Happy Halloween from the Head CT

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Crummy Lancet Propaganda Study

Hint to journal editors: when a submitted manuscript (reportedly) comes with the string attached that it be published before an election, be very wary. And, do a better job of peer-review than the Lancet just did.

Or, call Shannon Love, of Chicago Boyz, and await her rewiew of survey methodology:

First, even without reading the study, alarm bells should go off. The study purports to show civilian casualties 5 to 6 times higher than any other reputable source. Most other sources put total combined civilian and military deaths from all causes at between 15,000 to 20,000. The Lancet study is a degree of magnitude higher. Why the difference?

Moreover, just rough calculations should call the figure into doubt. 100,000 deaths over roughly a year and a half equates to 183 deaths per day. Seen anything like that on the news? With that many people dying from air strikes every day we would expect to have at least one or two incidents where several hundred or even thousands of people died. Heard of anything like that? In fact, heard of any air strikes at all where more than a couple of dozen people died total?

Where did this suspicious number come from? Bad methodology.

If you have the interest, read the rest.

I Voted Early

I and my wife voted today, early, and it was pretty painless. Given the line, and the crowds we’ve been seeing at the early voting stations, we knew there were going to be more voters than usual, and wanted to get it done before election day.

According to the Texas Secretary of State’s Office, as of yesterday a hair more than 25% of Texas Eligible Voters had cast some form of an early ballot!

That’s terrific. Make sure you vote.

ACEP Founder Killed in Tragic Car Crash

I just got an email from ACEP:

John G. Wiegenstein, MD, founder of the American College of Emergency Physicians, was killed yesterday in a tragic car crash near his home in Naples, Florida. His grandson, Parker Meyer, age 6, was also killed, according to the Florida Highway Patrol.

Dr. Wiegenstein?s car was struck by another vehicle as he attempted to turn left at an intersection in Bonita Springs, police reports stated. Dr. Wiegenstein and his grandson were transported by helicopter to Lee Memorial Hospital where they were pronounced dead.


Dr. Wiegenstein was instrumental in the formation of the specialty of emergency medicine. As a medical student and resident in the 1950s, he gained an understanding of the specialized training needed to provide quality emergency medical care. In 1968, Dr. Wiegenstein and seven other physicians founded the American College of Emergency Physicians.

Dr. Wiegenstein steered the College through the lengthy process that culminated in the recognition of emergency medicine as a new medical specialty in 1979. He was also a past president of the American Board of Emergency Medicine, served as emergency medicine’s first delegate to the American Medical Association and the American Board of Medical Specialties. He received the AMA?s Distinguished Service Award, the association?s highest honor, in 2001.

My specialty is brand new, in medical time, and wouldn’t exist at all without the incredible efforts of men and women like Dr. Wiegenstein. Thanks, Sir.

Happy Birthday, Andy!

To the coolest California Kid we know!

Hang Ten, Andy!

BoSox fan death and Paintballs

I thought the dead woman was hit with a much bigger projectile, so I didn’t look into this:
CodeBlueBlog: CSI MEDBLOGS: HOW DID BOSOX FAN DIE?

…The reason trauma to the globe does not cause death can be derived from standard evolutionary principles. Surely if this mechanism (direct blow to the globe) were fatal, our eyes would have developed behind calcium cages; however, the solution evolution worked out was to create a relatively closed-pressure chamber (the retro orbital space) with thin walls so that any backward-directed force on the globe would “blow out”? one of the thin surrounding walls rather than direct the force posteriorly to the central cerebral structures. So by teleological reasoning, the woman shot in the eye with an exploding pepper ball should not have died.

That’s the real news story here.

I agree, and I’ll bet the City of Boston regrets taking full responsibility for this death so quickly (that’s why I noticed and then dismissed this, the rapidity of the Municipal mea culpa).

I have yet to see someone hit with anything short of a bullet in the eye who expired. This can be because: a) they died before they were sent to the ED (doubtful, but cannot be completely dismissed), b) I haven’t seen everything (possible), or, c) it doesn’t happen (most probable). Elsewhere in my blog I have x-rays and CT’s of a person with a nail through their eye that was non-fatal. I don’t for a minute believe that a paintball striking the eye can cause death. I understand the kinetics are different, but having now thought about it, I don’t for a minute think that this Police projectile caused this death.

My request/demand to the City of Boston: Let’s see the autopsy results, and answer the question. Then this either rests, and I eat my words, or we know Something Else Happened. Given that this is the death of a civilian at the hands of the Police, this is a reasonable and rational request.

