Emergencies and Obesity

There’s more to this than just cops and donuts, keep reading.

The US Surgeon General, himself a Trauma Surgeon and a police officer in Arizona (interesting guy), today asked cops to lay off the Donuts:

In remarks to the National Sheriff’s Association, Carmona said that “being overweight or obese directly impacts job performance when you’re trying to defend the public safety. Remember, when you are called upon, you [must] be ready to back up your partner or a citizen. To me, failing at this calling when challenged would be a fate worse than death.”

Now, this is one of those things that’s obvious but needs to be said, and not just to police officers. As an interesting bit of motivational psychology this will help: for a group to really buy into the delivered message it neeeds to come from someone who’s both credible and one of them, otherwise it’s just preaching, and the more insular the group the more important the messenger.

This reminds me to opine about a very real problem the massively obese are getting themselves into, and that is that it very much harder to care for and evaluate obese patients medically. According to my elders in this specialty, seeing a 400 pound patients used to be a once a year, and we all have stories about 600 plus pound patients, but now it’s at least a weekly event to see 400 pound patients, or more, in the ED. It isn’t surprising, as the population is fattening up and aging, both of which make you more medically fragile.

Obesity severely limits applying the standard of care to patients, because the machines cannot handle the size or the weight. Our CT scanner in rated to 350 pounds, and it’s terrific, but if you’re a patient and you would have a CT scan under 350, it’s a problem to get it done when you weigh more than the machine is rated for. It’s been pushed a couple of times, but that can backfire and leaves us with a broken scanner and a bunch of people who need scans and get delayed. This also goes for the Cardiac Cath table and a lot of nuclear medicine equipment.

Reportedly there is one CT scanner in town that goes to 500 pounds, but it’s at one of those free-standing radiology centers so it’s only open during the day, which limits its usefulness when it’s 0230 Sunday morning.

MRI isn’t any better, because the hole size is smaller than a CT, even if the total pounds are ok there’s only so much size that will fit. I thought I had this solved once with an open MRI, but there wasn’t enough room for the patient’s chest to fit under the magnet to get the head scanned.

So, add ‘limited technical ED evaluation’ to the list of reasons to avoid obesity.

Moisture

freeze.jpg Yes, it’s been wet here, thanks. First came the 2 3/4″ of rain, where the orange marker is, then came the freeze, then more freezing rain, then sleet. We’re staying indoors, except for work (yesterday), and are re-living the truism that staying home from school sounds cooler than it really is (stir crazy kid).
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Hopefully, soon it’ll be summer, and we can complain about the heat and humidity.

Armed Pilot Chuckle

Make sure your speakers are on.

Go to the ER

If you’re ever called and asked what to do in and emergency, just say “go to the ER”. It works for everyone, receptionist to specialist.

You fell and scraped your hand? Go to the ER.

You’re on 47 medicines, have 11 active problems, I’ve been your doctor for 22 years, and you have the exact same thing I’ve admitted you for the last 17 times? Go to the ER. I won’t call to tell them anything about you.

You’re in my office and have high blood pressure without symptoms? Go to the ER. Here’s a list of tests you shouldn’t go home without, including renal artery MRA’s.

You have vague neurologic symptoms that have no basis in anatomy or known medical science? Go to the ER, and tell the ER doc you need an MRI. Tonight.

It’s 2PM, you’re in my office with a fracture? Take your unsplinted fracture to the ER, and have them call me so I can refer your fracture care to the orthopedist next door.

I’ll always have a job.

Many thanks to James Lileks for spurring me to this post.

Talking Turkey

I’m not sure what to be more pissed about: Turkey wanting 30 Billion Dollars, or our offering 26 Billion Dollars.

According to CNN, the Turkish Government wants $30 BN, with $10 BN in cold hard cash, and the US is offering $26 BN, with $6 BN in cash, and it isn’t enough. Are you kidding me? For the dirty job of crushing a tyrant on their border (armed with chem, bio, and maybe even nuclear weapons), and incidentally preventing an independent Kurdistan when the war starts, protecting them from military retaliation, keeping the Iraqi Republican Guard from ‘escaping’ into Syria, $26 BN isn’t enough. Aarrrghh.

The taxpayer in me says ?WHAT? This is on top of the no doubt substantial cash we pay to keep US fighters patrolling the no-fly zones of the Iraqi North out of our bases in Turkey, to an ally we have wrangled NATO into at least planning to defend, and they want HOW MUCH?

I need someone to explain to me how an ally, one we have stood with for decades, thinks they need Billions of Dollars to ‘host’ (give, temporarily, useless land in terrible geography, which we will develop into useful troop quarters, which we will leave in better condition than we found it, with all the facilities intact) our troops, which will be fighting to rid them of the crack house next door and generally clean up the neighborhood. And they want the SWAT team to pay them to cross the lawn.

