans were performed on all patients. Of those initial 116, nineteen patients (16%) had bleeding on their initial exam. Of the remaining 97 patients with normal initial CT scans, ten refused to be in the study. Repeat CT scans were performed on the remaining 87 patients 24 hours after the first normal CT scan and showed 5 cases of new hemorrhage. Three of those patients required hospitalization and one delayed bleeding patient required brain surgery. Even after a normal...

Medicine: a means, not an end

edwinleap.com — Fri, 20 Jan 2012 12:37:55 +0100

Sometimes, we physicians lose our way. It’s particularly a problem of young physicians, in training. But it can afflict anyone, at any time. And it happens when we see medicine as an end in itself, rather than a means. Oh, it’s an exciting thing, to be sure. I remember being an emergency medicine resident. I remember carrying the pager for the LifeLine Helicopter at Methodist Hospital of Indiana. Oh, the tingling thrill of the pager, the palpable, heart-racing excitement of running to the landing pad! How I loved strapping on a helmet, buckling in and flying off to the scene of a wreck, where we would swoop in and rescue some poor soul who had been crushed in twisting metal, thrown from a motorcycle or stabbed in the chest. Sometimes I found myself flying to a small hospital, w...

Friday Frontline Inspiration 015

Life in the Fast Lane — Fri, 20 Jan 2012 00:00:36 +0100

Life in the Fast Lane Medical Blog Friday Frontline Inspiration 015Shot on board with the paramedics of Pretoria and Johannesburg, TELL ME AND I WILL FORGET illuminates the new social challenges in South Africa, 15 years after the end of its oppressive Apartheid era.Below is the first 2 minutes of this amazing hour long documentary. I urge you to make the time to watch and digest the rest of the film – it will be an hour well spentDesperate human circumstance and a wave of violent crime have put immense pressure on the medical system, which is now as divided as the country’s dual economy. With the on going US medical debate, the documentary provides a timely look into the much less glamorous side of the nation that hosted the 2010 World Cup Football Games.ReferencesSnag Films (...

Test the Textbook Trilogy

Life in the Fast Lane — Thu, 19 Jan 2012 23:49:55 +0100

Life in the Fast Lane Medical Blog Test the Textbook TrilogyLate last year we completed a trilogy of textbooks relating to emergency medicine, toxicology and medical education.We are now looking for ‘volunteers’ to read and review these texts…and have 15 textbooks (5 of each book) to give away for FREE.Rules for reviewersBe subscribed to Life in the Fast Lane by email or RSS feedSend me an email letting me know which of the texts you would like to review, and whyEnhance your chances by sending me a Tweet on twitter or a Comment on Facebook or a Comment on Google PlusCross your fingersThe lucky winners will be drawn out of the proverbial hat on February 1st 2012…Emergency Medicine Diagnosis and ManagementAuthors: Anthony F. T. Brown, Mike Cadogan Edition: 6th Edi...

A headache patient and a lesson for the kids

edwinleap.com — Thu, 19 Jan 2012 14:19:37 +0100

(Source: edwinleap.com)

R&R In The FASTLANE 007

Life in the Fast Lane — Thu, 19 Jan 2012 00:00:03 +0100

Life in the Fast Lane Medical Blog R&R In The FASTLANE 007The seventh edition of our weekly series of eminence-based evidence (back after the festive season hiatus):A free weekly resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 18 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.This week’s ‘R&R Hall of Famer’Croskerry P. The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them. Academic Medicine 2003;78:775-780. PMID: 12915363.You won’t ...

Certificates of Medical Necessity

WhiteCoat's Call Room — Wed, 18 Jan 2012 14:49:52 +0100

Not too long ago I got a letter labeled “URGENT” in my mailbox at work. The letter was from Walgreens regarding a patient I had seen several weeks earlier. I cut and pasted parts of the letter to make it fit on one page above. As the prescribing physician, in order for our government to pay for the prescription I wrote for the patient … several weeks ago … I had to sign a statement stating the following: “I, the undersigned, certify that the above prescribed supplies/equipment are medically necessary for this patient’s well being. In my opinion, the supplies are both reasonable and necessary to the accepted standards of medical practice in the treatment of this patient’s condition and are not prescribed as convenience supplies. By signing th...

Timing is Everything

WhiteCoat's Call Room — Wed, 18 Jan 2012 04:57:41 +0100

I almost had an ironic picture to post from this week’s wrestling meets. Almost. There was a parent in the stands several rows in front of me. She was cheering on her son, which we all do. Her son was 13 years old and weighed 229 pounds. I know because wrestlers have their weights written on their arms in magic marker after they weigh in. The lady easily weighed 300 lbs. She was cheering loudly and bouncing up and down on the stands. Then her son won his match. She stood up and put her arms over her head and cheered. Fair enough. We do the same thing when our kid wins. In the woman’s left hand was a partially eaten doughnut. In the woman’s right hand was a partially eaten peanut butter and jelly sandwich. There she stood jumping up and down cheering while jelly dripped do...

Board Exams and a quiet revolution

edwinleap.com — Tue, 17 Jan 2012 22:11:07 +0100

Folks, my December column concerned the American Board of Emergency Medicine and the Maintence of Certification program. This is not unique to my specialty. In fact, the American Board of Medical Specialties has enormous influence, and in total rakes in some $300,000,000 per year across all specialties. I understand the need to prove our competency. I didn’t mind my original exam and I didn’t even mind the test every ten years. But as any physician knows, it is getting out of hand. The cost, and the requirements, are becoming substantial. We’re told, ‘oh, it’s just $100 here or $1000 there, just an afternoon here or a day there,’ but all of it adds up to costs in an already costly era, and it costs time which is more precious by far. Already ...

Surgeons behaving badly: a rant

Movin' Meat — Tue, 17 Jan 2012 12:30:00 +0100

I recently saw a patient who had had a major surgery at a downtown medical center. He had done fine initially, but at about 2 weeks out, the patient started having fevers and chills. He saw his surgeon in follow-up and was diagnosed, reasonably, with a UTI and started on antibiotics. Unfortunately, he got worse and presented by EMS to my ER quite ill indeed. It was clear that he needed to be admitted and possibly to have another surgery.In this case, I was pleased that the patient and his family thought the world of their original surgeon. "Dr Smith was great, so thoughtful and kind and he knows all about my problem, you will call him, won't you?" "Oh, I have to be admitted and maybe another surgery? Can you send me to Dr Smith? He's the one I really trust."No problem, I thought. So, on th...

What is the truth that lasts?

