Archives for February 23, 2007

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: (which isn’t live until the day of Grand Rounds).

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