Archives for April 2003

Satellite IS better

I have been critical of my satellite connection. It wasn’t as good as my DSL, and that irritated me, so I didn’t think much of it.

That was, until, dialup.

Thanks to my profesional college (ACEP), we stayed in a hotel without broadband (the horror). So, since I need the internet, I signed up for the MSN, which comes bundled on the computer (hello? Justice Dept?). And I was educated in the ways of broadband, and how good the satellite is.

Just don’t tell DirecWay, they’ll figure out another way to give substandard service.

ACEP Wednesday

Started early. Sorry, but day 5 of early mornings have made me a tad cranky. I’ve never been a ‘morning person’, and this is pushing my good nature.

I went to a conference at 8AM. I wish I could tell you what it was about, but right now I don’t remember. No direspect to the lecturer; it wasn’t bad, just not memorable. Then, a goood lecture on EMTALA (the road to hell, pavement, etc), then an interesting Tox lecture. Fun photos of snakebitten people (also Gila-monster bitten). Then I had to catch a plane, and I’m home.

A good time was had by me, and I got a good deal out of it.


These are just the lectures I attended; there are others.

Today’s lectures started with “Great Cases in Emergency Medicine”. This is always a fun topic, and can be very educational. The presenter is an accomplished EP and is academic faculty, so it’s no surprise she was good at her presentations. The three cases we covered were quite enjoyable, and as with most of the really fun EM cases they were toxicology.

The next was “Commonly Ordered Lab Tests” by one of the leading thinkers in EM (yes, there are thinkers). Mostly he railed against getting PTT’s (good point and good literature to support its exclusion except in very specific cases), he thinks we should be ordering more Magnesiums (something to consider). Time well spent.

Then onto “Acute Coronary Syndromes”, a topic I went to because I wanted to hear what this weeks’ recommendations from the oh-so-scientific cards community are. I won’t bore you with the details, but this talk was aimed at a very very small subset of my chest pain practice, but at least with those now I know what to discuss with the cardiologist.

Then onto ‘articles that should affect your practice’, again by the thinker. Except for one new treatment (Ivermectin for scabies?), it’s things I think most already knew. (Except for better coma survival in people who we make hypothermic after their cardiac arrest. Hmmmm).

Then onto a wound management update, where I learned one helpful trick (use a sterile glove for finger lacs; after the wound is prepped, apply the sterile glove sterilly to the pt’s hand, then just nip the tip of the glove and roll it back over the finger: viola! Really sterile field and a finger tourniquet that works. I’ll be using that, soon.

Aah well, break’s over. Probably done with blogging this thing today, maybe for the trip. There’s too much to do here other than sit on the computer with a dialup-connection (thanks, Hyatt, for not having any broadband or WiFi available).


That’s New Orleans, Louisiana.

The conference is pretty good so far; no super-usable facts for my practice, but a fair number of ‘style’ things and food for thought about the physician patient interaction.

Afterward, we went to have dinner in the French Quarter, tonite at the Acme Oyster Bar. Rick was touritsy and had crawfish, which you might starve trying to live eating; it’s a lotta work for not much food. I didn’t have oysters or crawfish, thanks.

We went and had more beignets at Cafe du Monde (Cafe of the World), and they are still good. I think we’ll check daily, and report, as a public service to my readers.

Ultrasound teaching

The course on EM ultrasound was very good, and filled in a few gaps for me. The instructors were incredibly knowledgable and patient, and skills of this sort aren’t taught by lecturing alone, there has to be some practical, hands on demonstration and training.

We had several ‘donated’ very nice ultrasound machines with their sono technician corporate educators (people who sell that brand of ultrasound machine) to answer all of our questions about which buttons do what and ‘how do you make it quit that’ sort of questions. Ultrasound machines now are incredibly capable, even in the more base models that are marketed to Emergency Departments. The sales force wasn’t teaching, by the way, the course instructors were, but as most were using machines thay weren’t personally familiar with, we needed a little orientation, at least at first.

What are ultrasounds used for? To examine specific parts of the body, and in Emergency Medicine, to answer specific questions (“It’s not a tricorder to help find disease” was one memorable quote). How do you practice ultrasound? On human models, which finally gets me to the point. Yes, they were all monetarily compensated for being there, and they were all very good at being still and letting us all slather them with ultrasound gel while the 60th person examined their liver/kidney/diaphragm/spleen/anotherkidney/heart/bladder, and later, their gallbladders and aortas. The ones who were most useful were the ones who consented to being models for endovaginal ultrasound (EVUS).