Life in the Fast Lane — Mon, 16 Jan 2012 23:42:19 +0100

Life in the Fast Lane Medical Blog What is the truth that lasts?Dr Newman helps us to tackle hyperbole and fear-mongering media head on by understanding the value of data in the age of information…As health care professionals we all have a responsibility to help curate and deliver the most accurate information and help define the ‘truth that lasts” – we should not take this responsibility lightlywww.youtube.com/watch?v=TDB6iBOhuq0Dr. Newman is the Director of Clinical Research in the Emergency Department at the Mt. Sinai School of Medicine. For the past ten years he has concentrated his work in medical evidence translation and appraisal. He is also the editor-in-chief for TheNNT.com, a resource for health care evidence summaries, and SMART-EM, a monthly audio revie...

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Field guide to quackery

Movin' Meat — Mon, 16 Jan 2012 20:09:00 +0100

From the inestimable folks at Sci-ence:Worth clicking through for the full read. (Source: Movin' Meat)

Healthcare Update — 01-16-2012

WhiteCoat's Call Room — Mon, 16 Jan 2012 16:44:56 +0100

Also check out the Satellite Edition of this week’s update over at ER Stories. Florida teen wins a $12.6 million medical malpractice award after being given an expired vaccination and then contracting an infection which developed into sepsis, DIC, and gangrene resulting in amputations of all four limbs. I’m sure the antivax crowd are having mind cramps over this concept. The vaccines are full of toxic waste and don’t work. The toxic waste is what caused the illness. They should be sued for giving it. Wait. The patient came down with an infection. Infections are good to build the immunity so we don’t need vaccines. That’s what we want. Then why did the teen win all that money? Wait. Maybe expired vaccines cause the infections. That’s it. Yeah. That’s ou...

The LITFL Review 053

Life in the Fast Lane — Mon, 16 Jan 2012 04:08:30 +0100

Life in the Fast Lane Medical Blog The LITFL Review 053Welcome to the awe-inspiring 53rd edition!The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team will cast the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle.The Most Fair Dinkum Ripper Beaut of the WeekEMCritTop spot this week is taken out by Scott over at EMCrit when he teams up with Dr Paul Marik to try and answer one of the toughest questions in critical care on assessing fluid responsiveness in the critical ill patients. Check out Podcast 64 – Fluid Responsiveness with Dr. Pau...

Best Of The LITFL Review 2011

Life in the Fast Lane — Sun, 15 Jan 2012 13:22:59 +0100

Life in the Fast Lane Medical Blog Best Of The LITFL Review 2011If you were to ask me:‘How do I find out about web 2.0 and social media education resources for emergency medicine and critical care?”I’d reply:“Easy, spend 10 minutes checking out The LITFL Review.”Just over a year ago it became clear to me that keeping track of all the fantastic free education resources in our field was becoming near impossible for even the most assiduous insomniacal social media savvy technophilic medicos among us. Recognition of this need led to the creation of The LITFL Review – a ‘one stop shop’ that brings together a week’s worth of new educational material from the very best blogs, podcasts, tweets and online multimedia from around the world.Kane Guthrie has been t...

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Wrestlemania

WhiteCoat's Call Room — Sat, 14 Jan 2012 20:16:54 +0100

So Jr. WhiteCoat is back to wrestling. During one match, he is winning 11-0 and the kid he is wrestling flings his head back and hits Jr. WhiteCoat in the mouth. He gets a little cut on the corner of his lip and his lip started bleeding. Referee stopped the match. It took about 45 seconds to get the bleeding to stop. During that time, there was a medical time-out. If the medical time out lasts more than 2 minutes, then the wrestler is disqualified. Started wrestling again. Then the referee notices blood on the back of the other kid’s uniform. No further bleeding from Jr. WhiteCoat’s mouth, just a couple of spots of blood that the referee hadn’t noticed before. He stops the match again for a medical time-out. Trainer has to come over and use soap to wipe the kid’s un...

Spirals and Fibonacci Series and Pine Cones

Movin' Meat — Sat, 14 Jan 2012 05:00:00 +0100

This is so freaking cool:And part two:How is it that the world works like this? How awesome is it that the world works like this?I remember once being criticized by a more touchy-feely friend who specialized in the humanities, for being a reductionist, too scientific. By wanting to break everything down into its component elements and understand how they work, he contended, we rob them of their mystery and their beauty. This video, I think, is a wonderful refutation of that contention. I get so much more satisfaction and joy out of understanding on a deeper level how the world works, and how deeply simple mathematics are embedded in the design of life. This is where the wonder and mystery reside, and this is why I will always love science and math, even when I'm not actively engaged in res...

Presidential Voting and Press Ganey Part 2

WhiteCoat's Call Room — Sat, 14 Jan 2012 01:51:05 +0100

If you haven’t read the first part of this two-part series, which was published before the primary results were known, please go here to review it. The final results in the New Hampshire Republican presidential primaries have been published and I’m confused. Based upon the sample from Dixville Notch, each candidate should have received one portion of the votes, but when a larger sample size was taken, the candidates all received different portions of the vote. None of the final results were even close to the predicted results from Dixville Notch. Jon Huntsman’s scores were off by 31% Ron Paul’s scores were off by more than 100%! Rick Perry’s scores were pretty close, but he still got votes even though the survey said that he wasn’t supposed to get any votes at all. Rick...

Washington Medicaid vs Prudent Layperson

Movin' Meat — Fri, 13 Jan 2012 21:24:00 +0100

Consider this scenario: You are driving down the road and your car is hit from behind. You car, being older, doesn't have the greatest safety features, and the seat back breaks, and your head is wrenched backwards by the force of impact. You feel a sudden sharp pain in your neck, and you are afraid to try to move because you don't know how bad the injury is. The next half hour is a blur. Bystanders and the police keep you in the car, the paramedics come and slap on a collar and strap you to all sorts of devices and next thing you know you are cold and naked under the bright lights of a trauma bay. You are examined, medicated, poked, prodded, scanned and rescanned. Finally, you are told that there doesn't seem to be any serious injury. Eventually, the collar is removed and you are taken off...

Historical Nuggets

WhiteCoat's Call Room — Fri, 13 Jan 2012 18:16:04 +0100

Parents bring their child to the emergency department for evaluation of nausea and vomiting. Well, mostly nausea. He vomited once. When I entered the room, the 7 year old child was underneath the bed trying to squeeze himself into the area where they usually put the patient belongings. He was rocking the bed back and forth. I couldn’t figure out whether he was trying to perform some impromptu Steve Santini routine or whether he had taken an interest in becoming a stretcher mechanic. His parents were just calmly sitting there playing video poker on their matching handheld games. I asked if they could put the child on the bed so that I could examine him. Once the child was sitting on the bed, he was all over the place. Crawling up and down. Reaching in my pockets. Continuing to rock th...