Interesting question, and many thanks to CodeBlueBlog for pointing it out. Let’s all hope there’s a public answer.

via Blogborygmi

Study: All docs should be like ED Docs

Well, brought on by this, that’s my inferred conclusion from this:

Conclusions: Interns made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts. Eliminating extended work shifts and reducing the number of hours interns work per week can reduce serious medical errors in the intensive care unit.

and backed up by this:

Conclusions: Eliminating interns’ extended work shifts in an intensive care unit significantly increased sleep and decreased attentional failures during night work hours.

OK, so maybe it doesn’t say they should emulate ED docs, exactly, but it makes sense to me. I wouldn’t want an ED doc who’s been up for 36 hours making my TPA decisions, and ED docs, though thought to be not too bright by the rest of the medical staff, are smart enough not to work themselves to death and to avoid the hospital whenever posiible (this excludes the sub-genus meetinglover, who lives at the hospital anyway).

Funny, I watched my dad work shifts throughout my adolesence, and said to myself “I’m going to be a professional, so I don’t have to work shifts”. And then I went into Emergency Medicine. Shifts Until Retirement.

via Kevin, MD

Advertising and My Blog

I have been approached by a site, which “specializes in services to physicians”, and from a peek at their site seems to be at least legit, though I have no way to know one way or another if their services are actually worthwhile.

And, my first inclination is to just formalize what my current policy has been: no advertising here. Yes, I do link to two commercial sites in the sidebar, but they’re sites I like (or at least don’t dislike), and I get no money from them.

The actual cost of running this blog every month is less than $20, so it’s not a huge financial burden, therefore, money isn’t really necessary. So, I don’t need the money.

I find the BlogAds (a different proposition, to be sure) to be distracting when reading others’ sites, and thank Firefox for giving me the ability to blot them out entirely. I want to read what there is to read, not an ad. (For the record, I still go back to those sites, and have clicked through a blog-ad or two, though I haven’t bought anything that way).

Now, I’m a “medical blogger” though I blog less about medicine than most others in the subgenre, and it’s a medically related ad, but…but. I feel like I’d be selling out.

I’d be interested to know what you readers think about sidebar ads in general, and on this blog in particular. I’d also like to hear from someone who has sidebar ads, to know how they feel about it.

Medblogs Grand Rounds 5

code blog: tales of a nurse

Welcome to Grand Rounds Five! We have some fascinating stories and news commentary this week.

And, she has the best presentation style so far, and by a long shot! Thanks, Geena!

And Tomorrow is Friday

Doctors are people too. Sure, we don’t really seem human, but we are.

Here’s a terrific article by one who can express himself, as he faces cancer:Medical Economics – And tomorrow is Friday

For 23 years, using the office bathroom was just part of my daily routine, like drinking coffee on the way to the office, opening the door, and turning on the computer. But on Saturday, my urine was bloody: painless blood. And as a physician I know that means the almost certain diagnosis of a cancer. First I tried some magical thinking: drank some water, tried again: still blood. Then I went to the other bathroom, drank more water. Still blood. A clear realization came over me: Today is the first day of the end of my life.

Read the whole thing.

via Kevin, MD

Sheepdogs

A couple of weeks ago, I wrote about Sheepdogs, a thread started by reading a poem about them. Of course, oops, there was no link to the poem that inspired the thoughts.

The poems’ author, Russ Vaughn, sent it to me:

The Sheepdogs

Most humans truly are like sheep
Wanting nothing more than peace to keep
To graze, grow fat and raise their young,
Sweet taste of clover on the tongue.
Their lives serene upon Life’s farm,
They sense no threat nor fear no harm.

On verdant meadows, they forage free
With naught to fear, with naught to flee.
They pay their sheepdogs little heed
For there is no threat; there is no need.

[Read more...]

My Side

“…you’re on my side, right?” said the nurse.

As an ED doc, you hear this a lot. Strife and minor skirmishing are just part of the life of the ED (especially the ED Nurse, the un-empowered overachiever and hero-ine (and I love every single one of you, even if I haven’t met you)).

I had about a second to process the question. (The second year of med scool is terrific, in that it has given me the near-Tivo ability to hear and retrieve the last 10-15 seconds of background info and replay it for important “Yes, dear” moments. This was not a yes, dear moment, and there wasn’t any conversation in there for me to go with, one way or another).

