Archives for February 2005

Consumers Union ad for Progenitorivox

Consumers Union: sent me an email, asking that I highlight their campaign to put pressure on Congress to get all drug test results released before a drug is released to the public. While I agree that sounds good on its face, I’d want to see the details before I signed on.

However, you should definitely follow the link to watch their catchy ad about a made-up drug called “Progenitorivox” by SquabbMerlCo, which I’ve now watched four times, seeing something new every time, and lauging. Watch to the end, their parody of drug disclaimers is terrific.

Then, read their site, and fill out the form to advocate for their position, should you agree.

ED doctors on receiving end of threats, violence

from AMedNews (the AMA’s news service) comes this:

Emergency physicians face perhaps the greatest likelihood of violent encounters with patients. But internists, surgeons and others are not immune.

By Damon Adams, AMNews staff. March 7, 2005.

A man high on cocaine punched four people in a Michigan emergency department before a doctor intervened and the unruly patient slugged him twice in the face.

The emergency physician needed eight stitches to close his gashed forehead. The patient spent the night in jail.

The scuffle was recalled by an anonymous emergency physician who participated in a new study on violence in emergency departments in Michigan. The study, released online last month by the Annals of Emergency Medicine, found that 76% of the 171 emergency physicians in the survey reported experiencing at least one violent act the previous year.

Three in four respondents to the 2002 questionnaire reported verbal threats, while 28% said they were victims of physical assaults. Nearly 12% were confronted outside the ED and 3.5% were stalked. The acts prompted 42% of the doctors to seek protection, including 18% who obtained a gun and 20% who bought a knife.

[Read more…]

What Happened to WriteWing?

Does anyone know what happened to Diana or The WriteWing? It used to be a frequently updated medblog of a nurse in Detroit. Now it’s something else, entirely. I’ve emailed her, no response. Anybody else know what’s up?

Disrobing Patients

No, this will not be an angst-filled post about the horrors of seeing beautiful female patients in their birthday suits. I’m pretty much over that.

This is the complete opposite. Most ED’s go through phases with their staffs about the relative importance of different tasks, and to whom it is important.

Last night I went into an exam room to see a patient, with a series of complaints indicating a very very thorough exam would be needed. This patient was in bed, covered by a hospital sheet and a blanket from home. Also, this patient was wearing a hat, an overcoat, a complete (and stylish) outfit underneath, shoes and Mittens! I said hello, got the very basics of the history, and asked the patient be assisted into changing for an exam.

I mean, I’m good, but I’m not THAT good.

It should be noted that our techs, who place patients in rooms, are very busy themselves with several things to get done in a short amount of time. They have things that are important for them to do, either because they take pride in the accomplishment, or they get immediate negative feedback. These things are typically done.

Then there are those things that aren’t important to them, for which they get negative feedback from everybody. Patients, for some reason, resist changing into a thin, ill-fitting, dehumanizing gown for an exam, and they tend to tell the tech what they think of that. So, they don’t change. Then in comes the doc, says howdy, and immediately finds the nearest tech to get the patient into a gown.

I do my part, I help with the stupid snaps on the arms (I have seen several very frustrated patients who just couldn’t figure out the fabric-origami and kind of wore it like a toga: they always get style points from me).

Anyway, meet us halfway. Take your clothes off, er, change into the gown. It’ll make one aspect of your ED visit a little faster.

The First Internet Photo

LHC: The First Band on the Web

Back in 1992, after their show at the CERN Hardronic Festival, my colleague Tim Berners-Lee asked me for a few scanned photos of “the CERN girls” to publish them on some sort of information system he had just invented, called the “World Wide Web”. I had only a vague idea of what that was, but I scanned some photos on my Mac and FTPed them to Tim’s now famous “”. How was I to know that I was passing an historical milestone, as the one above was the first picture ever to be clicked on in a web browser!”

Silvano de Gennaro

Well, it’s not much to see, but here it is:

Les Horribles Cernettes

via Slashdot

AED’s recalled; you are NOT affected (directly) – Medtronic recalling 2,000 defibrillators – Feb 25, 2005

Medtronic Inc. said Friday it is recalling nearly 2,000 automatic defibrillators that may not work properly.

