Emergency Landing Saves Stroke Patient

Lucky outcomes all around:

CLEVELAND — Surviving a stroke is no easy task, and timing is crucial: A stroke victim must get the right medicine right away.

So, imagine how serious it would be to have a stroke on an airplane, in the middle of a cross-country flight.

NewsChannel5’s Alicia Booth reported on one local woman who experienced this ordeal and how she is recovering from it.

As a highly successful 40-year-old attorney and mother of two, Jean Robertson didn’t have time to be sick — she had a plane to catch.

“I started to feel a headache come on but I suffer from migraine headaches, so I immediately rationalized it as a migraine,” Robertson said.

Robertson said she chatted for quite a while with the businessman next to her.

“He kind of looked at me and said, ‘Excuse me?’ And apparently at some point in our conversation I stopped making sense,” she said. “I go like this to touch my face intuitively and I realize my entire head is numb.”

Fortunately, there was a doctor on the plane who helped convince the pilot and the airline that an emergency landing was necessary to save Robertson’s life.

I’m supposing this patient got TPA for her stroke from the way the article is worded, but I’m having trouble with the timeline if that’s the case.  In any event, good for everyone involved!

Bird Flu Vaccine #1: 45% effective

Advisers urge OK of bird flu vaccine

Federal health advisers recommended Tuesday that the government approve the first bird flu vaccine as a stopgap measure, despite evidence it wouldn’t protect most people.

In separate votes, the outside panel said the vaccine was both safe and effective. A vaccine must meet both standards to win FDA approval. The votes came after Food and Drug Administration officials said the Sanofi Aventis SA vaccine still could play an important role in protecting against the increased likelihood of a pandemic, despite its limited effectiveness.

“I am of the view that anything is better than nothing,” said panel member Dr. Robert Couch, of Baylor College of Medicine in Houston, prior to the vote.

In a clinical trial, the two-shot series appears to provide protection to just 45 percent of adults who received the highest dose. An earlier, interim analysis of the same study had suggested it prompted a protective immune response in 54 percent of patients, when measured 28 days after getting the second of two shots. The FDA said it would like to see a response in at least 70 percent of those vaccinated against bird flu.

“The more antibodies, the better. But even at lower levels, there is a possibility of protection,” Goodman told reporters on the sidelines of the meeting..

Well, I’d take a 45% shot at a response over zero. For now.

MedBlogs Grand Rounds 3:23

Musings of a Dinosaur: Grand Rounds 3.23

In the beginning, there was the Big Bang; followed in short order by the dinosaurs, polyester, HMOs and the internet. Although the crowning achievement of creation — Grand Rounds — has already been accomplished, the only thing we can be certain about is that things change. The more they change the more they may stay the same, but they still change. So welcome to Grand Rounds, the weekly round-up of the best of the medical blogosphere, where we’ll expore what’s old, what’s new, what’s changed, what hasn’t, and whatever else happens to strike our fancy.

And nicely done, it is.

Grand Rounds are here next week. No theme. Bring (well, send) your A-game.

Blog Owners not responsible for comments of others

via Slashdot:

ACSBlog: The Blog of the American Constitution Society: Federal Court Reaffirms Immunity of Bloggers from Suits Brought Against Commenters

In Universal Communication Systems v. Lycos, a company who had allegedly been victimized by defamatory statements on a message board regarding the value of its stock sued Lycos, which operated the board. The message board allowed users to post comments with minimal moderation, and no one from Lycos was responsible for the allegedly defamatory statements.

Examining the impact of Sec. 230 on this case, the court noted that “Congress intended that, within broad limits, message board operators would not be held responsible for the postings made by others on that board,” adding that allowing bloggers and message board operators to be sued for the statements of commenters on their sites would have an “obvious chilling effect” on speech. Accordingly, the court dismissed the complaint against Lycos.

That’s good news! Here’s the original decision (.pdf) format.

Medical Bad Pun

One of the nurses let fly an entirely unintentional pun the other day.

A patient with a lower GI bleed (blood loss into the colon basically) didn’t look good; quite pale, in fact.  Quoth the nurse: “His hemoglobin’s in the toilet.”

Upon realizing the funny, we laughed, then groaned.

ER Docs will give you their opinions

…occasionally even if you don’t want them.

We recently beta-tested some new phones for the ED (and again they didn’t work out as promised).  We tested two different models, and one was clearly better than the other.  How much better?


And there it sat, in the Doc’s room, for the rest of the trial.  (We all agreed with the assessment).


Does anyone have an actual workable, reliable in-ED communication system?  We’ve tried Nextel: their radio feature is okay, but we/they cannot get the phones to work indoors (despite miles of wire, specialized antennas, and every level of tech help they were able to offer).  We looked at Vocera, but were scared off by a) concerns about background noise interfering with their function and b) their reported initial price quote. 