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Brain Dead?

Life in the Fast Lane — Fri, 13 Jan 2012 12:48:33 +0100

Life in the Fast Lane Medical Blog Brain Dead?aka Toxicology Conundrum 047A 35-year old female with a history of multiple sclerosis and depression is found collapsed at home. She is known to have access to quetiapine. On arrival to ED she is comatose (GCS 3), hypotensive (75/50), bradycardic (40 bpm), bradypnoeic (8 breaths per min) and hypothermic (34 degrees C). She is intubated for airway protection. Her hypotension rapidly responds to fluids. Prior to administration of muscle-relaxants, she is noted to have generalised flaccid tone with absent deep-tendon reflexes. Blood sugar is normal. ECG shows sinus bradycardia with normal QTc and no signs of sodium-channel blockade. Admission ethanol level is 0.13%. Full blood count, electrolytes, blood gases and thyroid function tests are unre...

Friday Inspiration 014

Life in the Fast Lane — Fri, 13 Jan 2012 00:00:30 +0100

Life in the Fast Lane Medical Blog Friday Inspiration 014Still nothing like a good book…Despite the blogs, the internet chatter, real-time search, tweets and likes…there is still nothing I enjoy more than the musty aroma of a second hand bookshop, the smell of bound leather and the allure of the virgin textThe book is dead – Long live the bookwww.youtube.com/watch?v=SKVcQnyEIT8After organizing our bookshelf almost a year ago (http://youtu.be/zhRT-PM7vpA), my wife and I (Sean Ohlenkamp) decided to take it to the next level. We spent many sleepless nights moving, stacking, and animating books at Type bookstore in Toronto (883 Queen Street West, (416) 366-8973)“I declare after all there is no enjoyment like reading! How much sooner one tires of any thing than of a book! &#...

New Year Thoughts – Celebrate You

Your ER Doc — Thu, 12 Jan 2012 13:51:14 +0100

There’s a lot to celebrate this time of year — families, friends, traditions, and good fortune. But I’d like to suggest that you find a moment in the midst of your busy day to take a look at your own life, and permit yourself some joy about what you have accomplished in 2011. Was this the year you finally got a promotion, found a new friend, or sent your daughter off to college? Did you finally forgive somebody, or discover a church where you feel at home? Were you able to lose that five pounds, or run a full mile? Break some barrier? Or just survive? What made you feel really good this year? It’s important to take inventory of personal successes, whether large or small. Give yourself a pat on the back, even if it’s just a quick one. Remember the more you take time to be grat...

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Emergency Imaging in Tassie

Life in the Fast Lane — Thu, 12 Jan 2012 00:00:29 +0100

Life in the Fast Lane Medical Blog Emergency Imaging in Tassieaka American ER Doc Gone Walkabout… 008 Plenty of differences in practice between Tasmania and my home hospitals in the US existed — the accent, the patient population, billing, interactions with consultants, roles of the residents and registrars — but didn’t really have an impact on clinical functioning. However, imaging did change clinical practice. During the day shift on weekdays, there wasn’t much difference — perhaps a bit less dependence on imaging to confirm every clinical impression, or to “rule out” really unlikely diagnoses. And, significantly, the absence of real-time written reports. They weren’t available for days. So, if we were satisfied with our own reading, we...

HCC Blog calls it quits

GruntDoc — Wed, 11 Jan 2012 03:49:05 +0100

Dear Readers, It has been my pleasure over the last 4 years to blog on HCC-related topics and exchange ideas with many of you. I have learned a ton from everyone. This is my last post and I anticipate retiring the blog by the end of the month. via HCC Blog » hccblog. Another good blogger taps out. Too bad. Related posts: Why I don’t blog much anymore, and why I won’t stop I don’t, and it’s not because I don’t appreciate the... Intruder calls 911, afraid homeowner may have gun – CNN.com A man who broke into a house in Portland, Oregon,... TrendsMD: TMLT’s blog TrendsMD is the blog of Texas Medical Liability Trust, and... Related posts brought to you by Yet Another Related Posts Plugin. (Source: GruntDoc)

Presidential Voting and Press Ganey

WhiteCoat's Call Room — Tue, 10 Jan 2012 19:21:26 +0100

Well, the results are in. Based on a survey of New Hampshire voters, Rick Perry and Rick Santorum will receive NO votes in the New Hampshire primaries. Jon Huntsman and Mitt Romney will receive the exact same number of votes and will be tied for first place. Ron Paul and Newt Gingrich will receive the exact same number of votes and will be tied for second place. And, in the general elections, Barack Obama will receive exactly three times as many votes as either Ron Paul or Newt Gingrich and will receive exactly 50% more votes than Mitt Romney or Jon Huntsman. You see, in the New Hampshire town of Dixville Notch, nine registered voters casted their votes in the Republican primary. The tallies of the votes were: Newt Gingrich: 1 Jon Huntsman: 2 Ron Paul: 1 Rick Perry: 0 Mitt Romney: 2 Rick S...

Benjamin Siu, doctor at Cook Children’s Medical Center, dies at 51 | Obituaries | News f…

GruntDoc — Tue, 10 Jan 2012 06:12:06 +0100

Awful. FORT WORTH — When Dr. Benjamin Siu saw patients at Cook Children’s Medical Center, visits began and ended with hugs, handshakes and prayers. In between, “Dr. Siu would patiently go through what he had seen in the tests. He wouldn’t bombard you with mumbo jumbo,” said David Faulk, whose son Jonathan, now 3, was born with three chambers in his heart. Dr. Siu, a pediatric cardiologist, died Jan. 3 after falling off his bicycle as he rode near South Z. Boaz Park in far southwest Fort Worth. He was 51. via Benjamin Siu, doctor at Cook Children’s Medical Center, dies at 51 | Obituaries | News f…. Related posts: Truman CO dies after collapsing – Navy News | News from Afghanistan & Iraq – Navy Times Carrier Command. On the pa...

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Eponymous

Blogborygmi — Tue, 10 Jan 2012 05:00:00 +0100

I love being at an academic institution for many reasons. One of which is that the residents keep me on my toes -- they've read the latest stuff, they want justification for proposed workups and treatment plans, and... ....they've got the sharpest grammar?Yep. I can only imagine the patients watching us in the ED -- when we're not hunched over our keyboards, charting, reviewing and ordering, we can be seen gesticulating wildly about things like the placement of apostrophes in eponymous diseases.For instance, can you pick what's proper, below?Down Syndrome or Down's syndrome Legionnaire disease or Legionnaires' disease The rule I've always heard is: if the disease is named for a patient, it deserves an apostrophe. If the disease is named for its discoverer, the apostrophe is ...

