MONEY Magazine: How to survive the ER

MONEY Magazine: How to survive the ER – Nov. 21, 2005: keeping notes

NEW YORK (MONEY Magazine) – Funny thing about emergencies: you don’t see them coming.

So when my 84-year-old stepfather Jim quietly slumped out of his chair late last year, my mother and I were stunned.

Ten years of helping him manage Parkinson’s disease hadn’t prepared us for this. Barely conscious and unresponsive, Jim needed an emergency room—like, stat. You know the image: overcrowded halls filled with doctors who don’t know you, overwhelmed with people unable to afford care elsewhere.

Panic.

This article has a good list of things to do, before, during and after a trip to the ED.

I have one (really minor) quibble, and then a comment/question. Quibble: the author states the ambulance is compelled to take a patient to the closest facility. This is very EMS system dependent, and probably geographically / legally variable as well. In my fair city, patients meeting trauma criteria bypass nearer hospitals for designated trauma centers. This is protocol driven, and seems to work pretty well. Stroke diversions are coming, though I have some reservations.

My comment/question: Patients, and specifically families who keep written accounts of their interactions in the ED always get my attention (I’m usually concerned they’re angry and are making a list of things to speak to their lawyer about). Now, were I a laymen in that circumstance, I’d keep records like crazy, if only to be able to tell family what happened, so I understand there are a lot of perfectly benign reasons to keep a contemporaneous log of goings-on. But it always raises my Attention-Meter.

Any patients do this, and what’s your reception been like?

I read this link on someone elses’ blog, but I don’t know where. Sorry for not giving you attribution).

Heifer.org

And now, for something completely different.

Waiting for dinner the other night, my wife and I were entertaining each other with items from a local very-small-town paper, but this is the one we talked about a lot:

“Want to give a meaningful gift that won’t be forgotten or stashed away after the holidays?

Heifer International, an organization working to fight hunger worldwide has a solution: livestock.

By donating a sheep, cow or any other farm animal in honor of a loved one through Heifer International, people can help impoverished families get the resources they need to get out of poverty and become self-reliant.

The farm animals provided by Heifer International give families wool, milk, eggs, transportation and other necessities. Families can sell their surplus products and use the money for school supplies, medicine, farming supplies, and housing improvements.

A goat, for example, can supply a family with several quarts of milk each day. Extra milk can be sold by the family or made into cheese, butter or yogurt.

Heifer International also provides Llamas, water buffalos, heifers, chicks, ducks, geese and hives of honeybees – to name a few. For more information, visit www.Heifer.org…”

That’s not something you read every day. I’m not sure about the “…in honor of a loved one..” thing, but suspect it’s a holidays appeal, and it doesn’t detract from the overall effort.

From their website:

Bringing an End to World Hunger Through Unimaginable Blessings

Today, millions of people who were once hungry will be nourished by milk, eggs and fresh vegetables.self-reliance

Families who for generations knew only poverty will be building new homes and starting businesses.

Children who once headed out to the fields to do backbreaking work will be heading into schoolrooms to learn to read.

And people who never thought they’d be in a position to help someone else will be experiencing the joy of charitable giving.

How is this possible?

With Heifer’s proven approach – almost 60 years in the making – to helping people obtain a sustainable source of food and income

In case you’re wondering, a full heifer is $500, but a heifer-share is $50. Water Buffalo are undervalued, at $250 with Llamas going for $150. You get the picture, and here’s the Gift Page.

This is terrific, and if you’re looking for a way to help people in the underdeveloped world, you could do a lot worse.

Tamiflubecue

via DocAroundTheClock:

Tamiflubecue:


From The Onion



If you eat at Kentucky Fried Chicken make sure you protect yourself.

Original art from The Onion, Volume 41 Issue 46 | November 16, 2005 – November 22, 2005

EM News Features Medical Bloggers; Yrs. Trly. Focus of Article

A couple of months ago I gave an interview about medical blogs for one of the monthly Emergency Medicine magazines. It was a nice interview, and I really figured I’d get a couple of quotes in a bigger article about EM and blogs.

I was wrong. Richard Winters (longtime friend) and I split an entire page, complete with mug shots and unfortunately-accurate quotes of the things we actually said. It’s terrific blogs in general, and EM blogs in particular, are getting more exposure, and it’s too bad EMNews doesn’t have an online version. (They do have a website, www.EM-News.com, but it’s last-generation stuff, and no real online content. Pity.)

Other EM blogs mentioned:
Symtym (preceeding Rick and I as Fresno EM grads)
Mr. Hassel’s Long Underpants
The Lingual Nerve (which is really a group blog with several doc types, but was started and is run by a Singaporean EM physician).

So, here’s a .gif of the article, which is reasonably sized and readable.

Vaccines and Legislation

Via CNN: Protection for vaccine makers debated
I think this is completely correct:

Legislation would require proof of willful misconduct
WASHINGTON (AP) — People injured by a vaccine against bird flu or anthrax would have to prove willful misconduct to bring a claim for damages against drug manufacturers or distributors, according to legislation being drafted behind the scenes by Republicans.

