Archives for December 2003

Shoulder Dislocated during arrest: MJ – Jackson: Authorities ‘manhandled me’ – Dec. 28, 2003

NEW YORK (AP) — Michael Jackson says he was manhandled by authorities when arrested last month on child molestation charges — and suffered a dislocated shoulder from the way he was handcuffed.

Usually a shoulder dislocation is caused by forced external rotation, like catching a ball; handcuffing involves forced internal rotation.

I did a medline search for both “handcuff AND dislocation” and “handcuff AND shoulder”, and it yielded one noncontributory article about peripheral neuropathy from handcuffs. Not a single article about shoulder dislocations due to handcuffs. I’d like to add that as a practicing emergency physician I have never had a patient with an actual dislocation due to handcuffs. (I have had several complaints, all malingering to stay out of jail for another hour).

So, Mike, show me the xrays, including the scapular “y”, and show me the record of the conscious sedation and the reduction.

Otherwise, apologize to the nice officers, and stop being a whiner.

Honda Accord Commercial Link

It is a great commercial, and links to it keep disappearing. I found it again, today:

Honda Cog ad.

It was never shown in the US; our attention spans are too low.

Intubation Criteria

as pronounced by one of our excellent ED nurses:

“When your respiratory rate and heart rate are the same, it’s time to intubate.”

I tend to agree.

Which Muppet are You?

From Quizilla, “What Muppet are you?
My Muppet alter-ego
This might be the prototype for an ER doc:
You are Scooter.
You are a loyal, hardworking person, better known as a doormat.
SPECIAL TALENTS: Going for stuff.
QUOTE: “15 seconds to showtime.”
LAST BOOK READ: “300 New Ways to Get Your Uncle to Get You a Better Job ”
NEVER LEAVES HOME WITHOUT: Coffee, clipboard, and Very Special Guest Stars.

Well, at least the coffee is right.

via Kill as Few Patients as Possible and Cut to Cure

Merry Christmas, My Friend

Seasonal sentiment occurs even in my grouchy heart. I recently read the real story about one of the military’s best poems, Merry Christmas, My Friend, and thought I’d repeat it here, and tell you about who wrote it, LCPL Schmidt, USMC.

The true story is that while a Lance Corporal serving as Battalion Counter Sniper at the Marine Barracks 8th & I, Washington, DC, under Commandant P.X. Kelly and Battalion Commander D.J. Myers [in 1986], I wrote this poem to hang on the door of the Gym in the BEQ. When Colonel Myers came upon it, he read it and immediately had copies sent to each department at the Barracks and promptly dismissed the entire Battalion early for Christmas leave. The poem was placed that day in the Marine Corps Gazette, distributed worldwide and later submitted to Leatherneck Magazine.

Merry Christmas, My Friend by LCPL Schmidt

Twas the night before Christmas, he lived all alone,
In a one bedroom house made of plaster & stone.

I had come down the chimney, with presents to give
and to see just who in this home did live
[Read more…]

Bleat Drought Ends

Lileks ends his self-imposed bleat-o-penia, and it’a bout time.LILEKS (James) The Bleat

Welcome back!

12 days of Christmas more expensive this year

What happens when wealth management advisors get carried away with the season? They figure out what the 12 days of Christmas would cost each year, and spot trends! PNC Bank – The Annual

Funny stuff. Thanks to AG for the link.

Letting Go

I had to let an old friend go today: the calculator that accompanied me for years and years of school and travels finally succumbed to the LCD wasting illness.
LCD wasting disease claims an old friendThis excellent calculator joined me in 1981, during frosh chem at junior college, and stayed with me through it all: BS, MS, MD.

As with all degenerative problems, I had noticed the early signs but decided it was probably nothing, and ‘they all do that’. Then the symptoms became more pronounced, the dark edges didn’t really affect its basic function, and lended a certain funkyness.

Reality set in this week. The numbers are now barely legible; the spirit is strong, but the display is weak. I bought new batteries, but to no avail.