New Year Medical Resolutions

Your ER Doc — Mon, 09 Jan 2012 19:47:29 +0100

Good news everybody, I’ve just distilled every New Year’s resolution in the world down to just one: In 2012 I’m going to be perfect! Why don’t you join me?! You might not stop smoking, lose weight, be nicer to your spouse, or stop driving so fast, but otherwise you’re going to be perfect. Just be who you are, and happy about it. I might eat too fast or slurp my soup. My wife says I snore. My eyebrows are kind of crazy. I don’t always make the bed. But otherwise I’m perfect. OK, occasionally I get cranky with people who don’t deserve it. I admit my fashion sense can be downright absent. I forgive myself. I’m sure I could be better in many ways, but all in due time. Meanwhile I’m going to continue to enjoy myself, and I suggest you all do the same. Happy New Year!...

Healthcare Update — 01-09-2012

WhiteCoat's Call Room — Mon, 09 Jan 2012 10:30:30 +0100

This study says that they aren’t. About 25% of the time, the rashes are due to something else. From my experiences, I’d say that 25% is an underestimate. The government comes up with an updated version of the emergency severity index to determine which patients need immediate care and which do not. Anyone in “severe pain” (can you say “10 out of 10”) or having “emotional outbursts” in triage should be considered for immediate treatment. Does anyone else see a problem with where this is heading? Texas nurse sues Emerus 24 HR Emergency Room for wrongful discharge after being accused of stealing/diverting drugs from the emergency department and then reporting defamatory information about her to the Texas Board of Nursing. In Pakistan, one hospital’s emergency department x-ra...

Too many Americans are dying from prescription drug overdose!

edwinleap.com — Mon, 09 Jan 2012 04:58:56 +0100

This is my column in today’s Greenville News. The Centers for Disease Control reports that prescription pain medication abuse, and deaths, are at an all-time high in the United States. In the November issue of Vital Signs, a publication of the CDC, prescription pain medication deaths were reported to number 3,000 in 1999, but 15,000 in 2008. However, many in the day-to-day practice of medicine have been predicting this sort of cataclysm for years. We’ve all seen too many young people die from accidental overdoses related to abuse of prescription pain medications. But why is it happening? It begins with the very real, very miserable problem of chronic pain in those with legitimate illnesses and injuries. The overwhelming majority...

Most Dangerous Items in the House

WhiteCoat's Call Room — Mon, 09 Jan 2012 00:19:34 +0100

There was a good article posted on My Health News Daily about the five most dangerous things around the house. They interviewed several experts (I must have been out of reach during my vacation, so I wasn’t quoted – although one of my friends was quoted) and came up with a pretty useful list of dangerous things around the home and how to make them less dangerous. What are my top 5? 1. Pain medications and other narcotics. They kill more people via overdoses than anything else. If we want to just use the general category “medications,” I’d throw in blood thinners and diabetes medications as well. 2. Alcohol. ‘Nuff said about that. 3. Weapons. I personally like the idea of being able to protect our home. We own several guns and will probably purchase a cou...

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The LITFL Review 052

Life in the Fast Lane — Mon, 09 Jan 2012 00:00:12 +0100

Life in the Fast Lane Medical Blog The LITFL Review 052 This week the sensational LITFL Review turns 1 years old!! The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team will cast the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle. As you troll through this weeks highlights from the EM/ICU blogging world – have a listen to ZDoggMD new smash hit Big Pharma! www.youtube.com/watch?v=vT2Xz5R6ZGs The Most Fair Dinkum Ripper Beaut of the Week Top spot this week is taken out by new Aussie Blogger Amit Maini over at ED Trauma and Critic...

An inflammatory condition

Blogborygmi — Fri, 06 Jan 2012 05:00:00 +0100

I've noticed more patients complain of gout recently -- maybe it's a sign the economy is improving (gout has long been considered a disease of excess).As I discovered while revising Rosen's new chapter on arthritis emergencies, the price of colchicine, an ancient gout treatment, has gone way up lately -- while suggested regimens for treating gout have recently changed. These are not unrelated, and the connection is actually quite interesting. You see, colchicine was grandfathered-in as an approved therapy by the FDA at its inception in 1938. Its safety and efficacy were never formally reviewed by the FDA......until 2009, when URL Pharma submitted the results of their new trial to the FDA, showing comparable efficacy and somewhat improved safety to high-dose colchicine regimens, ...

Funtabulously Frivolous Friday Five 073

Life in the Fast Lane — Fri, 06 Jan 2012 00:00:59 +0100

Life in the Fast Lane Medical Blog Funtabulously Frivolous Friday Five 073Followers of R&R in the FASTLANE will have noted in the third edition that Joe Lex recommended reading Danzl’s quirky, weird and wonderful 1992 masterwork on ‘flatology’: “A classic paper on an unpleasant subject – farts. Danzl approaches this sticky subject with tongue firmly planted in cheek, but he’s done his homework well. This remains the classic article on this unmentionable topic.” This week’s FFFF is dedicated to the science of flatology, and doubles as a study guide for Danzl’s exposition. Assiduous FFFFers will also recall a question regarding ‘son et lumiere’ sign from the 71st FFFF, which is also of great import to this topic. Without f...

Awesome CPR PSA Video

Movin' Meat — Thu, 05 Jan 2012 20:46:00 +0100

Yeah, this is pretty great:One thing that always bugs me about these videos is that the chest compressions look fake, well, because they are. If you've ever really seen CPR done right, pushing in 2 inches is a huge thing, in the videos, they're barely denting the skin. The consequence is that when someone does real CPR for the first time they NEVER push in deep enough.I wish they would swap in a dummy or use some effects to make the compression depth more dramatic and obvious. Yes, it's a nitpick, but it matters. (Source: Movin' Meat)

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Update

WhiteCoat's Call Room — Wed, 04 Jan 2012 23:03:48 +0100

First, thanks for all the e-mails. I’m fine. Family is good. I haven’t quit blogging yet. Remember the story about the Rock? My rock still sits on the corner of my desk every day to remind me of its importance. Well, the rocks in life just keep falling out of the glass. We got home and found that our house had been … not “trashed” … perhaps “abused” would be a better word. I’m going to get a couple of good posts out of that one. One of our fish paid the ultimate sacrifice when we came back and the water in the fish tank looked like Guinness Stout. Also issues with close friends and family that need to be addressed. Had planned to get several posts up in the past couple of days, but another time-sensitive matter came up that I had to dea...