Why aren’t they offering us money for the same service? I haven’t any idea. Perhaps you do?

Update: that’s $750,000 per American. Wow.

Ironic: USAF Commercial

Currently running is a recruiting commercial for the USAF, and it’s targeting those who might join their special forces. There are four commercials in this series, but the one running now, which catches my eye, is one in which a young American goes to rescue his sister’s backpack after it has fallen into a river and is carried over a waterfall by the currents. Our prospective hero jumps off into the unknown depths to retrieve the backpack, with a fast-forward to a young AF SF Parajumper saving lives in a stormy sea, with a subtitle of the ‘we’re looking for you’ type.

The really jarring thing in the visual montage is the legal weasel inclusion at the bottom of the screen during the leap of faith into the water to save the backpack: “professional: don’t try this”, or words to that effect.

Now, what is it they’re after? Are we trying to outlaw boldness? What possible good will those weasel words do, except (hopefully) alert the prospective applicant about the organization they’re about to join? If you want bold applicants, appeal to them, don’t try to hide behind meaningless weasely declarations. I want that young hero out there, I don’t need any more legal warnings about how things that look dangerous might actually be dangerous.

World Class Customer Service

COMMENTS=the download popup box to download the SP’B’ works; when I click the ‘download’ box at the bottom, the page thinks for a few seconds then gives me a page not found error. Has occurred through 2 days and several restarts.

Please wait …

http://www.mydirecway.com/

eddie has arrived to help you!
eddie says, “Hi Allen.”
eddie says, “Thank you for contacting DIRECWAY Technical Support, this is Eddie. Please give me a minute while I pull up your account information.”
eddie says, “Thank you for waiting. As I understand you are having an issue with downloading service pack b.”
You say, “correct”
You say, “correct”
eddie says, “Are you on the machine on which DIRECWAY product is installed.”
You say, “yes”
eddie says, “When was the last time you tried?”
You say, “30 seconds ago”
eddie says, “Okay.”
You say, “”Cannot find server” in the top bar”
You say, “”The Page Cannot Be Displayed” in the text”
eddie says, “We are currently facing temporary issues with our services. Please be assured that our technicians are working on this to make sure that the services are restored very soon. Please try after sometime”
You say, “how long is a sometime? Tomorrow? Next week?”
eddie says, “Expected time of restoration is unknown at this point of time but I can assure you it would be resolved as soon as possible.”
You say, “ok”
eddie says, “Is there anything else I can assist you with?”
eddie says, “For future reference, your Case ID is 3660926. Please mention this Case ID for any future correspondence and feel free to contact us if you need any further help or information. We are available 24 hours a day and 7 days a week.”
You say, “browsing seems slower than usual today; is it just me?”
eddie says, “No Allen its a problem at our end which will be restored.”
You say, “Thanks”
eddie says, “Is there anything else I can assist you with?”
You say, “Not today”
eddie says, “Okay have a nice day.”
eddie says, “It was a pleasure chatting with you. Thank you for contacting DIRECWAY Technical Support. Have a nice time.”
You say, “you, too”
eddie says, “Thank you Allen.”
You say, “bye”
eddie says, “Bye.”

Celebrity Idiocy Takedown II

This could be a regular feature, but that’d be too easy.

From The New York Observer:

“I’m being treated like a child,” she complained, adding, “Now that I’m sober I watch a lot of news.”

Tragic? You bet. Especially since Ms. Garafolo knows for an absolute fact that Saddam Hussein isn’t hiding any weapons of mass destruction.

But then, poor Janeane isn’t the only one suffering from these slings and arrows of public derision:

Sean Penn has been called a dupe for his fact-finding mission to Iraq.

Ben Affleck has been mocked for Congressional aspirations, based on the trivial fact he hasn’t voted since 1992.

Sheryl Crow has been soundly derided for her finely nuanced assertion that the best way for America to avoid war is “to not have any enemies.”

Good news: they have a solution to the problem!

Read the whole thing. Well worth your time.

via Jessica’s Well

Opera 7 Screenshot

I surf the web using the Opera web browser, and upgraded to Opera 7.01 today. First looks can be deceiving, but it’s at least as good as the old one, with several of the quirks (‘features’) fixed.

One unexpected bonus is that it displays the ‘icons’ made by some of my favorite bloggers next to their names in the url and the title bar, which is neat:

Opera 7 screenshot; Feces Flinging Monkey

Now, for a GruntDoc icon; suggestions?

Looters

per CNN:

In Texas, Merrie Hipp, 43, and Bradley Justin Gaudet, 23, were each charged with one count of theft of government property for allegedly stealing pieces of the shuttle. Hipp was accused of taking a circuit board, and Bradley a piece of inner fabric that acted as a thermal barrier, said U.S. Attorney Mike Shelby of Houston.

