A compilation, should you be interested.
Archives for March 2006
Yes, I know I haven’t done anything original here for several days. I have several things circulating in my spleen, but…
I’ve always engaged in a certain amount of self-censorship. I don’t type like I speak, because the sailor-words really don’t belong here. There are lots of interpersonal issues that I let go instead of rant about because, well, they’re just picayune.
Then GeekNurse gets "Management-concern-itis" and goes off the blogs, and all of a sudden my self-censorship level has increased substantially. True, I’m not a direct employee of anyone, and that makes it easier, not harder, to do without my services. I thought GeekNurse did a terrific job of keeping secrets that matter while letting regular people see what a good job his hospital did, and when I apply that same set of standards here I wind up with a similar mindset. That same one that just closed down.
No, I haven’t been talked-to about my blog or its contents, and this is probably paranoia that will pass.
But for now my spleen hurts.
PARIS (Reuters) – The next time a criminal in a getaway car in France looks in the rear window the chances are that the vehicle in pursuit will be a blue French police Subaru.
The Japanese car brand, part of Fuji Heavy Industries, has sped past French rivals to win a key contract for fast intervention cars for the highway police. "We have a contract to supply 63 cars to the Gendarmerie Nationale for patrols on the roads," Subaru spokesman Gilles Varmoux said on Thursday. "There was a tender for four-door, four-wheel drive cars that could go faster than 240 km per hour (149 miles per hour) and had a reasonable price," he added.
The Subaru Impreza WRX cars will replace Peugeot’s 306 S16 and the Renault Megane Coupe. The police forces are among the most faithful clients of the local car makers, but this time the French offerings were just too slow.
Second: This is pretty astounding, that a French Police Force wouldn’t buy French. It’ll be interesting to see if this order sticks.
NHS Blog Doctor: Grand Rounds Vol 2 (27) It’s that time:
Welcome to this week’s Grand Rounds, the weekly fest of the best of medical and medically related blogging from round the world. This week, the theme is cricket, the finest sport in the world. Test match cricket is played over five days. For those unfamiliar with the game, here is a thumbnail sketch.
I don’t know if it’s a British thing, or if it’s a case of crickets, but this is the longest version of Grand Rounds ever. Highly entertaining, though.
GeekNurse, an excellent blog by a NICU nurse in New Zealand, has been closed, and it wasn’t his idea:
Beware those who don’t even try to distance your public persona from your job and blogging.
GeekNurse, you’ll be missed.
Here’s how it’s supposed to work: EMS comes to your house, evaluates your loved one, initiates the appropriate stabilizing treatment, and starts to the Hospital, a brightly lit, spotless facility staffed with knowledgeable and highly-trained professionals awaiting your arrival. On the way they “Call it in”, usually over a radio, so the ED knows what’s coming in. Seasoned veterans can find fault with nearly everything in the above sentences, but stick with me here.
The only part of this I want to talk about right now is the EMS radio call. In theory, this is a terrific link in the chain, one which could make things smoother for all concerned: a general outline of the problem, their acutiy, what’s been done and how that’s working out. Several things could happen, depending on acutiy, resources available, etc. Ideally, the department would be readied for their arrival, a nurse assigned, and a swift and efficient transfer of the patient and information.
Here’s how it actually goes around here: there’s a 30 second to 2 minute long call in (with the mic button held down the entire time, so you can’t break in, ask a question, you get the picture) which is taken by whichever nurse has the time to answer the radio. The gist of the call is relayed to the Charge Nurse (if they didn’t take the call themselves), who adds that tidbit to the 244 already percolating in there. Except for the truly sick or injured who will need to be seen within seconds, no action is taken to prepare for their arrival. Why? Because getting space for the ones who are truly sick is quite an effort, and it always displaces people from a room to the hall, and that’s when there’s a place on the wall in the hall for them.