Reasonable Conclusion?

WhiteCoat's Call Room — Wed, 04 Jan 2012 21:49:19 +0100

When, over the period of 10 minutes, medical personnel hear the following statements from an elderly patient: 1. “You come any closer to me, I’m going to stick my boot up your a** so far, I’ll come out with a bare foot,” 2. “Up your a** with a meat cleaver,” and 3. [While making sure that the patient has a steady gait] “Stop following me. Next thing I know, you’ll be sticking something in my a**,” is it reasonable to conclude that the patient has not passed the Second Stage in Freud’s Psychosexual Development Model? This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me. (Source: Wh...

My post at KevinMD

edwinleap.com — Wed, 04 Jan 2012 13:26:12 +0100

Here’s the link to my recent column on board certification, now posted at KevinMD. http://www.kevinmd.com/blog/2012/01/time-critically-concept-board-certification.html Thanks! Edwin (Source: edwinleap.com)

Disco still saves lives

Life in the Fast Lane — Wed, 04 Jan 2012 11:19:01 +0100

Life in the Fast Lane Medical Blog Disco still saves livesAs we saw in Disco Saves Lives, it wasn’t long ago that the AHA recruited the hilarious Kendrick Kang-Joh Jeong MD (trained physician and insanely funny actor from the Hangover) to demonstrate ‘hands only CPR’ to the metronomic beat of the Bee Gees 1977 disco hit ‘Stayin’ Alive’. Now the British Heart Foundation have taken a similar, but different (?), approach. Vinnie Jones, notorious Wimbledon ball breaker and hard man from ‘Lock, Stock, and Two Smoking Barrels‘, shows how it’s done in Britain. www.youtube.com/watch?v=ILxjxfB4zNk Hat tip to @DaveAirways Just make sure you put your hands in the right place, eh Vinnie. Image from the Daily Mail (click image for source) Life in the Fast...

Quit medicine? (part one)

EM Physician - Backstage Pass — Wed, 04 Jan 2012 05:00:00 +0100

When I was a medical student there was a girl who, after 2 years of medical school, decided…she didn’t want to be a doctor after all! I remember hearing a rumor that she decided she would rather spend her days swimming with dolphins. Then…she was gone. That got me thinking, for the first time in my life actually, what do I WANT to do? Prior to this, my standard reply of “I want to be a doctor” achieved sufficient accolades from everyone, and the satisfied look on their faces served as confirmation that I was on the “right path.” I never really gave it a second thought. But this girl…had the audacity to decide on her own that she was going to “throw away” everything she’d worked for (and all the sacrifices her family had made to allow her to opportunity to attend me...

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All I need to do is write a final diagnosis, right?

Life in the Fast Lane — Wed, 04 Jan 2012 00:00:01 +0100

Life in the Fast Lane Medical Blog All I need to do is write a final diagnosis, right?aka American ER Doc Gone Walkabout… 007Once upon a time, in a far off land in the northern hemisphere, I could take care of someone really sick, a STEMI for instance. I could write a note: a 55 year old came in with chest pain, he looked bloody ghastly, he had a low blood pressure and a little CHF and an awful looking STEMI on his EKG. I treated him (actually, in those far off days, we mostly did stuff that didn’t much help, and hoped for the best) and he got admitted under the care of a cardiologist (who similarly, hoped for the best).Since he looked ghastly, I didn’t ask about nor record whether the pain was sharp, or burning, or crushing, or anything else. Nor whether it radiat...

The Worst Quackery of 2011: Battlefield Acupuncture – Forbes

GruntDoc — Tue, 03 Jan 2012 18:40:20 +0100

So: the 2011 winner of the worst quackery award is: battlefield acupuncture. This bizarre practice, invented just 10 years ago, offers a trifecta of ills: It offers no medical benefit and carries a real risk of harm for some patients. The U.S. government is wasting tens of millions of dollars per year on it, and plans to increase its spending next year. The patients are wounded combat veterans who have no choice about where to get treatment. In battlefield acupuncture, the “doctor” (no competent doctor would do this) sticks needles into the patient’s ear to relieve pain. via The Worst Quackery of 2011: Battlefield Acupuncture – Forbes. Incredible. And infuriating. (Found on Twitter, but I cannot recall who tweeted it). Related posts: Announcing Guess-a-Nobel 2011 MedGadget has ...

A few more iOS 5 considerations, for EM

Blogborygmi — Tue, 03 Jan 2012 05:00:00 +0100

I've been using my iPad in the ED, with my white coat's sewn-in iPad-sized pocket, for some time now -- mostly for patient and resident education, and to look up dosages or rashes. Hitting up my Evernote database or Dropbox documents is also useful. Occasionally I'll use my iPhone, for its LED light (when the otoscope can't reach to where I need to see) or rarely, its camera (in compliance with my hospital and department photo policy, naturally).Our ED's EHR isn't quite accessible enough via iPad for me to quickly check results or place orders at the bedside -- right now it's just too cumbersome. But there's been progress -- enough so that I start to wonder about the flip side: instead of reviewing iOS medical apps and pining for an optimized EHR experience on the iPad, what if there ...

The LITFL Review 051

Life in the Fast Lane — Mon, 02 Jan 2012 04:00:27 +0100

Life in the Fast Lane Medical Blog The LITFL Review 051This week the inspirational LITFL Review turns 51!!The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team will cast the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle.The Most Fair Dinkum Ripper Beaut of the Week Emergency Ultrasound PodcastTop spot this week is taken out by the dudes over at Emergency Ultrasound Podcast with their podcast on the Full Cric. This weeks podcast takes us on a journey through using ultrasound in bougie assisted cricothyriodotomy. Guest author Keith Cu...

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Stay Sharp – Memory – Your New Year’s Resolution

Your ER Doc — Mon, 02 Jan 2012 03:08:26 +0100

We all know physical exercise is great for the body. But exercising the mind is equally valuable, and experts say it can help us keep our memories sharp as we age. But you can’t put your brain on a treadmill, can you? Well, in a way, you can! To exercise your brain, you have to challenge it, get out of your rut and try some new things: Try learning a new language, a musical instrument, or a new game. If you spend a lot of time watching TV, turn that thing off, and do something else. Word games, crosswords, board games all help. To get your brain to make new connections, do simple things like using your nondominant hand to brush your teeth. Drive home a different way than normal. When you eat out, do you go to the same restaurant all the time? Or take the same vacations? Mix it up! Al...