Listen up, people. If your first response to a tragedy is, “…how can I profit from this disaster…” you need to GET A SOUL.

I predicted this, but thought it would take a couple of weeks to happen.

I hope they didn’t get the idea from me. (Unlikely given my traffic).

Update: looters

Physicians Slow Down; Patients Don’t Notice

Although more than 1,300 New Jersey physicians staged a work slowdown Monday to protest the high cost of malpractice insurance, patients reported no difference in service.

“Sure, I sat there naked under that flimsy gown for several hours, but what’s new?”

read the whole thing

via scrappleface

France Surrenders to Texas High School

From CNSNews.com comes the whole shocking story:

“Beating France is the biggest win for Eisenhower since we beat Conroe Judson in the ’88 Super-sectionals,” says longtime resident Wayne McDaniel, president of the Eisenhower Eagle Booster Club. “We’re planning a big wing-ding when they get back.”

Activities planned for the commemoration include a parade, as well as what McDaniel called “a very big plaque,” at the Aldine Kiwanis hall.

“Although, we might have to wait on that for a while,” added McDaniel. “We’re having a bake sale and car wash to send the football team to Germany.”

Here’s wishing them a successful trip to Germany!

via Jessica’sWell

Columbia

Again, a Space Shuttle returns to earth in fragments, and it brings back memories of the first shuttle disaster, Challenger. I found out walking to my car in the parking lot of my university. I don’t know why I recall where I was so vividly, but I do. I kept up with the recovery, and the investigation into cause, and then I tuned out.

And this morning, I found out about Columbia while lying in bed and listening to radio, but I ran to CNN to see, and the awful truth was there, replayed in full color glory over and over.

The recovery effort will be impressive; remember the weeks they spent getting everything possible off the seafloor? Here we’re dealing with about 150 miles of scattered debris, but very little will be under water.

The NASA website tonight has the following:

LATEST INFORMATION ON SPACE SHUTTLE COLUMBIA

A Space Shuttle contingency was declared on Saturday in Mission Control when communication was lost with the Space Shuttle Columbia during its return to Earth following a 16-day mission.

Communication and tracking of the shuttle was lost at 9 a.m. EST at an altitude of about 203,000 feet above north central Texas while traveling approximately 12,500 miles per hour (Mach 18). No communication and tracking information was received in Mission Control after that time.

Flight controllers in Mission Control immediately began the process of securing all information, notes and data pertinent to today’s reentry and landing.

News media wishing to cover the investigation should go to a NASA Center newsroom or watch NASA Television for the latest developments. NASA TV is on AMC-2, Transponder 9C, vertical polarization at 85 degrees West longitude, 3880 MHz, with audio at 6.8 MHz.

NOTE TO PERSONS IN THE AREA:
Anyone who believes they have found debris related to Columbia should call the Johnson Space Center Emergency Operations Center, (281)-483-3388. Be aware that hazardous chemicals may be present; do not disturb or move any debris.

All debris is United States Government property and is critical to the investigation of the shuttle accident. Any and all debris from the accident is to be left alone and reported to Government authorities. Unauthorized persons found in possession of accident debris will be prosecuted to the full extent of the law. (emphasis mine)

That last sentence bears remembering. I’m absolutely sure that shuttle pieces will be turning up on Ebay very soon, and I sincerely hope the government punishes the evil and warns the stupid. Texans are mostly very decent people, but there are the unscrupulous among us.

Rest in Peace, you brave seven astronauts. May your families cherish your memories, celebrate your accomplishments, and console themselves in the thanks of a grateful nation.

A couple of smallpox reactions

According to CNN, there have been “Two” reactions to the smallpox vaccine recently ordered given to about 500,000 servicemen/women. Although the emphasis is on the ‘two’, the number innoculated is not given, and there is no way all 500K have been immunized, making any stats from this meaningless. And, let’s be honest and state that the immunized group, active duty military personnel, are in better health than the average citizen, are younger and have fewer chronic medical problems.

Also, the report of at least one of the current dispositions is suspect. If someone has encephalitis, he may well recover and be released from the hospital, but someone with a “…rash with several pustules, or pus-filled blisters, about 10 days after he was vaccinated. The soldier is well and continues to work at his usual location,” is either a callous disregard for the health and safety of the uninoculated surrounded this person, or this person works in a biohazard lab in a big suit. Could be they counted on natural instincts for his co-workers to put a lot of distance between themselves and a rash, but that seems unlikely. Hopefully, there was a sentence omitted, ‘and after the rash cleared he’s back at work’, but this isn’t explicitly stated.

I have in my posession a big packet about smallpox vaccine, and I’m being offered the chance to take it. I’m aware of the risks, and I’m probably going to go ahead and get it. But, I’ll bet if I break out in a pustular rash afterward I won’t be allowed back to work for a while; the upside is that I’d probably act the same with encephalitis, so who’d know?