Ramblings of an Emergency Physician in Texas
My friend, Rick, spent a few hours and created a terrific website called Big Needle. It is a place for the medically inclined to gather, featuring quizzes for fun and edutainment (a stupid word I feel bad for repeating).
I’m adding a link in my sidebar too Big Needle, and I hope you give it a chance. The link requires a registration.
Rick can always use question writers, and lurkers are, of course, welcome.
I am an Emergency Physician, residency trained to save lives quickly, economically and compassionately. Recently, I read a mildly derrogatory post about the “meet-em and street’em” attitude of Emergency Physicians, and it spurs me to comment about the realities of Emergency Medicine.
Yes, there are cases which require only a brief history and physicial examination, allowing a focused evaluation and treatment, appropriate for the complaint. The majority of my practice is not that patient, it’s the 92 year old I had today who fell and broke a hip, who is also hypotensive and has an altered mental status. He needs a quick and comprehensive workup, taking into account all his infirmities and illnesses. While at the same time caring for the 70ish lady who came in for her ankle fracture but is hypotensive from her adrenal crisis (no kidding). How about my ED partners’ case, the hemophiliac with HIV, now with fever, headache, and thrush. Yeah, there’s a meet and street.
So, we all need each other in this big medical treatment complex. Yes, ED care is sometimes impersonal, but that’s because it’s brief and intense, not because we aren’t people.
I caught, on CNN, that a “Third heart attack death after smallpox shot reported”. This strikes me as a ridiculous connection to make without formal study.
Then I read the details, and this is bizarre beyond reason.
The CDC issued its warning after a Maryland nurse died of heart attack Sunday and a Florida health worker died of a heart attack later in the week. More minor cardiac problems were seen in 15 others who had been inoculated, including 10 people in the military and seven civilians.According to the CDC:
(out of the 25,645 vaccinees) The seven cases prompting today’s precautionary action include three cases of myocardial infarction (heart attack), one of which resulted in death; two cases of angina (chest pain); and two cases of myopericarditis (inflammation of the heart muscle or sac surrounding the heart). In each case the individual’s medical history, including risk factors for heart disease, is being studied.
Cases of heart inflammation following smallpox vaccination were reported in the 1960s and 1970s. However, the information from these reports does not provide any information about the types of people who may be at higher risk for heart-related problems following smallpox vaccination.
I suspect the smallpox immunization also causes people to bounce checks, fail to floss and wear mismatched socks. Just so you know all the potential risks.
Rick sent me a very amusing link to Ftrain.com’s American Military Operation Name Generating Device.
A sample:
Operation Infallible Gunship
Operation Massive Toad
Operation Sexually Ambiguous Assassination
Operation Bloodthirsty Wizard
Operation Umbrageous Rain of Burning Death
Operation Hot Marsupial
Operation Touchy Amphibian
Operation Medieval Teacher
Operation Furious Capitalists
Operation Very Mad Imperialism
Operation Plunging Supernova
My favorite one so far was Operation Ceasless Wombat. Reload often for new names, and remember this page should the Pentagon ask you to name an operation.
Medscape (link requires free registration) has an interview with Col. Cliff Cloonan, MD, chairman of military and emergency medicine at F. Edward H?bert School of Medicine, the military medical school at the Uniformed Services University of the Health Sciences. His CV is impressive, and he knows what he’s talking about. His experience is Army, and so’s his jargon, but the medicine is the same (though Navy Corpsmen are better trained than the basic Army medic).
Medscape: Does working in desert conditions while traveling pose unique challenges, such as maintaining a clean field during surgery, or preventing shock in injured patients exposed to extremes of heat and cold?
Col. Cloonan: Most wars are fought in uncomfortable, dirty, nasty environments, but that’s just where we operate. In Korea we had the freezing cold; in Iraq we have the blazing heat and windstorms blowing sand in your eyes. We tend not to fight wars in Hawaii.
I like this, and hope Medscape gets their in-theater doctor/reporter they want.
Dr. Sanjay Gupta reports on CNN.com that the Navy has developed and deployed a forward surgical capability. That’s great news, and I look forward to their publications in the future as to their effectiveness, mortality and infection rates. I actually would not hold a modestly increased mortality rate against them, as they’re going to get very injured combatants, the most injured of whom might have died on the way to a more remote OR.