Tell me why (My January column in EM News)

edwinleap.com — Sun, 01 Jan 2012 22:02:56 +0100

Here’s my column in this month’s Emergency Medicine News. Tell me why! http://journals.lww.com/em-news/blog/BreakingNews/pages/post.aspx?PostID=36 I went to the ACEP Scientific Assembly in San Francisco this year. Although I was only there for two days, I learned a great deal. Our specialty is populated by intelligent, capable physicians, and I am always humbled to be in their company. I am endlessly impressed by their dedication to the health of their patients. They practice, they research, they probe the boundaries of mortality, always looking for new ways to slip people across the border between death and life. For that I thank them. My family has benefitted from the collective efforts of our specialty over the decades. And yet, as I sat in that enormous lecture hall, as I l...

Why Bundling Payments Won’t Reduce Costs — Part 3

WhiteCoat's Call Room — Sun, 01 Jan 2012 01:42:10 +0100

If you haven’t read parts 1 and 2 of this manifesto, please do so here and here before reading further. How will bundled payments affect the incentives for each of the players in the medical market? For patients, a change to bundled payments will probably have little effect upon monetary issues or fears. Demand for medical care will increase. With millions of additional patients being added to Medicaid roles, and with government “paying” the costs, there will still be little disincentive for patients to seek comprehensive care. In addition, patients who are forced to purchase insurance through health care reform will want to get something for their money. Bundled services will obviously benefit the insurers. Otherwise there would be no incentive to move to such a model. F...

Mediterranean Emergency Medicine Congress – VI – Podcasts

Life in the Fast Lane — Sat, 31 Dec 2011 04:58:35 +0100

Life in the Fast Lane Medical Blog Mediterranean Emergency Medicine Congress – VI – PodcastsKos Greece – 12 – 14 September 2011Joe Lex has just uploaded more than 170 free MP3 podcasts of talks from MEMC-VI on Kos Greece, from September 12-14 2011. You can either search directly for talks on Free Emergency Talks, visit the YouTube channel, use the catalogue of links below to access them or wait for them to be entered into the LITFL podcast database…enjoyDay 1, PlenaryPatrick Croskerry (Canada): Diagnostic Error – A Case of Neglect Ziad Kazzi (Georgia): The Public Health Impacts of a Nuclear Plant Crisis in Your BackyardDay 1: ResuscitationMarc Sabbe (Belgium): ILCOR 2010 Guidelines – Implementation in Different EnvironmentsDeborah Diercks (California): U...

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Dear Diary

WhiteCoat's Call Room — Fri, 30 Dec 2011 15:12:36 +0100

Well, it’s been over a week since I posted anything online. I think that’s a record for me. In fact, I haven’t been online that much at all since well before Christmas. First, there was a miserable work week before Christmas. Almost 70 hours of work in 5 days. A lot of people were sick. Some people just want to come in and get “checked out” before the holidays. One lady with a cough and runny nose wanted me to give her antibiotics to guarantee that she wouldn’t get her unimmunized grandchildren sick when she saw them for Christmas. No guarantees, ma’am. Those children are at an increased risk of catching communicable diseases regardless of whether you get a ZeePack or not, so the only way I can guarantee that you don’t get them sick is to ha...

The most productive time of the year

Blogborygmi — Fri, 30 Dec 2011 05:00:00 +0100

For years I noticed a burst of productivity around the holidays. stuff that had been hanging over my head for months would suddenly get done. New ideas would suddenly pop into my head. I attributed it to things like the psychology of the calendar, or just having fewer emails to answer, or more unstructured time... But the recipe is simple:Eat well. Sleep well. Stay connected to loved ones. Get some exercise.That's it. That's all it really takes to complete projects, tackle nebulous fears, and poke the box. (Source: Blogborygmi)

Emergency Medicine Literature of Note: Yet Another Highly Sensitive Troponin – In JAMA

GruntDoc — Thu, 29 Dec 2011 21:23:39 +0100

Wow. Short, and sweet, and painful. …peddling the same tired phenomenon of magical thinking regarding the diagnostic miracle of highly sensitive troponins… via Emergency Medicine Literature of Note: Yet Another Highly Sensitive Troponin – In JAMA. Nice! Go and read. via @nickgenes on that Twitter thing… Related posts: HHS Audits the 1% … and the Rest: First HIPAA Privacy and Security Audits Begin – Davis Wright Tremaine As the original twitterer ( @NickGenes ) said, “…because there... The best bumper sticker evah! « My Strong Medicine The best bumper sticker evah! « My Strong Medicine. ... Trying out embedding a Tweet 165mph winds in Scotland. http://t.co/2qzwHX49 See that link for picture... Related posts brought to you by Yet Another R...

Merry Christmas! Belated…

edwinleap.com — Thu, 29 Dec 2011 14:26:12 +0100

Merry Christmas dear friends! This was my Sunday Christmas Day column. I didn’t post it yet, so my apologies. I hope it remains relevant for you. Oh, and Happy New Year! Today we celebrate the birth of Jesus Christ. We’ve been preparing for weeks; maybe months (if the Christmas music on the radio is any indication). Our homes are decorated with lights and trees. We’ve purchased too many gifts and eaten too much food. We’ve worn shocking red and green clothes. Even today may have traveled to see family and friends; sometimes people we don’t particularly like, but love nonetheless. Christmas, in my opinion, transports us to a kind of glorious, frantic madness. We stretch it out as long as possible, and celebrate it as well as we can afford (and maybe a l...

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Greatest Hits 2011

Life in the Fast Lane — Thu, 29 Dec 2011 02:20:19 +0100

Life in the Fast Lane Medical Blog Greatest Hits 2011That’s it folks, another funtabulous year in the fast lane is coming to a close. In keeping with LITFL tradition it’s time for a recap of the year that was, and to announce LITFL’s ‘Greatest Hits’ for 2011.That's right, ours!But before we get stuck in, we must humbly thank our readers for their incredible loyalty and support, which amazingly sees LITFL achieve an average of over 10,000 page views daily (!). We must also recognise the encouragement and inspiration we receive from our families, colleagues and friends around the world. Without you all we wouldn’t be able to keep working on this labour of love and to keep serving up free edutainment for anyone, anywhere, anytime.That’s enough so...

