Ramblings of an Emergency Physician in Texas
at doulicia:
This week’s Grand Rounds is meditation on symbiotic relationship between law and medicine. I mean, without medicine, what would lawyers do? And without lawyers? Well, probably some aspect of medicine would be worse off than it is now.
Probably. Let’s find out.
Quick, go get yesterdays’ WSJ and turn to page R5, or if you have online access, here’s the link:
WSJ.com – Net Benefits
Doctors and nurses are joining the blogging revolution, ruminating about medical issues — and providing a rare window into their world.
Those listed: SneezingPo, KevinMD, DB’s MedRants, MedPundit, Dr.Rangel, Shrinkette, Blogborygmi, yrs. trly, Codeblog, Chance to Cut, Bioethics Discussion Blog, Medical Mad House, Cheerful Oncologist.
A couple of notes on the article: SneezingPo is a fine blog, but the article makes it sound like Grand Rounds is there every week, while it’s a rotation thing.
And, for the emailer who took me to task for using a pseudonym while blogging: a) I’m fully identified in the article, and b) 8 of the 13 blogs listed are anonymous. So, I’m in pretty good company.
I’m fooling around with the MT Notifier plugin for MovableType, which should allow you, gentle reader, to be automatically notified of new comments in a post you want to be updated on. That’s a roundabout way of saying you’ll get an email with the comments to that post, instead of having to visit to see what comments were made.
This is new for this blog, and though it’s worked for me, I’m sure there are bugs to be worked out. If you so desire, give it a whirl, and let’s see how it goes.
My flight instructor died a few days ago.
One of the things I found out in reading his obituary (in the extended entry) was that his name wasn’t Hank. That’s what everyone always called him, and it tells much of his personality and temperament that Hank is a name that fit him comfortably.
Hank had existed at the airport my dad worked at (MAF), and indeed he was my dad’s instructor when he finished his private pilot’s license in the late 60′s. Dad had a friend with a Cherokee 6, so on weekends I’d go with him when it needed a tweak, and Hank’s FBO was at the end of the t-hanger row. He had a coke machine, so we went in there now and again. Hank was a Fixture.
Fast forward 30+ years, and I had returned to Midland, and wanted to take up flying. I didn’t even look anywhere else, I called Hank, and we were off into the bright and open skies of West Texas. He taught me through solo, and a few more local hours, then it was time for me to move to Fort Worth. I owe him the gift of flight, and thank him for it.
My logbook, with a pittance of hours in it, will always be cherished by me, because of the interesting doodles Hank would put in the entries:
An aortic valve replacement put a serious crimp in his instructing career, so he was limited to VFR instruction, but took the every six month certifications with good spirit and good humor.
I failed him by not giving him a Polaroid after I’d soloed (he’d forgotten until after I’d moved), and I never sent it. I’ll always regret that.
Rest in Peace, Hank. You were a Fixture, in the best way. You’ll be missed.
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From Waking Up Costs: I Am A Propofologist:
“I’ve decided to change my title from ‘Anesthesiologist’ to the more descriptive ‘Propofologist.’ “
You heard it there, first.
Tonight I experienced a patient who reminded me there are limits to drug seeking behavior in the Emergency Department. Having been on the receiving end of this, I’d like to pass on some words of wisdom.
Basic rules: don’t put
on your triage list.
Advanced rules: don’t
And the most basic rule: and ED nurse can smell BS at 20 paces, and can point out ‘not right’ in about 3 seconds. Never, ever, screw with an ED nurse.
Oh, and ticking off the ED doc isn’t good, either.
Dr. Winters has had a thought:
Taser Defibrillator:Time to defibrillate is key in resuscitating a cardiac arrest.
The shorter the time since onset of ventricular fibrillation…the better people do.Lots of people are buying up personal defibrillators.
Storing them in the trunk of their car or in their closet.
Waiting for that one day when they will shock someone back to life.I think that Taser should consider making a defibrillator gun.
Pretty funny idea, and a great leap forward for staff safety. It’s also good to know Dr. Winters is still alive.
via Fox News, and the on-target Radley Balko:
This fall Mothers Against Drunk Driving marks its 25th anniversary. The organization certainly has much to celebrate: Deaths from drunk driving are down more than 35 percent since the early 1980s. We no longer chuckle at the bumbling drunk who can barely get his key into the ignition — we scorn him. Hopefully, we arrest him, too.
Unfortunately, MADD has come to outlive and outgrow its original mission. By the mid-1990s, deaths from drunk driving began to level off, after 15 years of progress. The sensible conclusion to draw from this was that the occasional drunk driver had all but been eradicated. MADD’s successes had boiled the problem down to a small group of hard-core alcoholics.
It was at about this time that MADD began to move in a different direction, one not so much aimed at reducing drunk driving fatalities but at stripping DWI defendants of basic criminal rights. MADD also seemed to expand its mission to one of discouraging the consumption of alcohol in general — what critics call “neo-prohibition.”