A 10-page draft of the legislation obtained by The Associated Press says it would be up to the Health and Human Services secretary to declare that such misconduct occurred. If that declaration is made, the case must be heard in federal court.

The measure, which would be included in a spending bill, would bar any punitive damages and limit awards for physical and emotional pain and suffering and other noneconomic damages to a maximum of $250,000.

The government has done this before, with the Swine Flu scare (which ended pretty badly for all concerned), and the vaccine manufacturers were very happy they had the legal protection they did.

The draft legislation was provided to the AP separately by two parties opposed to its provisions, who did not want to be identified.

The courage of their convictions is remarkable. It must be incredibly frustrating to work in an environment where trust is just a word on your money.

An aide to Sen. Bill Frist, R-Tennessee, confirmed the majority leader was looking to add the liability protections to a spending bill.

Amy Call said the legislation is important because “it would be a pity to appropriate $7.1 billion to purchase vaccines and antivirals but have no capacity to produce them.”

She said Frist is seeking clearly defined standards for an industry that is already heavily regulated.

“We would only provide liability protection in a serious situation and for a set period of time and for a specific purpose,” Call said. “The protection would only go into effect if the secretary makes a declaration that we are grave danger and the public is advised to take the product.”

President Bush’s plan for dealing with a flu pandemic called on Congress to give drug manufacturers sweeping immunity against lawsuits. “In the past three decades, the number of vaccine manufacturers in America has plummeted, as the industry has been flooded with lawsuits,” Bush said last month. “Today, there is only one manufacturer in the United States that can produce influenza vaccine.”

Let’s repeat that: there’s only one influenza vaccine manufacturer in the US. Hug a plaintiff’s lawyer if that makes you feel all warm inside.

Lawmakers from both political parties also have cited a need to grant the industry some protections. However, the protections described in the draft are quite broad, and some say they would make it extremely difficult for those harmed by a medicine to get any financial compensation.

Nice little editorialization thrown in pretending to be news, and who is ‘some’? The same ‘some’ who leaked a draft, ‘some’ already defined by their opposition to this legislation? Or the reporter and the mouse in his pocket?

“The Republican leadership in Congress is trying to do another special favor for the drug companies by slipping a provision into a massive spending bill to absolve the pharmaceutical industry of any responsibility to patients injured by dangerous drugs or vaccines, with no compensation for those who are harmed,” Sen. Edward M. Kennedy, D-Massachusetts, said in a statement.

He called for an open debate on the issue.

Dang Republicans, wanting to “do a special favor for the drug companies” like not see them sued out of existence for making a life-saving vaccine at government request. I am all for an open debate on the subject, and a roll-call vote. In two years if there isn’t vaccine and there is a pandemic, let’s have a full record so the survivors know who was responsible.

And, the vultures are unhappy:

Trial lawyers said they oppose having to prove “willful misconduct” to get financial compensation from an injury.

Yeah, shouldn’t emotion be the determining factor? It doesn’t matter that the vaccine company worked their tails off to produce a vaccine for a deadly disease on a tight deadline, if there is an adverse event, let’s sue!

“Basically, as an average person, I would have to prove some scientist at Merck or some CEO somewhere had made a determination to hurt me,” said Chris Mather, a spokeswoman for the Association of Trial Lawyers for America.

Willful misconduct, according to the draft legislation, would occur if manufacturers or distributors of a particular product knew that it presented “a significant or unreasonable risk to human health” and there was a “conscious failure to act” to avoid that risk.

If the HHS secretary rules against the petition, then those claiming to be harmed could seek judicial review from the U.S. Court of Appeals.

Unless there are legal protections, there won’t be a product to worry about, so all that is moot.

Rep. Dave Weldon, R-Florida, a doctor who said he is involved peripherally in the talks, said he doesn’t want protections so broad that people might be unwilling to take medicine in the event of a flu pandemic.

“The way it’s being discussed is lacking,” Weldon said.

I have to assume the reporter nodded off there, and didn’t write down the rest of Dr. Weldon’s sentence, as what is there doesn’t make much sense.

Unfortunately, this is the wave of the future, getting legislation passed to protect us from the legal wolves who would gladly devour us all.

BBC NEWS | Health | Decaf coffee linked to heart risk

via BBC NEWS | Health:

Drinking decaffeinated coffee could increase the risk of heart disease, a study has suggested.
It could lead to a rise in harmful cholesterol levels, the US National Institutes of Health study found.

Stick to the leaded stuff.

Unless you’re pregnant:

The finding comes as a Danish team reiterated that drinking eight or more cups of coffee a day while pregnant may double the risk of losing the baby.

They advised pregnant women to drink no more than three cups of coffee a day, in line with existing UK advice.

As I’ll never be pregnant, I’ll have another cuppa’.