Our ED seems to be a comm black hole.

BritMeds 2007 (8)

NHS Blog Doctor: The BritMeds 2007 (8)

Up, now.

There’s Gold in them there bronchi…

Pulmonary Roundtable: Digging for gold

NASA has a plan for everything

at least in space.  Including a psychotic event by a astronaut in orbit:

Science and Space NewsCAPE CANAVERAL, Florida (AP) — What would happen if an astronaut became mentally unstable in space and, say, destroyed the ship’s oxygen system or tried to open the hatch and kill everyone aboard?

That was the question after the apparent breakdown of Lisa Nowak, arrested this month on charges she tried to kidnap and kill a woman she regarded as her rival for another astronaut’s affections.

It turns out NASA has detailed, written procedures for dealing with a suicidal or psychotic astronaut in space. The documents, obtained this week by The Associated Press, say the astronaut’s crewmates should bind his wrists and ankles with duct tape, tie him down with a bungee cord and inject him with tranquilizers if necessary.

Interesting.  I can’t imagine what a chore wrestling with another in zero-g would be.  I’m guessing a choke-hold would be the only real option, but again, that’s just a guess.

And, who knew they take Haldol into space?

Social Engineering in the ED?

I’ve been having the same interaction in the ED, day in and night out, since I began:


me: Hello, I’m GruntDoc, what is the problem today?

patient: umm….


I feel bad.

me: okay, what does that mean to you?  Do you have pain?

pt: uh, well, I uh, it started a while ago, and now it’s not better…

What follows is usually a long question and answer session to clarify the problems, timing, etc.  (I keep reading that if we just let patients talk they’ll tell us what’s wrong with them.  I tried that one day, I really did, and I either got very long, strange silences or a literally 5 minute long monologue that went nowhere.  Maybe that works in office-based practice, but it doesn’t often work in the ED).


Please understand I’m not making fun of patients, what I’m trying to point out is that patients present without actually thinking about how to describe their problem(s).  (There’s the exception, and they’re rare, and usually complicated).  So, I wonder if a little social engineering might be in order (and that may be the wrong term).

What I’d like to try (has it been tried?) is putting up a sign that says ‘you may be asked the following questions’ in each room, the waiting room, etc.  In that way the patient could be assembling their thoughts into a more usable and understandable fashion.  This would have (I hope) the following happy outcomes:

  • a quicker, more usable history
  • more inclusion of patient history, pertient facts
  • not missing important history because they didn’t remember for 2 hours, etc.

I think having better histories would do more for patient safety than all the medication reconciliation forms in the world.  Has this been tried?  I think it’d work, but maybe I’m kidding myself. 

MedBlogs Grand Rounds 3:24 here in two weeks

…will be held here in two weeks, March 06, 2007.

There will be no required theme
. This is different from my applying a post-hoc theme to tie the submissions together, should I have the time and talent to do so.

The best “x” number of articles will be featured, subject to adulation, and the authors will be suitably proud yet humble.

Those not judged ‘the best’ will still be included, in whatever manner I see fit. So, this isn’t going to be an exclusionary Grand Rounds.

This post is a warning order; the actual will appear here: http://www.gruntdoc.com/2007/03/medblogs_grand_70.html (which isn’t live until the day of Grand Rounds).

Don’t forget, Grand Rounds next week is at Musings of a Dinosaur.

Change of Shift 1:18

PROTECT the AIRWAY ? Blog Archive ? CHANGE OF SHIFT, Vol. 1, No. 18

CHANGE OF SHIFT, Vol. 1, No. 18

Well, I’ve been luck enough to reprise my first time hosting Change of Shift on December 14, 2006, and though there were slightly fewer submissions this time around, the writing does Change of Shift justice and is testament to the amazing people out there working long shifts and then coming home only to do more work by blogging about their experiences.

An aside: sites like this make me glad I have a java color-killer (makes black text on a white background), the second down on this page.

Loss, or Master of Domain?



Ask the Doc! on the latest AHA heart recommendations for women


February is Heart Health Month in the US. This week, the American Heart Association
released new rules to help women prevent heart disease such as heart attacks and
strokes. The information to follow is sourced from The Johns Hopkins University Gazette,
WEBMD, The American Heart Association, The CDC.

Be sure and read the comments at the end.

MedBlogs Grand Rounds 3:22

Is up, here:

Pure Pedantry : Grand Rounds, vol. 3 no. 22

Posts for this edition have been grouped according to movie themes. The images are from those films nominated for Best Picture (click on them for information).

For my money, if you’re going to do a ‘theme’, this is the way to go. Get the posts and make up your own theme to highlight the submissions. A very nice presentation.

(I’m hosting in two weeks).