Dr. Tony has a Bad Night in the ED

Holy cow.  This is the scariest thing I’ve read in an ED.  Dr. Tony is to be commended.

Indy F1 Debacle Hearing Result? Typical F1 Stupidity

Just when you thought they couldn’t look any more incompetent, they do this: The Official Formula 1 Website. (For the background story see this post).

…Following a meeting of the FIA?s World Motor Sport Council attended by the teams in Paris, President Max Mosley revealed that they were deemed guilty of not being in possession of suitable tyres for the event, but with strong mitigating circumstances, and of wrongfully refusing to allow their cars to start the race.

The teams were cleared of three other charges of refusing to race subject to a speed limit, of combining to make a demonstration damaging to the image of the sport by stopping after the parade lap and of not informing the race stewards of their plans to withdraw.

Okay, that’s insulting enough.  If that wasn’t a "demonstration damaging to the sport", what does it take?  The people in the stands booing and giving the thumbs down for the race really appreciated the demonstration.

Then the bizarreness continues, and really gets insulting:

However, the Council decided to delay a decision on what punishment the teams will receive until a further extraordinary meeting on September 14. Before then Mosley said they would be considering the steps taken by Michelin and/or the seven teams to compensate fans who attended the US race and to ensure nothing similar happens again.

Speaking in a press conference following the Council meeting, Mosley hinted that if the situation has been satisfactorily resolved by then, penalties were likely to be financial, rather than extending to points deductions or race bans. He stressed that the FIA?s primary concern was the American fans and the image of Formula One racing in the United States.

What in the world?  If Michelin covers the ticket price for those who attended the race, it’s all OK?  This is some small consolation to those who attended (though I’d hold out for reimbursement of my travel, lodging, etc), and those of you who are fans who watched on TV, well, tough luck.  This isn’t nearly harsh enough, and the delayed nature of the fines is a perfect example of F1 making the future worse (and appearing even more incompetent at best) by trying to avoid the present unpleasantness.

Here’s where this blows up in their faces, and just makes their failure to take their medicine and move on worse: Waiting until September 14 leaves three races left in the season when the hammer falls, and nobody is going to be happy with the result on September 15th.  Why?  If the penalties assessed change the constructor’s or driver’s championship significantly, those teams are going to be howling until the (very near) end of the season; if it’s perceived as not being a significant enough penalty, favoritism will be alleged by the Bridgestone teams (who did bother to race), reviving the well-deserved feckless reputation of F1 leadership.

Either way, this just keeps the issue boiling until the lid comes off September 14.  Mark my words, postponing the punishment is going to poison the entire season, not just the USGP at Indy.

Phishing isn’t just for Grammarians

Wow, who wouldn’t fall for this?

Dear PayPal User ,

After fraud complaints from the PayPal members, the PayPal Inc. had developed a security program against the fraudulend attempts of accounts thefts. For that we have to securise all the members informations by updating and checking the registrated informations. Please go to…

I wonder if ‘fraudulend’ and ‘securise’ are words in some language, not to mention the grammar errors.   At any rate, I suspect this genius doesn’t have English as his first language.

No, we didn’t fill out the form, but did send this one to PayPal, like all the others.

Info on Phishing.  To report PayPal phishing: spoof@paypal.com

Nurses Week Tribute: Grace under fire

Excellent article about Military Nurses in Iraq: NursingCenter.

WE SEND OUR American patients home?sometimes on their feet, sometimes in wheelchairs or on crutches or stretchers. Some of our patients are badly disfigured, and some have horrendous scars that can’t be seen. Others we send home in black body bags, after we lovingly wrap their bodies in woolen Army blankets.  But send them home we do. We’re nurses of the 31st Combat Support Hospital in Baghdad, Iraq, and soldiers pass through our hands by the hundreds.

Besides American soldiers and marines, we care for coalition troops, Iraqi and foreign dignitaries, and ordinary civilians, including children and babies. We also take care of Iraqi soldiers, whether friend or foe. They all need our caring and our compassion, so we push ourselves to do more than we’d ever have thought possible.

Being a caregiver in a combat zone takes a special set of skills, and a lot of compassion.  Thanks to all of you, from me.

Hat tip to reader Janelle for the link.

Socially Awkward Moments

Answering the door holding the beer you’re taking to the fridge, and finding the Methodist Greeting Ladies there.

Google Ads are Sometimes Odd

Well.  As none of these topics have been directly written about on my blog, it’s interesting these particular ads have been selected for this site:

Fvo

Do you think it was the Porsche post?

In the mail

Today I got a copy of Vaccines: Preventing Disease and Protecting Health, published by the Pan American Health Organization, ("Regional Office of the World Health Organization").  For some odd reason I like reading about Public Health, and I have a profound appreciation for vaccinations.

If you want bang-for-buck in medicine, vaccines beat an MRI scanner hands down.  (Yeah, I know they aren’t interchangeable, but I like the contrast).  So, soon another book review!

MedBlogs Grand Rounds XL

It’s up: Health business blog: Grand Rounds XL, or 1:40 for those non-Roman readers.

Welcome to Grand Rounds XL, this week?s best of the medical blogosphere.

Another good collection!

Overlawyered: “Batman Begins”: Bruce Wayne, Defendant

Why Batman would be toast today: Overlawyered: "Batman Begins": Bruce Wayne, Defendant.

Funny, the Chief of Police always seemed glad to see him.  Times have changed.

Alcohol poisoning kills 49 Kenyans; Toxic Alcohols strike again

It’s neither for breakfast or drinking: CNN.com – Alcohol poisoning kills 49 Kenyans.