The company said the machines may not correctly analyze a patient’s heart rhythm, possibly preventing the machine from defibrillating the heart when it is needed.

The recall covers 1,924 Lifepak 500 AED’s made in 1997, the company said. Automatic defibrillators analyze heart rhythm in people that may be having a heart attack and, if necessary, shock the heart back into rhythm.

Nowhere in this disturbing article do they actually use the word EXTERNAL, which is what these defibs are: they’re the ones with the patches on the outside of the chest used in airports, sports arenas, and big amusement parks in case you drop dead.

Now, this article is disturbing, as

Medtronic said it has received 54 reports of instances involving this group of defibrillators, including eight cases where it may have prevented patient resuscitation.

Wow, that’s a lotta failures, even for a device that’s fairly complicated but supposed to be foolproof enough to save a life.

Anyway, they’re external defibrillators, so don’t lose any sleep over your implanted one.

The Saddest Honeymoon Pics Ever

…come from the memory card of a camera belonging to deceased honeymooners John and Jackie Knill of Vancouver, British Columbia. Their camera was recovered and the pictures survived them. The ones shown feature the tsunami from ground level, as it approached. By the time the shutter clicked they probably knew they had no hope of suriviving.

Georgia Stabbings from the Surgeon who Treated

A Chance to Cut is a Chance to Cure

I was helping out a gynecologist friend of mine answer the age old question: Is it appendicitis or PID? I won, he lost. As I helped him free up the TOA the ED called up with a “trauma alert”. Several children in cardiac arrest. Bidding farewell I went down to the ED. Four children with penetrating injury, unknown number in full arrest.
First child arrives, followed shortly by another.

And yes, even people who see tragedy daily are affected by it:

It was truly like a bad episode of “ER” with shouting and lots of people working furiously to save these children’s lives. Paramedics carrying limp bodies of bloodied children into the trauma bay. Then going outside to cry, vomit, or both. Nurses and house staff running these patients to the OR, then themselves breaking through the brittle shell holding their emotions in check.
As for myself, I could not comprehend what could drive someone to do this. How sick or evil this person was to do this to innocent and helpless children. What psychological price will these little ones pay for the rest of their lives?
As I was rounding one them today one told me, “I was bad.”
“No ____, you have been very good throughout all this. And you will get better”
So far, my brittle shell is only cracked.

Read it all, if you can. Man is capable of the most extraordinary evil, and astonishing good, both demonstrated here.

Internal Disaster

code blog: tales of a nurse: Internal Disaster

Those aren’t words you want to hear over the loudspeaker of your place of employment.

The alarm sounded, but although it’s usually cleared within a few moments, this time it just kept going. Ding. Ding. Ding. What the heck was going on? The rumors filtered down over a matter of minutes. A doctor who had been on the Floor In Question came down to ICU with stories of patients being evacuated. Huh? If patients are being evacuated, why are you down HERE telling us about it instead of up there? We thought he was full of it, trying to pull our collective legs.

But then we heard the announcement, and it cemented everything he’d said. We were having an Internal Disaster. “This is not a drill.” Soon, we heard our charge nurse’s Vocera chime in: “Please have all evacuation litters and chairs ready to go when the transporters come for them.”


This was real! A real, live emergency!

Though she’s being (appropriately) cagey about the cause of the disaster, there are Lessons To Be Learned from reading this.

Singing “Happy Birthday” in an ER

…tonight were, I presume, relatives of a patient. Not my patient, and it was busy, but I couldn’t help but look into the curtained cublcle from whence the tune was coming.

Two nicely dressed ladies were singing “Happy Birthday” to an elder in bed, with a c-collar in place. It was a perfectly good rendition, but not something I hear very often (OK, ever) in the ED. I suppose a decent number of people wind up in the ER on milestone dates like anniversaries and birthdays: illness and injury are disrespectful of our mortal celebrations.

Again, I was busy and didn’t get the whole story, but it seemed these people were making the best of a bad situation, and they’re to be commended for it. I hope I’m never a patient on my birthday, but if I am, sing me the song!

Camera Phones and Medicine – Camera phones may make a doctor’s house calls – Feb 22, 2005

Next up for cell phones with built-in digital cameras: making house calls for doctors.

Next to come: plaintiff’s attorneys paying for their photos.