Jan’s PET scan…normal!

edwinleap.com — Wed, 28 Dec 2011 14:52:02 +0100

Yesterday Jan’s follow-up PET scan was read as normal. God is good! Thank you all for your prayers and concerns. Please let me know if I can be in prayer for you at any time. Happy New Year! Edwin (Source: edwinleap.com)

Automatic Radiodiagnostic Security Entrance

Life in the Fast Lane — Tue, 27 Dec 2011 08:00:16 +0100

Life in the Fast Lane Medical Blog Automatic Radiodiagnostic Security EntranceUCEM‘s research boffins are perpetually pondering possible solutions for the great challenges facing Waiting Room Medicine.For example:Violence in emergency departments is on the rise. Patients can possess all manner of potential weapons… machetes, firearms, smelly socks and even a hospital bed from time to time. Could such patients be immediately detected and disarmed on arrival, thus ensuring the safety of staff and other patients?Since the advent of the four picosecond rule, the pressure on Waiting Room Medicine subspecialists to make early management and disposition decisions has been intense. But not every patient has obvious Signs of Imminent Admission or fits the admission criteria for a Pati...

Clear!!!

Life in the Fast Lane — Tue, 27 Dec 2011 00:00:42 +0100

Life in the Fast Lane Medical Blog Clear!!!aka American ER Doc Gone Walkabout… 006We cardioverted a few Tassies with A Fib and defibrillated (attempted) some cardiac arrests. I double gloved, and used my gloved hands to assure good contact of the pads — in the case of the cardioversion, and briefly took over the CPR myself to continue CPR, with no interruption during the defibrillatory shock — so called “hands-on” CPR.Interestingly, the Tassie crew didn’t freak out as much as my American compatriots on first being introduced to this option.So, where did such insanity come from?Many years ago, I worked at a community hospital where anesthetics were a tough crew to work with, and as a favor we’d sometimes do the procedural sedation for our cardiologis...

Scanxiety and follow up on my wife

edwinleap.com — Mon, 26 Dec 2011 21:06:23 +0100

For all who have followed along, Jan is doing well. For those who didn’t know, she had squamous cell carcinoma of the base of the oropharynx last year, and received radiation and chemotherapy. She’s doing well, eating, gaining weight, has a little saliva and pretty good sense of taste. However, she has an insane husband/physician who hovers over her endlessly and always expects the worse. That is, recurrence. Tomorrow we go back to MUSC for a follow up PET scan. I hate scans. I have scanxiety! I always expect the worst, despite the lack of clinical evidence to the contrary in the way she feels, acts, etc. Cancer follow up is a terrifying thing. Everyone who has been there understands. I feel perhaps more terrified than when she was being treated. So for thos...

The LITFL Review 050

Life in the Fast Lane — Mon, 26 Dec 2011 07:34:44 +0100

Life in the Fast Lane Medical Blog The LITFL Review 050This week the LITFL Review turns 50!!The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team will cast the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle.The Most Fair Dinkum Ripper Beaut of the WeekEmergency in the ShedTop spot this week heads over to Queensland and is taken out by David Corkhill from Emergency in the Shed. David teams up with Aussie ED doc Jeff Hooper to have a chat about Avoiding the Pitfalls of Trauma Part 1 — they highlight the top 10 common mistakes tha...

The True Meaning of Christmas

Movin' Meat — Sun, 25 Dec 2011 14:00:00 +0100

Well said, Linus.From Calamities of Nature. For each of you that click through the link before the end of the year, the artist will donate $1 to Doctors without Borders. (Source: Movin' Meat)

Merry Christmas 2011

Life in the Fast Lane — Sun, 25 Dec 2011 03:00:10 +0100

Life in the Fast Lane Medical Blog Merry Christmas 2011The LITFL team wishes everybody a happy and healthy Christmas.We would like to share some of our favourite festive tunes…First up a sentimental song about Christmas by the very awesome Western Australian… Tim Minchin.www.youtube.com/watch?v=fCNvZqpa-7QThis version is taken from the Australian ‘Ready For This?‘ DVD. The December 2009 & December 2010 proceeds were donated to The National Autistic Society (NAS). Proceeds from worldwide downloads from November 2011 to February 2012 will also be donated to the NAS. Life in the Fast Lane Medical Blog - Emergency Medicine education blog (Source: Life in the Fast Lane)

A song for christmas

Movin' Meat — Sat, 24 Dec 2011 14:00:00 +0100

The snowflake thingy makes it even cooler. (Source: Movin' Meat)

Thank FFFF it’s Christmas

Life in the Fast Lane — Fri, 23 Dec 2011 01:10:09 +0100

Life in the Fast Lane Medical Blog Thank FFFF it’s ChristmasDraw near, and gather round the wireless for this very Christmas edition of Funtabulous medical trivia.We celebrate the festive season with a DOUBLE edition of FFFF and an eclectic mix of festive related questions to amuse and bemuse….www.youtube.com/watch?v=iIxhXHds20IQuestion 1A 2 year old boy presents with acute airway obstruction in March, following a 15 month history of ‘noisy breathing and hoarseness’. A lateral neck X-Ray is performed…What is the most likely aetiology?Reveal Answerexpand(document.getElementById('ddet723419898'));expand(document.getElementById('ddetlink723419898'))Stridorosi ornamenti chronicusAn urgent laryngotracheal bronchoscopy was performed following inhalational induction o...

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Frontline Friday Inspiration 2

Life in the Fast Lane — Thu, 22 Dec 2011 23:00:44 +0100

Life in the Fast Lane Medical Blog Frontline Friday Inspiration 2War drives innovation and in this series, Michael Mosley travels from the frontline of war to the frontline of research to uncover the medical breakthroughs that are coming out of current conflicts.The survival rate in Afghanistan is the highest in the history of combat – but this means people are surviving with dreadful injuries. Michael wants to find out what medicine and technology can do to help rebuild their shattered lives. From mind-controlled prosthetics to growing spare body parts and face transplants, he explores the innovations which are helping both wounded troops and civilians to overcome life-changing injuries. www.youtube.com/watch?v=JDdoqWZ9pdoLife in the Fast Lane Medical Blog - Emergency Medicine ...

With explanatory graphics! The Sources of the SGR “Hole” — NEJM

GruntDoc — Thu, 22 Dec 2011 21:53:12 +0100

This article and its graph (from the NEJM), and its interesting, informative but probably useless graph, was referenced today on twitter, via the Washington Post’s Wonkblog, Recently, the Centers for Medicaid and Medicare Services announced a scheduled cut in Medicare physician fees of 27.4% for 2012. This cut stems from the sustainable growth rate (SGR) formula used by the physician-payment system. … To illustrate the level of inequity in this system, we broke down the national spending for Medicare physician services by state and by specialty and determined which states and specialties have contributed most to the SGR deficit between 2002, when the program was last balanced, and 2009. Although SGR spending targets are set on a national level, we computed state targets by appl...