According to Dr. Gupta:
In this mobile operating room — a tent that can be set up or torn down in less than an hour — it’s not unusual for these doctors — Navy personnel who work for the Marines Corps — to perform surgery on their enemy.
(snip)
Monday was the first time the Frontline Resuscitative Surgical Suite has been used, and doctors began treating some of the first patients coming from the front line.
Dr. Gupta did a creditable job of describing the facility but wasn’t given enough room to explain the odd title: Devil Docs?
In WW I, at the battle of Belleau Wood, not only did the USMC distinguish itself in combat, but they won the grudging admiration of their German enemy, who reportedly stated they fought like ‘Teufelhunden’, or Devil Dogs. The Marines liked the sobriquet and adopted it as a nickname, often greeting each other as such. The Devil Docs is a natural extension, applied to the US Navy medical personnel who proudly serve in the Green Machine.
It’s a terrific capability, and I hope it save a lot of lives. I’m rooting for our Devil Docs, the Corpsmen and Physicians alike.
One of my cousins was recently wed, and their honeymoon is in Paris. I received this from them, forwarded:
Bonjour,
(spouse) and I are sitting in some
computer dork infested gaming place
….. and since French keyboards are
wierd, I’ll keep it short …Watched a little war coverage on SkyNews
this morning …. We’re ok (no bombs
here. What would be the point. The
French are wussies. Saddam doesn’t know
they exist) We’re now off to Versaille
…. we hope to squeeze in the Louvre
and the Eiffel Tower (after dark)Aurevoir.
Hehe.
The 1st Marine Division is now reported (by CNN) to be on the move across the border from Kuwait into Iraq. I was part of the 1MARDIV for 4 years, but never (thankfully) in combat.
In peacetime most battalions will have one doctor and a variable number of corpsmen; memories play tricks, but I seem to recall the wartime TO for a BN was 2 doctors and about 48 corpsmen. At least half those corpsmen would be in the rifle companies (where the casualties would be most likely to occur), and a battalon aid station (BAS) with the doctors and corpsmen. They have had ATLS and have the ability to intubate (but not RSI unless things have changed recently), chest tubes, and pressure dressings. The docs have completed internships but no specialty training. They have crystalliod volume expanders but no blood, no cardiac monitor or defibrillator (although Corpsmen seem to appropriate things they think they’ll need, so individual units will be better equipped). This care is doctrinally given within about 1000 meters of the battle lines. The aim is all ATLS, and all aimed at ABC’s and evac.
The next stop is a Casualty Clearing Station, which should have a Dentist (Dental officers do triage in the Navy when the Surgeons are busy, and they’ll be busy), then a surgeon or an EP, or both. (Oh, the Dental officers do some backup anesthesia, too). The point here is the stabilization that didn’t happen at the BAS, then getting them to the fleet hospital in the right order. I think they can give untyped blood there, but no big operations wil happen. This is 1 – 10 miles behind the battle lines.
The next stop is either a Fleet Hospital or a Hospital Ship; these are scratch hospitals for trauma, heavy on surgeons, orthopedists, etc, for definitive stabilization. Then, if required, the casualty can be returned to a fixed medical facility for further care and rehabilitation. I never saw either of these, this is all from my initial battalion surgeon training.
Having been a battalion doc for the USMC, I know what their training, staffing and supplies are, and I wish them the best of luck. I sincerely hope things have changed, but when I was in there was only minimal casualty play in any training scenario, and we would not have been ready to evacuate our wounded. There’s a lot of reasons this training didn’t happen, and many are valid, but I sincerely hope this has changed. Here’s hoping for the best for them and their patients.
I could tell you my opinion about President Bush’s speech, of my respect for those still in uniform who are not able to be with their families, but that’s not what I do. Yet.
What I will add is another humor link, and this one is medical! QFever is the best regular medical satire on the internet. For instance, this week’s lead articles are:
Facing Blood Shortage, Hospitals Turn To Jehovah’s Witnesses
Recruiting efforts expected to decrease need for transfusions“Confusing” Brand, Generic Drug Name System To Be Replaced
Full scientific nomeclature will be mandatoryMedical School Introduces Innovative Curriculum
Not-my-problem-based learning draws praise, criticism
Read, laugh, enjoy; that’s what I do! And I’ve added QFever to the sidebar.
