MedBlogs Grand Rounds: 1:38

It’s up: Red State Moron: Grand Rounds: Volume 1; Number 38.

Welcome to Grand Rounds: Volume 1, Number 38 (XXXVIII), June 14, 2005, an exploration into the deeper recesses of that evolving organism known as the medical blogosphere.  And given that recess was always my favorite time…

Note the nice new naming nomenclature.  I agree with BardParker that the Roman numerals, though classic, were getting cumbersome.

Medpundit: How Rabies was Beaten

I was wondering exactly what they did to get the first completely unimmunized survivor of rabies: Medpundit.


The strategy consisted of a multi-drug cocktail. Ketamine and amantadine, members of one class of drug that protects brains against damage, with additional specific activity against rabies in animal models, were used. A second class of brain protectors, benzodiazepines with supplemental barbiturates, were also used at levels that suppress brain activity and metabolism and induce a coma-like sedation. Her brain activity was monitored with the help of an electroencephalogram or EEG.

MedPundit has the details, but the good news is that this young woman was as good as dead, and they pulled off a medical miracle.  Good for them, and good for their patient, who has recovered but still has some deficits.  Read the post for the details.

The 10 Commandments of Medication Usage

He took a long time off, but it was worth the wait: RangelMD.com.

The 10 Commandments of medication usage

This should be engraved and put in every patient room.

About.com names MedBlogs ‘Weblogs of the week’

About.com Weblogs of the Week name five medical weblogs of the week: Medical Web Logs – WOW #5.

I’ve been down with the flu the past few days. In fact, I’m not in tip top shape just yet. So, I guess it’s inevitable that this week’s featured blogs on Web Logs of the Week (WOW) are all about medical/health science. And, they are as follows: Family Medicine Notes, Genetics and Public Health Blog, Grunt Doc, In The Pipeline, MedGadget, and MedPundit. Anyway, whether you’re sick like me or not, you might be interested to get to know these Medical Blogs.

Your truly is named, along with Family Medicine Notes, Genetics and Public Health Blog (new to me), In the Pipeline and MedGadget.

‘Meth Mouth’ – New York Times

Link: Grisly Effect of One Drug: ‘Meth Mouth’ – New York Times.

From the moment on Thursday when the young man sat down in Dr. Richard Stein’s dental chair in southwestern Kansas and opened his mouth, Dr. Stein was certain he recognized the enemy. This had to be the work, he concluded, of methamphetamine, a drug that is leaving its mark, especially in the rural regions of the Midwest and the South, on families, crime rates, economies, legislatures – and teeth.

Every EM doc in the US knows this, by sight (it’s a ‘doorway diagnosis’).

I wrote before about Mothers Against Methamphetamine, and it’s a good site with a good cause.  Unfortunately, it’s probably not visited by that many unaffected folks, but is more likely a resource once the drug has damaged someone in the family.

via FFM, who reminds me of the meth triad: tiny tits, tattoos, and terrible teeth.

Trauma 11, ED 9

Today, teams representing the Trauma service and the ED squared off for a coed game of softball.  Fun was had by all.  Here’s some photos of the event:

Edteamphoto
Good looking team!  Definitely Best Dressed.

Dugout
Plenty of teammates, and food.

Crowd
Pretty well attended!

I think this’ll be an annual event.

Mary (spankysplace.blog-city.com)

Azygous on the untimely passing of a friend: Mary (spankysplace.blog-city.com).

It took me the better part of the week to write about this.

I was stopped in the hall and asked if I knew?

Knew ?what? I asked?

Oh, Mary was found dead in her home last night.

You mean Mary the hospice nurse?

Ya, that Mary.

It’s a touching remembrance.

Welcome Home Mercy!

CNN.com – Hospital ship back from tsunami region – Jun 9, 2005.

SAN DIEGO, California (AP) — The hospital ship USNS Mercy returned home from Indonesia after treating thousands who survived the tsunami in December and thousands more who survived an earthquake in March.

The floating medical center and 270 crew members docked Wednesday at Naval Station San Diego to the cheers of families waving signs and balloons. The ship left port on Jan. 5.

"If you haven’t cried on this mission, you haven’t been on this mission," said Capt. Mark Llewellyn, repeating what he told his staff several times during the mission.

Arriving in Banda Aceh, Indonesia, in February, the Mercy’s advanced treatment facilities filled a desperate need. The tsunami, caused by a December 26 earthquake, killed more than 176,000 people in 11 countries and left about 50,000 missing and hundreds of thousands homeless.

The first 10 days of the mission, the Mercy’s first deployment since the Persian Gulf War more than a decade ago, saw nonstop orthopedic surgeries on injuries that had gone untreated for 11/2 months. By March, the military and civilian medical staff had treated 9,500 survivors.

"We saw a resiliency in those people that was hard to imagine," said Llewellyn, who ran the ship’s 1,000-bed hospital.


Bravo Zulu
to the USNS Mercy!

A Day When I Love my Job

Every once in a while I have one of those rejuvenating, terrific shifts that makes me glad I’m an Emergency Physician.  Tonight was one of those, and I needed it.

My very first patient, who I saw before I even got my shoe covers on, was a massively injured man involved in an MVA.  Open leg fracture, tubed on the scene, helo crew report no BP but a pulse of about 130 until they landed.