Madhouse Madman Loves EM, Shows it with Post

Chronicles of a Medical Mad House: Possibly the Most Hysterical Thing I’ve Ever Read In a Medical Journal

As any emergency physician knows, it is normal to ride through the hallways of the hospital doing CPR atop the chest of a dying patient while shouting out orders to nurses at the top of their lungsā€”at least on television. And, while miracles occur in emergency departments (EDs) every day (such as a specialist coming in to see a patient), they are not always sufficiently dramatic for prime time. Like it or not, the American public learns more about emergency medicine from the television than from their personal experiences. ER has just finished 10 seasons; Trauma: Life in the ER has finished 7. Since it’s only a matter of time before these shows fade from the airways, a replacement will soon be necessary. In this era of reality television, something that will grab the public attention and let them feel the true grit of today’s ED is needed.

The following are reality television proposals for the next generation of emergency medicine viewers:

EM is ‘real’ medicine, and this is ‘really’ funny. Go have a read!

shrinkette: Heinous, deplorable, contemptible NYT article

I think Shrinkette is a mite peeved:

shrinkette: Heinous, deplorable, contemptible NYT article:
Strong words from Shrinkette, no? Here…partake of this (go ahead, register). Count the ways in which this article is unambiguously wrong and bad. Not just a little bad…I mean, a breathtaking level of badness. Bad, as in dangerous. “

Goodness. I hope she never gets peeved at me. Oh, and she’s 100% right.

Med Blog Voices: I’ve been listening to Sound Prac…

MedPundit wonders:

I’ve been listening to Sound Practice’s medical blogger interviews this evening while completing my paperwork. It’s nice to have the chance to associate a voice with the bloggers, but why don’t Grunt Doc and RangelMD have Texas accents?

While I cannot speak for Dr. Rangel, I do have quite the West Texas accent, but only bring it out when I’m really tired or under the influence of an adult beverage or two. I’m a real Texan, even if I don’t sound the part.

Point of Law discussion on Med-Mal Health Policy

Condition Critical? is this months’ Featured discussion over at PointofLaw.com.

I just spent about 30 minutes reading, and cannot find any one passage to abstract, it’s that good. It will probably not make either the doctor or atla side completely happy, but it’s a very enlightening discussion.

MedBlogs Grand Rounds 2:8

Mr. Hassle’s Long Underpants

Doc Shazam is honored to host this week’s roundup of the best in medical blogging. I usually don’t read every entry linked in grand rounds, but hosting this week has helped me expand my understanding of what blogging is about. Some of us are politicians, some are patient advocates, some are great storytellers, and others just like to make people laugh. I’ve grouped this week’s entries into a few broad categories, so either read them all, or just straight to your pleasure. Here we go!

There you are!

Concerto of Chaos

Our ED is being remodeled, but the patient volume stays the same. Sometimes it’s, well, hectic.

One of the scribes diagnosed the situation as “A Concerto of Chaos”.

I like that description of an ED very much.

CPR can be taught in 20 minutes

AP Wire | 11/13/2005 | Research shows 20-minute CPR class works (requires annoying but free registration)

Research shows 20-minute CPR class works

DALLAS – Too busy to take a four-hour CPR course? New research shows the lifesaving procedure can be effectively taught in a little more than 20 minutes.

The finding, presented Sunday at an American Heart Association meeting in Dallas, could broadly expand the number of Americans who can perform CPR.

The study, led by Dr. Ahamed Idris, professor of emergency medicine at the University of Texas Southwestern Medical Center in Dallas, found that just five minutes of training on defibrillator use and 20 minutes of instruction in CPR was as effective as the standard four-hour course.

The study used American Airlines employees and compared standard training to a short course taught by DVD. Participants were tested by performing cardiopulmonary resuscitation on a computerized mannequin that took data on chest compression and ventilation. Their performance was also reviewed and graded by instructors.

The 150 people who took the short course did as well or better than the 118 who received standard training. More importantly, retention rates of knowledge remained similar six months later.

This is terrific, and I truly wish CPR were taught in High School health classes for everyone. The vast majority of people don’t need or want a ‘certification’ in CPR, they just want to know how to do it. Not to throw cold water on the hyperbole here, but the training video is 20 minutes long, but it’s left unstated how much time is spent on the mannequin.

I know CPR, but I have to for my profession. It’s occurred to me on more than one occasion that I’m the only one in my house with the knowledge, and with my luck it’ll be me who needs it.

Bring on the 20 minute training video! And make sure you can get it through NetFlix.

West Nile Virus 2005

As predicted, the West Nile virus cases this year were mostly on the West coast:

WNV Nov 8, 2005

That’s what happens as a pandemic like WNV is spread. Make no mistake, it’s here to stay given the number of animal reservoirs for the virus.

CDC West Nile Virus page.

Astonishing USGS West Nile maps.

Medical Licensure and Residency in State

Perusing the latest California Medical Board report (warning:pdf file), I was struck by the number of CA licensed docs who don’t live in the state:

So, 92,852 out of 120,027 CA licensed docs live in the state (77%). I knew I wasn’t the only doc with a license there who lives elsewhere, but had no idea there were twentyseven thousand of us.

To see if this was a CA thing or not, I compared the Texas numbers:

And found that 77% of the docs live in-state. The exact same percentage of licensed docs in the two states actually live in their respective states. That’s really odd.