Answer to name the fractures

Oops, I messed up. I was supposed to have the answers out yesterday. I hope none of you were injured in the rioting resulting in the missed deadline.

For the answer(s) go to the original entry, and look in the extended entry.

Thanks for playing!

MedBlogs Grand Rounds XXVI

It’s Tuesday, so that means MedBlogs Grand Rounds!

The Well-Timed Period: Grand Rounds XXVI

Welcome to Grand Rounds, a weekly showcase of posts from the medical blogosphere. Make yourselves comfortable, relax, and prepare to be illuminated.

I like her first two categories:

Politicians Are Intrusive Ninnies

and

Doctors and Lawyers Are From Different Planets

Another fine edition.

Bogus JCAHO Surveyors Visiting Hospitals

From the emailed newsletter of ACEP:

The Joint Commission on Accreditation of Healthcare Organizations warned hospitals to be on the lookout for bogus JCAHO surveyors, following reports earlier this month that individuals posing as surveyors were at three hospitals.

In two instances, one on the East Coast and one on the West Coast, the bogus surveyors arrived around 3 am and asked to survey different areas of the hospitals. In another instance in the Midwest, the phony surveyors arrived around 8 am and claimed they did not need to show JCAHO identification. In all three cases, hospital staff questioned the imposters, who then left.

Hospital staff always should request to see a surveyor?s ID badge and an official letter explaining the visit, according to JCAHO officials.

The organization is urging hospitals that experience a similar situation or have any questions about whether an individual is a surveyor to contact their account representative or JCAHO?s vice president of accreditation field operations, Joe Cappiello, at (630) 792-5757.

JACHO said they were going to start doing “unannounced visits” last year, and this is someones’ attempt to take some unknown advantage (why?). Anyone know why?

EPMonthly Article, featuring Yours Truly!

Well, now. I’ve been made (temporarily) famous. According to a couple of the medical bloggers, I’m on the front page of one of the EM monthly newspapers! I gave an interview, as did symtym, snd now our 15 minute clock is ticking. The article is about EM bloggers, and how we got started, etc.

EmergencyPhysicians Monthly
Click the picture to read the article

After the interview, I’ve had several nice emails with Dr. Mark Plaster, who runs EPMonthly, and with whom I have a lot in common (Texas natives, ER Docs, Navy time). He sees blogs, and the comments, as a great way to find out what’s happening in EM, and as a potential source of news articles for his publication. To that end, they’ve started a blog/bulletin board of their own at EPMonthly. I think this is a pretty neat idea, and wish them the bset of luck. (Contrary to the opening verbiage, I will NOT be moderating their blog, I have plenty to do here.

So, fame at last. As Steve Martin said in the movie, “Things are going to start happening to me now”!

EMS Live

EMSLive emailed me the other day, mostly so I’d know they exist. They have audio interviews about, by and for Paramedics (and I suppose other prehospital healthcare people, but their focus is the Paramedic). They also have a chat function.

EMSLive is the place to start. Now, I’m always reluctant to sit through taped content like this unless I’m already trapped (in my car, for instance). I can visually scan written material and decide if I want to read / get involved in about 5 seconds, which is impossible with audio (IMHO). So, I haven’t tried it yet.

Anyway, if you’re a Paramedic, you should go and give it a try!

Socialized Medicine, Cuban Style

In case you were under the impression that “free” and “quality” are synonyms in medicine, here are some photos from a Cuban hospital.

Match Day was Yesterday

Oops, I missed it. But, it doesn’t affect me like it does Blogborygmi.

The NRMP match algorithm takes, I’m told, about 90 seconds to assign this year’s 16,500 medical students and 10,000 FMGs to one of hundreds of programs in dozens of specialties. On Monday, we were informed whether or not we matched. The program directors learned the neames of their new trainees yesterday. The medical schools got the list of programs this morning.

And, just after noon, as results were posted on the NRMP website, our Dean handed the each applicant an envelope with our match results.

YES.

He’s linked to some other medical students who have matched, which is a great feeling. Bright futures all around.

Comments Take Off

For those who don’t really study the comments counters, this thread has been very busy of late: GruntDoc: Texas MedMal in the News.

A synopsis of comments: me: medmal reform good. Other commenters: medmal reform bad; those who believe it dupes, stooges for insurance companies, or worse.

Oh, and with a Cigna settlement thrown in to muddy the waters. Just some of the fun of blogging!

Symtym linkage

symtym links to two good stories affecting law and medicine. In one of those ‘reasons I like blogs”, his two articles were found by him from two other blogs.