NAIROBI, Kenya (AP) — An illegal brew laced with industrial alcohol caused the deaths of 49 people in Kenya, medical workers said Sunday, while police continued to search for a woman suspected of distributing the drink to local bars.

More than 174 people were hospitalized Saturday and Sunday, after drinking the homemade brew containing methanol — a toxic wood alcohol added to the concoction to give it more kick.

More poisoned patients were still arriving at Machakos General Hospital, medical superintendent Simon Mueke said by telephone.

"Two people have gone completely blind, and another eight have reduced vision of varying degree," he said.

(emphasis added; and, it doesn’t give ‘more kick’, it’s just a cheap, easy and deadly substitute for ethanol)

Toxic alcohols are one of the toxicology problems Emergency Physicians are taught to think about, and to treat if they are found.  Methanol (windshield washer fluid, among other sources) is the prototypical toxic alcohol, followed by ethylene glycol (antifreeze).  The time-honored treatment?  Ethanol.  That’s right, good old booze, tonsil-wash, stupid-juice, hair-of-the-dog, idiot-oil, hooch.  Why?  Glad you asked.

The problem with methanol metabolism and its toxicity has to do with the enzyme, alcohol dehydrogenase (adh-ase).  Or, rather, the lack of ethanol if methanol is around.  Basically, adh-ase very much prefers to metabolize ethanol, and will essentially ignore methanol if there is any ethanol for it to work on.  Enter the Alcohol Treatment.

So, giving the patient a decent buzz (an ethanol level above 0.1, where 0.8 is the limit to drive legally) is a proven, safe way to limit methanol toxicity while other measures are worked on (dialysis, +- folate, etc).  If the patient is a chronic drinker, the trick is just to keep the patient juiced on oral ethanol.  This is problematic, however, and since the adverse event is blindness and deathm it’s to be avoided.

That’s where either IV ethanol or the latest miracle, Fomepazole, comes in.

[Read more…]

A Porsche gets attention…even if it’s not yours

Two days ago I had a beautiful Porsche Carerra S parked in front of my home.  Alas, it wasn’t mine, nor will it be.  Pity.

No, my dad is acquainted with an Entrepreneur (E).  E has this work of art sports car, and it ran rough, for a few days, then smoothed out.  E asked my dad to bring the wunderkar to the dealer to ask the computer What Was Wrong.  Dad, being the block off which I-am-but-a-chip, said "OK!".  So, I wound up with my parents in the house and a Porsche in the driveway.  (Nothing wrong with the car, BTW).  (Nice to have the parents here, too).

So, this Porsche (which goes like crazy and rides like a go-cart) is in my driveway for about 6 hours when I get an email from a neighbor (who doesn’t have a line of sight to said driveway): "Hey, like your new ride.  The Porsche and BMW clubs are having a combined meet…"  …and I realized I’m in too deep.  Just having the Porsche in the drive has attracted attention.

I had to confess, immediately, to accept brief embarrassment to prevent permanent ostracism.  I replied to the email, the awesome Porsche left (home to E), and my life goes on.  Really.  I don’t miss it or the rock-hard ride.  No, I don’t.  The emailer has yet to let me in on his disappointment, or relief; either way, I’m not in his club.

And, no, I don’t want a 911.  Not this year.  Nope.  Not at all.

Where’s the combo drugs for MRSA?

MRSA is the latest major problem to be dealt with in medicine.  Of the usual bugs that cause cellulitis and abscesses of the skin, this one has been pressured (by docs giving antibiotics) into becoming resistant (Methicillin-resistant Staphylococcus aureus).  Something that was an ICU problem four years ago is now an everyday problem here.

The recommended treatment is now to give two drugs, which (so far) the bacteria cannot deal with effectively.  There are several recommended combinations, and apparently they work well.

So, where are the ‘combo’ antibiotics?  This would seem to be a place where a pill combining the two drugs together in one pill would be more effective (better compliance, etc).  I’m not in the pharmaceutical manufacturing world, and wonder if this would have to basically be a new med and go through every single FDA hurdle, or if it’s a bit simpler than that.

I’ll add some links to the above after my shift.

The Onion 2056

Again, they have out-done themselves: The Onion 2056.

Survival isn’t an accident: it can be taught. Teach your kids this week.

CNN has been covering the story of a young Scout momentarily separated from his Troop, with a rare happy ending four days later.  Relieved parents and relatives all around, and all’s well that ends well.

An explanation for this:  I listened to an excellent medical CME tape about two years ago.  The speaker was a Navy SEAL who taught survival to SEAL candidates.  It was mind-opening.  He opened with the story of going to LA talk to college kids about survival, and starting with the following exercise:

"Get a piece of paper, and draw the outline of your house/apartment.  Now, draw where the gas and electric cutoffs are."  (Blank stares come his way).  "You live in an earthquake zone, you need to know this.  Survival isn’t some way-out concept about rubbing sticks together to make fire, it’s about thinking ahead and anticipating problems".

I paraphrase, and it’s from memory, but that was the gist I took from it.  I think about survival a lot, it’s an occupational hazard.

This is an excellent occasion to have a chat with the kids about survival, the do’s and don’ts, those basic things that make happy endings that don’t get covered on TV, thankfully.  There are web resources, and please use the ones you want, but I like these: Texas Parks and Wildlife and A Kid’s Wilderness Survival Primer .

Tomorrow I’m taking the little ones out back where there’s trees and some space, and we’re going to talk about survival basics.  Do it with/for your kids, even if you don’t intend to go into the wilderness.

Whistles for less than a buck each (don’t leave home without one for everyone).

F1 at Indy Update

Enraged race fans find the Michelin Man

well, leave it to hoosiers to get it right…

By the way, I didn’t invent this, it was forwarded to me in an email.  I’ve asked the mailer for attribution.