Back when it was Johnny and Roy making the call-ins, and there weren’t 20 ambulances arriving an hour, the call in made more sense. Now it serves no purpose other than to a) make sure we’re still open to EMS traffic and b) alert us about those few terrifically ill or injured folks; the medical therapies are very protocol driven and direct communication is only needed for protocol deviations (and when things don’t fit the protocol, that happens). All the rest is wasted effort, for EMS an the ED staff.
I think my joint needs to do away with the EMS call-in, or at least only make it when there’s one of those people who are really sick or a question needs to be answered. The rest of the time the EMS dispatcher could call and say “one there in ten minutes with chest pain”, and that’s more efficient for everyone. (That would also allow for the ‘we’re closed’ check).
And, the one-way radio? Relic from way-back. Yes, very very useful in disasters, and pretty reliable here in the flatlands. However, they’re supposed to facilitate communication, and the three minute monologue about grandma’s vomiting, past medical history, breakfast and whatever else is just that, a monologue, which isn’t really communication in any usable medical sense. Brevity is not, apparently, rewarded. Also, there are still people who live to listen to EMS / police radios, and we don’t need to give them entertainment. Just use the cell if you need to call, it’s a 2-way thing, and that’s more useful anyway.
(A Don’t-Write-Letters concession: Your mileage may vary; you may need the EMS call in to martial resources. You might like hearing that one medic who thinks this is a filibuster that cannot be stopped until the patient is in the ED. )
There’s an excellent rant in this Month’s ACEP News (members only section, unfortunately). I’m going to edit it a bit, and I hope you enjoy it as much as I did.
March 2006 By David f. Baehren, MD
….. Whoever thought up the "30-minute guarantee" unknowingly sent what little joy there was in triage to the same black hole that consumes manners, common sense, and lost socks.
Now every nurse manager in the universe is under the gun from the CEO to "do something about waiting times–or else." The "or else" implies either unemployment or the institution of their local version of the 30-minute guarantee. Patients could be guaranteed free movie tickets, free gasoline, or 10% off a colonoscopy if the doctor fails to meet the 30-minute goal
Of course, everyone knows that patients wait because the doctor is not working fast enough. The solution is to give the doctor more patients to see simultaneously. ….
For a thousand years, I will maintain that patients are relatively happy in their blissful ignorance in the lobby. Move them back to the patient care area where they can be ignored in person, and they really start to get annoyed.
Their ringside seat also makes them instant experts on what the nurses and doctors should be doing with their time. Apparently, talking to consultants on the telephone and reviewing a chart while seated are not acceptable activities. God help you if you eat a handful of nuts to prevent starvation while your lunch from 2 days before grows mold in the refrigerator in the break room.
…Any circus juggler will tell you that there are a finite number of balls that can be put in the air simultaneously. Three are easy; things get hairy with more than 10. Problems and mistakes happen when someone tosses in an anvil (patient with acute coronary syndrome and ventricular arrhythmias), and all the other balls drop to the ground. A few roll under the Pyxis.
Everyone has a threshold where productivity falls as the number of active patients goes up. I think mine is 8.6, give or take a tenth. I could make you a graph, but that kind of thing makes my brain hurt (as my third grader likes to say). I’ve tried to communicate this thought. Possibly you could do better.
What sense does it make to pile more nonacute patients into the treatment area when the physician says (in a pleasant and reasoned manner) that it will slow him or her down? Putting these patients there may make the triage nurse feel better, improve the "door-to-doctor" time, and keep the CEO off the nurse manager’s back, but it doesn’t help the patient.
And it doesn’t help the doctor. But this antiquated idea is not often spoken of these days. Emergency patient flow is complicated. Few understand it, and those who don’t will continue to try to "improve" it by driving you to distraction unless there is reasoned discussion with someone who makes a lot more money than the poor triage nurse.
They had a discussion like this about bloodletting once.
Dr. Baehren is the author of "Roads to Hilton Head Island" and practices emergency medicine in Toledo, Ohio.
via Treat Me With Respect, yet another new medical blog:
Bilston illustrates one of the biggest problems in the doctor patient relationship. The same patient who insists that she is a consumer of health care, entitled to all information and to control of medical decisions unconsciously views the doctor patient relationship in parent-child terms and acts accordingly. She’s mad at her doctor as if he were her daddy; he gave her the “wrong” advice and she was forced to follow it. Well, the doctor is not her daddy, and she is not a child…
Seems the NYT article she read pushed a button. Nice rant. Blogrolled.