I am ashamed to say I dropped the friend in the trash, but quickly dug it out (sorry). It will be retired to a shelf in my office, where it’ll be my heirs responsibility to dispose of.

Sharp no longer makes a calculator in the format of the EL-5100, which is a shame. I’ll get a replacement, and it’ll probably be another Sharp.

Tiger no-no’s

So, Tiger Woods is engaged. I’m happy for him, and hope his fiancee is tough enough to deal with life in his fishbowl.

In that vein, let’s all agree that excess publicity has never helped any relationship, and the relationships of the rich and famous are doomed nearly from the outset.

Therefore, I move that we all forswear the following:

Tigers’ Pride (Spouse or offspring)
Tiger’s Cubs (offspring)
Tiger’s Den (home of above)
Tiger’s Lair (ditto)

Those refusing to forswear such descriptions should be prepared to pay me 5 US cents for every use. I’ll use the proceeds to establish a retreat for the insanely famous and wealthy to iron out their problems caused by media over-exposure.

Word to the Wise

When you wind up in the ED, please consider the following:

Your Doctor is your Doctor, not your waiter. “Will you be waiting on me” is the wrong question.
[Read more…]

LCOL West hearing result – U.S. officer fined for harsh interrogation tactics

TIKRIT, Iraq (CNN) — The commanding general of the 4th Infantry Division’s [sic] on Friday accepted a U.S. military investigator’s recommendation and ordered administrative action against Lt. Col. Allen West, who was accused of using improper methods to force information out of an Iraqi detainee.

Following a military hearing, West was fined $5,000 over two months, according to West’s civillian attorney, Neal Puckett.

The punishment does not affect West’s eligibility for retirement and pension, Puckett said in a statement.

West, 42, will be assigned to the rear detachment of the 4th Infantry Division awaiting the processing of his retirement request, the statement said.

I think justice was done in this case, and that everyone concerned can declare victory.

First, the rule of law is preserved. There is no open season declared on Iraqis, and a commander who decides to break the rules gets punished.

Second, the punishment is painful but not excessive. His potential punishments ranged up to a GCM and 11 years in military prison, in addition to losing his rank and retirement. Five thousand dollars, about a months’ pay, is a managable fine. His family may well feel the pinch more than he will, which will make it a real punishment.

And the worst punishment of all: he’s being reassigned to a rear area command while awaiting retirement.

I don’t have any personal knowledge of LCOL West, but he seems to be the kind of commander I’d want to serve with. The Army is losing a good man. I hope someone on the Army side of the world is starting a collection to help LCOL West with this fine.

12-13 Update: Yes, there is a Defense Fund:

Allen West Defense Fund
c/o Angela West
6823 Coleman Dr.
Ft. Hood, TX 76544

Many thanks to Jessicas’ Well for the steer.

“a crisis in personal morality”

Via Overlawyered comes this excellent article about MedMal. Calvin College – Spark – Fall 2003

It’s an excerpt from a book I’m going to have to get, Delta Doctor, by Dr. Peter Bolens. It’s too good for me to abstract, and when you read it, I’d ask that you not think this is isolated to Mississippi. It isn’t.

Bar codes matching drug to patient coming soon – Bar codes matching drug to patient coming soon

…Inside hospital pharmacies, tiny bar codes just an eighth of an inch tall adorn the blister packs that hold single-pill doses of certain drugs, like Dilantin for seizures and Lipitor for cholesterol.

With a handheld scanner, health care workers guard against medication mixups by matching each pill’s bar code to a hospitalized patient’s wristband and medical chart. It is to ensure the right person swallows the right dose of the right drug at the right time. If anything’s off, an alarm beeps.

By February, the Food and Drug Administration will issue orders requiring that every medication sold to hospitals soon bear supermarket-style bar codes.

It’s a major move that, once fully phased in, is expected to protect many of the estimated 7,000 hospitalized patients who die every year because of drug errors.