I thought about this while suturing a patinet recently, and the patients’ friend took ‘before and after’ photos while I was in the room. While I wasn’t in the pictures (so far as I know), it made me wonder what new chicanery lies in store. Makes me want to take my own ‘before and after’ wound pictures (although when I brought this up so many committees and lawyers were suggested I let it go).

It’s a brave new world, and it’s going to be caught on digicams. Goody.

PS: (I’ll know it’s a new world when my telephone book doesn’t make me feel soiled just touching it: plaintiff lawyer ads front, spine and back covers).

Abbreviations, Acronyms and Medicine

Gentle Reader,
On occasion it’s handy in medicine to use the “insider” acronym, as COPD is easier than Chronic Obstructive Pulmonary Disease. Notice the little dots under COPD? Hover your cursor over the letters, and an explanation should magically appear.

So, if there are little dots under acronyms from now on, there’s an explanation available.

Crud. After fooling with this ‘feature’ in 3 browsers, trust Internet Explorer to screw it up. So, if you use IE you won’t be able to see these, unless you just hover the cursor over every acronym, as the little dots don’t show up. Thanks, IE. Turns out it just doesn’t preview correctly in IE, but publishes as hoped. Sorry IE!

ED Volume: Loud

Holy cow, has our volume picked up! And from colleagues it’s not just here, it’s throughout the ED’s of North Texas. Less than 3 years ago my ED occasionally held admitted patients. This morning, we were holding 27, and that’s nowhere near the high for the last several weeks.

We have theories, but no facts, as to why this is occurring, and there’s no end in sight (we’re looking). One of my favorite quotes has to do with personnel management: “You ride your best horses to death”; in this instance, our staff are all thoroughbreads, and they’re tired. Troopers, but tired.

Tangentially, this has made me have some uncharitable thoughts: who were the genuises in the mid to late 80’s I kept reading about who had meetings and decided we had way too much hospital capacity, too many beds, and we needed to close them to avoid disaster. I’d like to have them carry urine samples in my ED, all day long. It’s a fitting punishment.

And, again, we lack any prolonged surge capacity. We’re running full, at top speed, all the time. We could handle something like a plane crash, but an epidemic (natural or manmade) would be nearly impossible to manage.

Where are the pointy haired fortune tellers who set us up? Send them to me, I have something for them to carry.

Emergency Medicine, Hunter S. Thompson style

The Cheerful Oncologist

“When the going gets weird, the weird turn pro.”

(written in the manner of one Raoul Duke)

Why am I here? Who is this woman in a giant muu-muu, standing before me squeezing what appears to be a copperhead snake in her hands? She spoke to me in some strange language – obviously disrespectful of the country that took her in after a long canoe trip across the oceans. I thought of screaming “Back! Get Back!” but suddenly sat bolt upright and remembered:

I am a doctor…on call in the emergency room of the world’s greatest hospital. My shoes were smeared with thick crusts of vomit and blood, as were my pants, except I wasn’t wearing any. I must find them, I thought. The lights above my head burned into my skull like the first kiss of the electric chair. I reached for my pistol to shoot at them, but it, too, was missing. The situation was rapidly deteriorating. I began to sweat like a champagne fountain at a coal miner’s wedding.

As I reached the lounge I realized that the sun was shining, meaning my hell-night was about over. All that was left to do was clean up the forty or so charts that I had tossed behind the soda machine, locate the rest of my clothes, sign in to the intern relieving me and slip out through the window in the men’s room. Before leaving I decided to eat – after all, being a servant of the needy gives one an appetite like a crazed Samoan wrestler. My forged I.D. card was good for at least one more trip through the outlet store for the local waste dump, also known as the hospital cafeteria….

Utterly inspired insanity, the best tribute I’ve read to the late Mr. Thompson.

via Shrinkette

MedBlogs Grand Rounds XXII

Catallarchy ? Grand Rounds XXII

Welcome to Catallarchy, home of this week’s Grand Rounds. This is the first time that the Rounds is being hosted by a blog not solely dedicated to medical topics. However, I am a fourth-year medical student preparing to enter pathology, and my co-blogger Jonathan Wilde is a resident in the Northeast. It is an honor to take part in the growing medical blogosphere’s weekly gala.

A terrific number of contributors this week, something for nearly everyone!