Before you write excoriating emails, I am an Emergency Physician and I see the effects of drunk driving virtually every shift, sometimes several times per shift. I have previously denounced drunk drivers, and truly wish there were more prosecutions of the actually impaired driver. I’m also very aware of research that the drunk drivers I see are less likely to be prosecuted.
And, MADD is off the rails. Their actions toward a new prohibition are both wrong-headed and counterproductive. Their initial goal, a change of laws and attitudes toward drunk drivers, is done. They must stop before they damage their initial cause, and trivialize their initial gains.
In the “He made what?” category is this tale of a man, a neutered dog and a dream: Pooch Neuticles top Ig Nobels
BOSTON, Massachusetts (AP) — Gregg Miller mortgaged his home and maxed out his credit cards to mass produce his invention — prosthetic testicles for neutered dogs.
What started 10 years ago with an experiment on an unwitting Rottweiler named Max has turned into a thriving mail-order business. And on Thursday night Miller’s efforts earned him a dubious yet strangely coveted honor: the Ig Nobel Prize for medicine.
“Considering my parents thought I was an idiot when I was a kid, this is a great honor,” he said. “I wish they were alive to see it.”
The Ig Nobels, given at Harvard University by Annals of Improbable Research magazine, celebrate the humorous, creative and odd side of science.
Miller has sold more than 150,000 of his Neuticles, more than doubling his $500,000 investment. The silicone implants come in different sizes, shapes, weights and degrees of firmness.
So, he’s grossed at least $500K making this product. For a purely cosmetic ‘addition’ to a pet, this takes the cake.
An interesting blog by a reservist who was called up for Katrina relief: Camp Katrina.
Added to the blogroll.
Alerted by Dr. Serani, today is National Depression Screening Day
National Depression Screening Day (NDSD) began fifteen years ago as the first nationwide, community-based mental health screening program. Today it is the largest provider of mental health screening services in the country through its partnership with thousands of community-based, college and primary care screening sites. NDSD has expanded in recent years to offer both in-person and online screening for four of the most common and frequently co-occurring mental disorders: depression, bipolar disorder, generalized anxiety disorder and post-traumatic stress disorder.
If you think you might need a screening, by all means go do it, and don’t wait for this day next year, just go and do it.
via MedScape Daily News: Bush Proposes Using Military in Bird Flu Pandemic
Bush Proposes Using Military in Bird Flu Pandemic
WASHINGTON (Reuters) Oct 04 – President George W. Bush suggested using the military to contain any epidemic of avian influenza on Tuesday, saying Congress needs to consider the possibility.
He said the military, perhaps the National Guard, might be needed to enforce quarantines if the feared H5N1 bird flu virus changes enough to cause widespread human infection.
“If we had an outbreak somewhere in the United States, do we not then quarantine that part of the country? And how do you, then, enforce a quarantine?” Bush asked at a news conference.
“It’s one thing to shut down airplanes. It’s another thing to prevent people from coming in to get exposed to the avian flu. And who best to be able to effect a quarantine?” Bush added.
“One option is the use of a military that’s able to plan and move. So that’s why I put it on the table. I think it’s an important debate for Congress to have.”
Someone please tell me we’ve already thought this one through. The threat of Bioterrorism has been a topic at every professional society meeting I’ve attended in the last decade. Smallpox, Ebola, Typhoid, and Plague are all person to person transmissible, very lethal pathogens. Three years ago the Government was concerned enough about smallpox bioterrorism a round of smallpox revaccinations was started, so there is at least some concern at high levels. I cannot believe that quarantine hasn’t been discussed and thought out, at high levels before.
One thing the President was quoted as saying highlights a big problem / misconception about quarantine, …” It’s another thing to prevent people from coming in to get exposed to the avian flu…”. The problem isn’t in keeping people from coming TO an infected area, it’s keeping people from LEAVING the danger, and by their travel spread the virus elsewhere.
That’s where the problem lies.
JetBlue flight 292 landed on September 22, 2005 with its nosegear turned 90 degrees to the direction of travel, and proceeded to have an entirely safe and spectacularly uneventful landing. Here are some photos from the nosegear after removal from the aircraft:
If you’re looking for other interesting aviation photos, here are some others from this site:
Iraq C-130 Crash Photos
Thunderbirds Accident Report Released: With Photo
Bird Strike
It’s out! at The Haversian Canal: Grand Rounds Vol 2 Issue 2.
Go, enjoy.
PS: the host of this weeks’ Grand Rounds is not only a Navy man, he’s an evacuee from the Tulane School of Medicine, which has (temporarily) resumed at the Baylor College of Medicine in Houston. Kudos to Baylor for taking them in, and best of luck to the Tulane classes of 2006-2009!