And, not just drugs:

The impact promises to go beyond routine drug mistakes. For example, printing a matching bar code for the vial of Mr. Jones’ blood before the nurse leaves his bedside guards against mixed up samples is crucial in ensuring patients receive the right blood type and other test results.

Patients get the wrong blood in one of every 14,000 transfusions, causing at least 20 deaths a year.

“Those are totally preventable tragedies,” says Dr. Gerald Sandler, Georgetown University Hospital’s transfusion chief. He began pushing for electronic solutions five years ago when his hospital had a near-miss — two children awaiting transfusions switched seats after the nurses double-checked who was supposed to get which bag of blood. But he says hospitals can’t afford the systems unless drug and blood safety are paired.

I am, with minor reservations, all for this. Medication errors large and small are all over the medical literature, and this has some promise to stop the majority of them.

My reservations revolve around human factors in several ways, and some silly old practicality. First, this will make sure the right patient gets the prescribed medication. However, it won’t help if the wrong medication or the wrong dose was prescribed, but there are efforts underway to address those issues separately.

Second, people will get the wrong bar code applied to them, or scanned into the system. It’s a GIGO world.

This leads to the third concern: now, again, we have people working for machines, and not machines helping people out. I’ll give you the example you’ve seen but maybe not realized: take something to the checkout line that has a bad code that isn’t in the system, and the entire transaction grinds to a halt. There’s a full length rant about this topic I’ve decided to skip, but you know what I mean.

Lastly, we (medical professionals in all fields and disciplines) have to make sure that common sense stays in the loop as these scanners are implemented. There will be hospitals that put into their rules that no patient can get a medication before all the barcoding has been done, which is fine for stable inpatients but would be a disastrous delay in the ED. Also, fallbacks for mass casualties, power and equipment failures need to be in place.

I’m generally glad this will be implemented, and hope it ends medication errors. It won’t, but it should stop the majority of them.

New QFever Issue

There’s a new issue!


Arvin Mayor Dissed, Probably Deservedly

Reading, I found this in the ‘Offbeat News” section: – Dude, where’s my respect?

BAKERSFIELD, California (AP) — Arvin Mayor Juan Olivares had just one request of a Kern County sheriff’s deputy during a traffic stop — “Don’t call me dude.”

Olivares planned to file an official complaint with the sheriff’s department, seeking to have the deputy fired for what he called disrespectful behavior.

“I asked him five times, ‘Please, officer, don’t call me dude.’ I’m not a dude. I’m 41 years old, I’m a businessman, I’m a Christian and I consider myself a gentleman,” Olivares said Monday.

Olivares is mayor of Arvin, a city of 20,000 in Kern County, about 20 miles south of Bakersfield.

I couldn’t believe I was reading this, a Mayor going to the press because a Deputy called him “dude”. I would assume the way this is usually taken care of is a cordial phone call from the Mayor to the Sherriff of the department in question, and it all rolls downhill from there.

Then, googling for “Arvin Mayor Juan Olivares” I found out why his relations with the law enforcement community might be strained: “Police officers in Arvin are taking the mayor to court

Bakersfield, CA, Nov. 19 – The police officer in Arvin said the city breached its contract with the Arvin Police Officers Association when it decided to stop paying 100 percent of officer contributions to social security.

The California Organization of Police and Sheriffs is representing Arvin police officers in their lawsuit.

A spokesman said Arvin mayor Juan Olivares was warned last week of the impending lawsuit and did nothing to stop it.

And, he seems to have trouble working and playing with others: Arvin Mayor outraged: Allegations against D.A.’s office and Arvin Mayor Reportedly Implicates City Manager In Tauzer’s Death.

So, now the press plea makes sense: he has no allies inside the Sherrif’s Office (and maybe anywhere else), so he chooses the press to complain to. Perhaps he physically resembles a Dell spokesman, but I doubt it.

After totally alienating his own police force, now he’s moved on to the Sherrif’s Office. Good career move. Lookout CHP!