The rest of the second year is why I’m losing my hair, many years later.

“Well, (valued nurse colleague), if I’m gonna ride your ass, it’s only fair I’m behind it”. Then I realized what I’d said. Sailor talk came after the second year, and I’m still fighting it.

“He he, I knew you were!” Oh, thank heavens, no unpleasant talks with the Powers That Be. I love you Powers, too, but those talks are Less Fun.

If you’re an ED nurse, I’m on your side. Especially if I give you a hard time.

PFC Sensing, USMC

A proud dad blogs about his son, recently graduated from Parris Island: One Hand Clapping

Here is one of the newest US Marines, my son, PFC Stephen Sensing. He graduated yesterday from Marine Corps Recruit Depot, Parris Island. It was a fantastic day! Behind him is the Iwo Jima memorial on the base, next to the parade deck (parade field for all us dogfaces).

Eight platoons of new Marines graduated, including two platoons of women. Unlike the Army, the Marines segregate initial-entry training of men and women. However, the requirements are the same for both sexes.

Like most recruits, Stephen lost weight during boot camp, almost 25 pounds. He also dropped several minutes off his three-mile run time, more than quadrupled the number of pullups he can do, and almost doubled the number of situps (the Marines call them “crunches,” he did 138 in two minutes a weeks or so before he left, with a drill instructor counting).

Excellent proud parent stuff, and I would be, too.

Of course, there’s a downside to this much stress and sudden weight loss: immune system dysfunction.

Unfortunately, my son has a large and deep suppurating wound on his left forearm (hence the bandage) for which he was hospitalized from Sunday evening to late Thursday morning in Beaufort Naval Hospital. The whole time he was on IV antibiotics and still has three stout oral antibiotics to take now. The wound probably was caused by an insect bite becoming infected during the Crucible which took several days to develop into an abscess.

Hence, while Stephen has graduated from boot camp, he has not been released from Parris Island and will have to return there when his leave expires Oct. 31. He’ll be on medical hold at PI until the doctor certifies his wound has healed. The Navy physician told us it will take at least one week after his return, probably more. Eventually, Stephen will go to Marine Combat Training at Camp Lejeune, NC, then he assigned to another school where he’ll learn his specific job in the Marine Corps.

I recall that Army Ranger and BUD (SEAL) students have been studied extensively, and they have severely depressed immunity during this kind of intense and stressful training, and this no doubt contributed to his forearm abscess. I’m not saying that this training is bad or should be changed, just that we need to recognise the physical costs and be prepared to deal with them.

I’m betting the PFC here rebounds very nicely with a low-stress environment and home cooking. Good luck, PFC Sensing, and Well Done, Dad, for having raised such a fine young man.

The Nurse’s Guide To Specialists

Head Nurse

Internal Medicine:

Fit, well-dressed, with a cholesterol of 130 and the oddest prescribing habits you’ve ever seen. If you need electrolytes repleted or your INR brought to its proper level (that’s a measure of clotting time that’s influenced by coumadin), the internal med specialist is your gal. Or guy. If you’re a nurse, having an internal med consult means that you’ll be cutting tablets into quarters and giving 7.5 milligrams of something that comes in a 25-mg dosage, but only on alternate Thursdays during the dark of the moon.

No mention of EM, but she’s stuck on the floor, so she doesn’t get to seen the best (hehe).

via Feet First

Outsource your Medical Care

Another interesting turn in the ‘get it somewhere less expensive’ department:

MSNBC – India draws ‘medical tourists’
…Last year, an estimated 150,000 foreigners visited India for medical procedures, and the number is increasing at the rate of about 15 percent a year, according to Zakariah Ahmed, a health care specialist at the Confederation of Indian Industries.

Eager to cash in on the trend, posh private hospitals are beginning to offer services tailored for foreign patients, such as airport pickups, Internet-equipped private rooms and package deals that combine, for example, tummy-tuck surgery with several nights in a maharajah’s palace. Some hospitals are pushing treatment regimens that augment standard medicine with yoga and other forms of traditional Indian healing.

The article is about an individual who, when faced with a $200K bill for a heart valve replacement went to India to have the procedure for $10K, including airfare. Hard to argure with that.

My first thought was that ‘my job’s safe, good luck outsourcing your emergency care’. Then I realized, with enough of this, my hospital would close, and wouldn’t need an ER.

I wonder what kind of medmal they face in India. Heh.