Update: oops, it’s not being updated. I’m going to leave the link up for a few weeks. Perhaps that’s what they were waiting for.
I am aware that there are medical tattoos. The ones I am familiar with are tiny dots used as ‘aimpoints’ for radiation during the treatment of cancer, and they’re usually quite small and hard to find unless you know what you’re looking for.
Yahoo has a report of a person getting a tattoo for medical reasons, but not for life-saving, quite the opposite: she got a DNR tattoo!
LONDON (Reuters) – An 85 year-old widow is so determined not to be resuscitated against her will by doctors that she has tattooed the words “Do Not Resuscitate” across her chest.
Frances Polack, a former nurse, said she paid $40 for a tattoo with the instruction and a heart with a ‘no-go’ sign in red and blue to ensure medical staff knew she did not want to be revived.
I guarantee that is one DNR request that would be honored. And I hope she doesn’t have to use it for a very long time.
via codeblog
In an accident in the way out West Texas mountains, Jeff Bezos, Amazon founder, crashed as a passenger in a helicopter, MyWestTexas.com
He apparently had only minor injuries, which is fortunate. He was treated and released at the local hospital, and hopefully is having a speedy recovery. His treatment is one of my corollary ER horrors, treatment of The Famous in the ER. It is never good, because either they, and certainly their loser hanger-on entourage, insist on being painful and involved, demanding things nobody else gets. I was only peripherally involved with the treatment of an “A List” actress, and it turned our ER into a zoo.
I’m glad nobody was badly injured, and I hope they were nice to their ER folks.
This evening, I have upgraded the software that powers GruntDoc.com. I really hope it worked out well, but as it involved ftp’ing 194 files into about 15 different directories on the server, it’s possible I missed one, or just blew it.
So, if you find something that doesn’t work, please let me know so I can do something about it. My email is to the side, or just leave a comment below.
I really like Movable Type, but think that the upgrade needs to be smoothed a bit. I am not a computer rocket scientist, but I am willing to tinker where I shouldn’t, and not everyone will be interested in this upgrade technique.
I generally like the internet tests, like the one I’ll link to below. I tend to score on the conservative end of the spectrum, usually, but it depends on who writes them; I once scored only 27% conservative and was labelled a (gasp) moderate.
This one is more to form for me. Imagine my surprise that I scored:
Republican – You believe that the free market will take care of most things, but that the government should be there with moderate taxation to provide for national defense and enforcing morality. Your historical role model is Ronald Reagan.
Which political sterotype are you?
brought to you by Quizilla
Several of the questions struck me as oddly phrased, but these are for entertainment. And, I’m not for moderate taxation, I’m for the least functional taxation possible that leave 14 carrier battle groups and a functioning Bush Doctrine. Take the test, and feel free to tell me how you did.
via MeanMr.Mustard
I’ve been holding out on you. I’ve been reading a site that has the best daily, topical humor anywhere, and I’ve not linked to it myself (now that I have, I’m sure their traffic wil soar, adding my 3 readers to his totals).
Scrappleface is the funniest thing on the web, but you need to have been paying attention to current events to really get it. Dry, sardonic humor is my favorite, and here it is.
I’m going to update my links list to include it. I hope you enjoy it as much as I do; if not, keep it to yourself.
Working nights is different, and nobody can tell me otherwise. The patients are different, the complaints are more interesting, and I get to see multiple applications of alcohol and or drugs.
Last night I had 2 different patients, from 2 different MVA’s, and they both had surprises for me. The first had minimal complaints, said he’d been being treated for bronchitis but didn’t feel better, and his oxygen sats were a little low. Chest xray showed bilateral infiltrates, and he got admitted for pneumonia (for those keeping score at home, came in because of an MVA, admitted for pneumonia).
Patient 2 was a nice young lady in an MVA who hurt everywhere, and was tachycardic. Big workup = hyperthyroidism! (Score: 2 MVA’s that had worse medical problems than their traumatic injuries).
Interesting night.
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