Dr. Crippen, across the pond, has the full text of a BMA News article about medical bloggers, and medblogging. The Usual Suspects, including yrs. trly. are mentioned.
Echoing Kevin, MD, thanks Dr. Crippen!
Another medical blog I didn’t know existed: Fingers And Tubes In Every Orifice
“Fingers and tubes in every orifice”…It is a tenet of critical care medicine that I learned years ago during my training in Emergency Medicine. It is also a reminder to be tenacious, thorough and leave no stone unturned. You’d be amazed at what can be discovered by a prying finger or an invasive tube.
He looks to be a natural-born ranter, and writer.
FORT WORTH — Kinky Friedman has a perfect explanation for what he calls "Guinness-Gate," and he gave newspaper publishers convened in Fort Worth a scoop.
The grand marshal in Dallas’ St. Patrick’s Day Parade, Friedman was caught on videotape taking a drink of a can of Guinness in the lead car, which was traveling through downtown, Friedman said, at 1 mph. Friedman was not driving, but he was in violation of the state’s open container law.
At Tuesday’s annual meeting of the Texas Daily Newspaper Association, Friedman, who hopes to collect enough signatures to get his name on the ballot as an independent candidate for Texas governor in the November election, did acknowledge he had a beer with him in the car.
"Here’s my explanation," Friedman said. "I was drinking it … but I did not swallow."
I may, just may, have to rethink who to support in the Texas gubernatorial race. He’s funny, he’s a Guinness drinker (but, from a can?), and he has the right attitude about stupid laws.
I blog here at HealthyConcerns from the layperson or patient’s point of view. I tell my stories as a relatively healthy person, and I tell the stories of people I meet…any of whom have a story about health care if only I ask them.
No matter where you go, there you are.
Another home flood, I kid you not.
We’ve gotten a bit over 5 inches of rain the last three days (It’s bright and sunny out now), and that was after a prolonged drought.
The last few years, a gentle spring rain was my cue to clean out the rain gutters, but there were no gentle rains this year. Then came the gully-washer. I heard the gutter overflowing in front of the dining room and resolved to get it cleaned out when the rain stopped.
Day 2 of the Rains: wife comes and says, very calmly, "there’s water in the basement". It took us a while to find the source, trickling down the wall behind the fiberglass shower enclosure. This was coming from the area where the gutter was overflowing upstairs.
And, again, having a wet-vac saves. My wife has some tips for the wet-vac novice:
Tips for using a wet vac
Always empty a wet vac before using. If it happens to have fireplace soot in it, use a large trash bag that you have taken outside first. . Do not upend wet vac into the trash can in garage. (Note to self, take cars to carwash tomorrow).
A wet vac has allot of suction! Possibly enough to pull carpet off a tack strip. Use caution.
Avoid using a wet vac if you can. Ask a child who is no longer afraid of vacuum noise to operate it for you. The threshold age seems to be somewhere over 21, give or take a year or two.
Never ever turn off a wet vac before letting it siphon off the contents in the wand and hose. You will have to re-vacuum an area, if this happens to you.
Using a wet vac on sopping wet carpet can be very tedious. You can not talk on the phone or watch TV, how ever, an adult beverage can be consumed, using care not to spill…or if it spills, you are ready.
The gutters were cleaned during the rain, and latest home flood is under control, and if there’s a silver lining, at least there aren’t any snakes in the house.
The US Navy has had a skirmish with some pirates off the coast of Somalia, and unsurprisingly did well.
But, CNN has this oddness in their article:
Perhaps I’m oversensitive on this issue, but it’s baffling to me that reporters (and editors) are ignorant of even the most basic points of military nomenclature. For instance, the Army has soldiers, and the Navy has Sailors.
Update: They fixed it, to their credit.