‘Twas the Night Before Christmas, Submariner style

GruntDoc — Thu, 22 Dec 2011 08:40:29 +0100

Pretty neat. Related posts: 12 STI’s of Christmas, 2011 My yearly Christmas favorite, reposted: Courtesy of the British National... Feed The Wards (Do They Know It’s Christmas Time?) Zdogg and Dr. Harry have the Christmas spirit. Sorta. There... Related posts brought to you by Yet Another Related Posts Plugin. (Source: GruntDoc)

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Christmas as a pilgrimage

edwinleap.com — Thu, 22 Dec 2011 03:49:57 +0100

Cross and Caduceus … by Ed Leap By Ed Leap (FYI, Cross and Caduceus is the title of my Baptist Courier column now!) Published December 22, 2011 Every year I face the same dilemma. I struggle to grasp the meaning of Christmas. Maybe I’m not being clear. I think I understand the essential meaning of Christmas. It’s about God-become-man, in order that man could come to God. But even with that simple understanding, it’s hard to comprehend something so big. It’s even more difficult and frustrating in a computer-generated, cable-modem world, where answers seem always available at the speed of light. It’s no easier than when all we had were books, spoken stories or pictures. The hard reality is that the meaning, the comprehension, of important things has always lingered just outside t...

Christmas R&R In The FASTLANE 006

Life in the Fast Lane — Thu, 22 Dec 2011 00:00:38 +0100

This article proposes that Tiny Tim suffered from distal renal tubular acidosis (type 1), an illness characterized by growth impairment, osteomalacia, and hypokalemic muscle weakness. Although the pathophysiology was not known in Dickens’ time, the condition was often treated with tonics including sodium bicarbonate. Other authors have suggested Tim suffered from rickets.Recommended by Leon GussowWillis FR, Adams SL, Doyle S, Everitt IJ, Lovegrove M, Slee J, Sparrow A, Willis J. Children’s Nomenclatural Adventurism and Medical Evaluation study. J Paediatr Child Health. 2009 Dec;45(12):711-4. PMID: 20415998. A study showing there is a real risk in having weird names!Recommended by Meredith BorlandYanchar N, Pianosi P, Fraser R. Oh Christmas tree, oh Christmas tree …...

Feed The Wards (Do They Know It’s Christmas Time?)

GruntDoc — Wed, 21 Dec 2011 08:37:34 +0100

Zdogg and Dr. Harry have the Christmas spirit. Sorta. There comes a time…when we heed a certain call—when the world must come together as one. This is NOT one of those times. But it is the Holidays, so we should probably take a moment to think of those less fortunate than ourselves. People who go hungry while others feast. People without a single shred of hope remaining. I’m talking about healthcare workers taking call during the Holidays. via Feed The Wards (Do They Know It’s Christmas Time?). Follow the link and enjoy their latest video. The chorus is very good. They aren’t Bad Lip Reading quality with their chorus, but not bad… (Yeah, jealousy, I wish I had this kind of creativity. Or any, really.) Related posts: 12 STI’s of Christmas, 2011 My yearly...

Navy HPSP / GMO Query

GruntDoc — Wed, 21 Dec 2011 06:28:53 +0100

I got a nice email form someone who stumbled across this Humble Blog, and had the following questions; my replies follow. Those who have something constructive to add, please do so in the comments. 1. I’m most interested in EM. Given that I have no prior military service/experience, am I basically going to have to do a GMO tour to get this specialty? Well, it depends on a lot of factors. Your branch of service is probably the biggest determinant (AF is best, Navy is historically worst at going from Internship straight to residency without a GMO tour), but there are several reasons you might not want to go straight to residency. Honestly, residency is easy compared with being a GMO, at least the first year of a GMO tour. I finished a Basic Surgery Internship, and went to the fleet as ...

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The Battle that is Christmas

edwinleap.com — Wed, 21 Dec 2011 05:46:49 +0100

History brings us many touching stories about Christmas. How foe became friend; how battles ceased while combatants met across trenches and sang carols. There are legends of miracles and wonders, and of course, the story of the nativity itself when eternity burst onto a nowhere town in the middle of a nowhere country. But on the whole, life and all its suffering goes on during Christmas, free of miracles. The pain of this life is unrelenting. In wars across the globe men, women and children die and are maimed. Murders and rapes take no holiday break, though they seem a little more terrible for their timing. Accidents rob families of their dear ones, often on the busy highways of Christmas and Christmas Eve. And disease takes young and old. I remember being a young resident physician and...

Maggots Clean Wounds Faster Than Surgeons | Wound Healing | LiveScience

GruntDoc — Wed, 21 Dec 2011 05:10:55 +0100

Aah, the French: The idea of putting maggots into open flesh may sound repulsive, but such a therapy might be a quick way to clean wounds, a new study from France suggests. via Maggots Clean Wounds Faster Than Surgeons | Wound Healing | LiveScience. I kid. I think this is a good idea, and it’s natures’ way of saying ‘cleanup on aisle three’. Patients not infrequently will be brought to the ED with awful, non-healing wounds infested with maggots. We typically kill them off, more because a) the staff is completely grossed out and b) if you’re living at home and have maggots in your wounds, let’s just say your personal hygiene is deeply suspect. Rank, in fact. Needs a decon level bad. However, there is a legitimate role for biological wound cleaning; I ha...

Didn’t See That One Coming …

WhiteCoat's Call Room — Wed, 21 Dec 2011 04:39:33 +0100

When a young male patient has a urinary tract infection and difficulty urinating, usually a check for prostatitis is in order. Add prostate checks to the list of things where you can “expect it.” When checking a patient for prostatitis, I will usually say something to the patient along the lines of “When I press here [while pressing on the prostate] does it cause you to have more pain?” Most of the time, patients are already screaming. “Yeah, it hurts like hell. You done yet?” -or- “Owwwwwwwwww. Daaaaaaamn. Owwwwwwwwwww.” Really want to skeeve your doctor out a little? When he asks you if pressing on your prostate hurts, tell him “Actually, it feels kinda good.” [shudder] I’m considering empirical treatment for prostatitis f...

Fine Tuning the Injured Brain

Life in the Fast Lane — Wed, 21 Dec 2011 00:00:30 +0100

Life in the Fast Lane Medical Blog Fine Tuning the Injured BrainWhen Joe Lex makes his “pick of the week” on Free Emergency Medicine Talks you know its worth listening to. This week’s pick is exceptional. It’s a talk by Bart Besinger, an emergency physician from Indiana, who delivers an excellent current review on the medical management of the severe brain injured patient in the emergency department.Listen to Bart’s talk for free here: Fine-tuning care of the injured brain.Many patients with severe brain injury will succumb to their injuries. However, there is a subset of patients for whom optimal early management has a profound impact on their prognosis. If we do things right, some patients have a chance of actually walking out of hospital alive wit...