EVUS is very very useful in EM, and is an important diagnostic tool/question answerer. It consists of a high frequency probe (with appropriate protection and gel) being inserted into the EV region for a very detailed look at the uterus to answer specific questions (Pregnancy in the uterus or not? It’s important to know in many instances). The models were all yound and healthy, and it amazes me people will model as such to help their fellow humans. Or, it could just be mercenary desire for cash, but there’s got to be a better way to make money than that. The docs were all very correct and all I worked with were very polite and courteous toward our US models.

And thanks, models, for helping us help others.


Ok, first, Friday night. We went to the French Quarter, which is very rundown in a quaint, tourist-trap way, and which smells vaguely of vomit (go figure). We had a nice dinner, went for another walking tour, and got a tad lost on the way back to the Hotel, but no problem, home safe.

Today we went to the first of 2 days of ED Ultrasound training, which for both of us is more refresher than training, as we got this in our residencies, but are a little out of practice.

The machines for ultrasound (US) are terrific, and the Philips is a clear winner for usability and image clarity. It costs about what a Cadillac Escalade does. New. Without a rebate.

The course is good, and we’re adding incrementally to our knowledge. And I’m starting to fume again about how every specialty on earth thinks they get to set standards for ED practices, when they’re not EP’s and they don’t practice emergency medicine professionally. Full scale rant on this someday.

Tonight we had very average (but pricey) steaks for dinner, and watched the Hornets win a playoff game (on TNT).

More later.

In the Big Easy for ACEP

I am now in New Orleans, for an EM conference. The SWAT team and 20 rabid dogs are patrolling my house. Don’t even think about it.

Rick is here, too, and he got the Delta Force (he won the coin toss for home security). I cannot speak for him, but I will: it’s humid and pretty interesting.

Something about the conference each day.

Rick says watching me type is better than watching the weather. It’s not all that quick or accurate (kind of like weather forecasting, actually).

Airport Officials Keep Close Eye on American

Sounds like a suicide watch.

A New Q Fever!

I knew this day would come! Literally minutes of wishful thinking on my part, and my critical linkage in the sidebar, has resulted in

a New Q Fever!

And it’s funny, too! The article about the Fresno Psych program acceptance policy tells me one of the writers did time there.

Coffee Rehab

Dilbert Comic Strip Archive – – The Official Dilbert Website by Scott Adams – Dilbert, Dogbert and Coworkers!

Wally has been banished to coffee rehab (Wally drinks lots of coffee and is rarely without his coffee cup). I need coffee rehab, as I drink about 1/2 a pot before going to work, then several cups at work (free coffee – not gourmet).

After discussing my coffee fetching with my wife, she opined that it’s like a smoking break for others – a few minutes where I’m doing my own thing, and not having to focus on work. Interesting, and that’s probably it. And I’m not addicted, I’m not. I can quit anytime I want. Really.

Update: Another blogger weighs in on the Coffee talk, with a terrific graphic!

Cities to Avoid

China plans broad SARS quarantine

WHO: Travelers should avoid Beijing, Toronto

Yeah, like we need the WHO to tell us that. Oooh, SARS. OK, for that too.

But, this means that eventually the WHO will say it’s OK to travel there? Hmmm.

OK, but really, I think this highlights why the Smallpox vaccination is a good idea. Once the health authorities decided to quarantine one of the ‘source’ housing complexes (which would be much easier to quarantine than a regular city block), and, guess what? They had scattered to the four corners, and the quarantine didn’t work. Now, make that an incredible contagious disease with a 30% death rate, and the idea that ‘containment’ would work is nutty.

We’ve been lucky SARS hasn’t hit the US like Asia, and let’s hope that lasts.

And stay out of Beijing and Toronto.

Which Monty Python Character Are You?

from Quizilla

my Leige!

I don’t think this result is a surprise to my readers. All three of you.

MedPundit Outed

I’m not going to give it away, but I will link to it. The best medical blogger going is MedPundit, who posts under the pseudonym Dr. Smythe. As she states on her own blog, she’s a practicing Family Physician, so having her name directly attached to her blog could be problematic; it’a problem I’ve dealt with by not dealing with it; I used to post under my real name, but no longer.

Anyway, the second reason I don’t give interviews (the first is that nobody ever asks me) is that I’m jealous of my privacy, and I’ll bet Dr. Smythe is, too.

How did I spend Easter Sunday?

how I spent my Easter Sunday
I’m glad you asked. At least some was spent in this dignified position.

The M&M Tree

M&M treeWhen visiting a few months ago, grandson’s Uncle Tom helped grandson plant M&M’s, “…and an M&M tree will grow here!”

3 year olds have a selective but effective memory, and he checks evey time he’s over for any growth of the M&M tree. Today, Easter Sunday, it grew; it’s been explained it only grows this one day.

He’s happy, and so are we.