In the ED, no pulse upon arrival, so CPR started and blood squished in as fast as the Level 1 would squeeze.   CXR was normal, leg splinted, and a pulse returned, pretty much simultaneously.  Patient emergently to OR for laparotomy.  More later.

Literally my second patient was a (very) senior who had yet another of his syncopal episodes, which resulted in a face plant.  Unfortunately, it also came with the inability to move his arms (but not his legs) per the sending hospital (the patient was a transfer).  By the time he got to me (not on a SoluMedrol drip) his movement and sensation were back to normal.  However, we’ve had odder transfers, so a repeat CT was ordered to confirm whether a fracture exists (arrived with paper printouts of his CT’s), and an MRI to look at the spinal cord of the neck to look for damage there.  Oh, and this poor fellow with recurrent syncope has an artificial heart valve, so his INR is >4.  Goody.  More to follow.

My third very sick patient was in an MVA, and the helo crew said ‘we don’t know driver or passenger, we don’t know ejected or not; intubated on scene, no drugs, but ‘Tachy‘; has a BP on arrival.  Obvious limb fracture.  Fluids given, initial CXR shows all but the third rib broken on one side, bilateral scapular fractures, C2/3/4 fracture, astonishing pelvic fracture with bladder injury due to the markedly displaced acetabular fracture.  Bilateral chest tubes, fluids, and off to the scanner.

The next patient to come in was cared for by a colleague, and also had a c-spine fracture.  So, at one time there were three patients in our ED with c-spine fractures.  The neurosurgeon was busy, to say the least.

Patient One had an emergency laparotomy, which was grossly negative per the surgeon.  Apparently lost his blood volume through the leg fracture.

Patient Two had fractures of C6 on the CT, and the MRI shows no cord injury, but does show both the anterior and posterior longitudinal ligaments are ruptured.  (Those provide the stability of the spine on motion; when torn, the inherent stability of the spine is gone).  Off to the neuro ICU.

Patient three has a huge liver fracture in addition to the other injuries, and is off to the trauma ICU.

In the first two hours of my shift I’ve done more acute-care medicine than in a literal month of shifts, and it feels good.  Occasionally I wonder about my career path, and today is one of the days I’m glad I’m an Emergency Physician.

Overlawyered: Every law-blog post an advertisement?

Seems blogs have yet to be fully defined: Overlawyered: Every law-blog post an advertisement?.

The Kentucky Bar is advancing the unreasonable position that when a lawyer operates a weblog, every post he or she puts up counts as an advertisement for legal services. Ben Cowgill is at the center of the controversy, and on the case are David Giacalone, Eugene Volokh, Larry Ribstein, Evan Schaeffer and John Steele, among others.

For the record, this blog is not an advertisement for my Emergency Medical services.

Fascinating look inside UK and US Hospitals

by the husband of a patient who needed medical help: OpinionJournal – Extra.

There’s No Place Like Home
What I learned from my wife’s month in the British medical system.

BY DAVID ASMAN

"Mr. Asman, could you come down to the gym? Your wife appears to be having a small problem." In typical British understatement, this was the first word I received of my wife’s stroke.

Very interesting account of the similarities and differences in the systems.  Oh, and his wife seems to be doing well.

Qatar Requires EM training

You’ll be glad to know on your travels: The Peninsula On-line: Qatar’s leading English Daily.

Training in emergency medicine made compulsory for private sector physicians

Doha: Physicians having their own practice or those employed by private clinics will now have to compulsorily undergo one of the six emergency medicine courses, the Ministry of Public Health has stipulated in a recent circular.

The completion of such a course is mandatory for such physicians to renew their practicing licenses, the Al Sharq daily, reported.

According to the report, the courses are: Cardiac and respiratory resuscitation, accidents and emergency first aid, instant resuscitation, treating emergency child birth cases, resuscitation of neonates and paediatric emergencies.

Such courses were made compulsory for private medical practitioners following a case where a child lost his life since the physician was not aware of the proper treatment in an emergency, the report adds.

The MPH had since cancelled the physician’s practising licence, it added.

There, that’s reassuring.  It’s at least better than ‘multi-culti awareness’.    Travel away!

MedBlogs Grand Rounds XXXVII

MedGadget.com — Internet Journal of Emerging Medical Technologies.

Ladies and Gentlemen, distinguished guests, family, and friends: the faculty of Medgadget is pleased to welcome you to Grand Rounds XXXVII.

It’s a special time of year, when we celebrate Commencement — and send a new crop of doctors, nurses, researchers, and health policy wonks from the comforting confines of academia, and force them to finally start contributing to society.

On this happy occasion, we’ve lined up a diverse group of speakers to share their wisdom with the Class of 2005.

The doctor is logged in

Tomorrow’s news, today: The doctor is logged in.

June 6, 2005 latimes.com : Health

The doctor is logged in

What do physicians really think? A new wave of blogs gives the rest of us a glimpse into their world.

Nice article featuring medbloggers.

Nursing Moments II

code blog: tales of a nurse: Nursing Moments II.

Welcome to Nursing Moments II, the 2nd installment of the Carnival of Nursing! These posts are written mostly by nurses, or by others about nurses or nursing. Because codeblog focuses mainly on personal experiences in the healthcare world, most of these posts follow in that vein. (Ha ha! Get it? Vein!!) Anyway, we have a great array of posts for you to read. Enjoy!