Neat. The article synopses are good, but you have to get the WSJ to read any more of the second. Pity, that’s the one I wanted to read more.

Name the fracture(s)

It’s been awhile, so here goes:
Name the fracture(s). Your prize: the adoration of your fellow commenter. Extra points for the correct eponym of the pediatric fracture type (guess what I’m thinking, sorry).

name the fxname the fx
Click for larger images
And, yes, these are the same wrist on the same patient (sorry, no lateral available).

Update: Answers in the extended entry
[Read more...]

Ground Level Fall and the C2 fracture

At work recently, I got one of those really interesting phone calls:
PMD:”I’ve just sent a patient of mine to your ER. Fell a few days ago, came in today, and I got a CT.”
Me:”OK, what’s the CT show?”
PMD:”Got a C2 fracture with a 1.2cm subluxation.”
Me:”Uhh…call EMS, have patient put in a c-collar, secured to a backboard with head sandbagged, and we’ll be glad to see them.”
PMD:”Oh, they’ve already left, pt’s daughter is driving them over”.
Me:”….okay….”

The patient arrived, completely neurologically intact, thank heavens. A more pleasant patient and family could not be had, and this nice patient had probably had this fracture for several days, from the history!

Film on the left, normal alignment diagram on the right:

And patient's alive, walks and talksnormal alignment
Click for larger images

If you showed me this CT and asked me to guess the patients’ neurologic status, I’d guess high-quad at best, but patient was completely intact! Admitted to neurosurgery. Ground level falls can and do cause c-spine fractures. This is the scariest one I’ve seen with a good outcome.

Women, WBC’s and Heart Disease

Count me a sceptic: Kevin MD is on the same track.

Medblogs Grand Rounds XXV

Respectful Insolence (a.k.a. “Orac Knows”)

As a child of television, I had to wonder what Grand Rounds would look like if it were TV, presented by a TV critic from a magazine known for its somewhat snarky TV reviews. Well, it might look something like this…

And quite the vision it, is! Another highly recommended compilation of the best of medblogs.

Airbus A310 loses rudder in flight

Mail & Guardian Online: What made an Airbus rudder snap in mid-air?

At 35 000 feet above the Caribbean, Air Transat flight 961 was heading home to Quebec with 270 passengers and crew. At 3.45pm last Sunday, the pilot noticed something very unusual. His Airbus A310’s rudder — a structure over 8m high — had fallen off and tumbled into the sea. In the world of aviation, the shock waves have yet to subside.

Mercifully, the crew was able to turn the plane around, and by steering it with their wing and tail flaps managed to land at their point of departure in Varadero, Cuba, without loss of life. But as Canadian investigators try to discover what caused this near catastrophe, the specialist internet bulletin boards used by pilots, accident investigators and engineers are buzzing.

So, should you and I be concerned?

Despite these and earlier assurances, some pilots remain sceptical. The Observer has learnt that after the 587 disaster, more than 20 American Airlines A300 pilots asked to be transferred to Boeings, although this meant months of retraining and loss of earnings. Some of those who contributed to pilots’ bulletin boards last week expressed anger at the European manufacturer in vehement terms. One wrote that having attended an Airbus briefing about 587, he had refused to let any of his family take an A300 or A310 and had paid extra to take a circuitous route on holiday purely to avoid them: “That is how convinced I am that there are significant problems associated with these aircraft.”…

Sounds like it.

Two photos of the tail, minus the rudder, here.

via Instapundit

Pacific Center Sued Over Tsunami Warning

In the “Excesses of Torts” column comes this:

Yahoo! News – Pacific Center Sued Over Tsunami Warning Sat Mar 12,10:49 PM ET

HONOLULU – Tsunami survivors and relatives of victims have sued the federal agency that operates the Pacific Tsunami Warning Center, alleging the center did not do enough to warn people about the disaster.

The lawsuit was filed last week in New York federal court by a plaintiffs group that includes at least 58 European survivors and family members of victims.

The U.S. National Oceanic and Atmospheric Administration’s Pacific Tsunami Warning Center monitors seismic and ocean conditions in the Pacific Basin and issues warnings to member nations. It is based on the Hawaiian island of Oahu.

NOAA officials refused to comment on the complaint but have previously said the center was not set up to warn nations outside the Pacific rim.

A Dec. 26 earthquake caused the massive tsunami that killed at least 166,000 people in 11 countries on the Indian Ocean.

Uuh, does the NOAA have responsibility for the World? What’s the responsibility of the NOAA to non-US citizens in foreign countries?

This is just ‘blame the USA first’ crud. Apparently, nothing in the world can now happen that isn’t the fault of the US.