Archives for February 2008

The Navy HPSP Wiki – NavyHPSPWiki

Niels Olson is a medical student at Tulane, and also a Navy Line Officer now going to med school through HPSP.

He’s done prospective students a HUGE service by creating a Navy HPSP Wiki, which he describes as:

The Navy HPSP Wiki – NavyHPSPWiki
This wiki is here to collect and disseminate information about Navy HPSP, whatever you’ve got, we want. Organized. The big ticket on the google group seems to be clerkships, but add what you got, where ever you can.

It’s up and running, and it’s about time something like this was started. Good for Niels, and now I finally have a good resource to refer the emails I get to for more current information.

Grand Rounds 4.22: The Future of Medicine « ScienceRoll

Grand Rounds 4.22: The Future of Medicine « ScienceRoll

It’s a great pleasure for me to host Grand Rounds again after almost a year.

It’s actually 4:23, but who’s counting?  Except me, I mean.

» project N: from little things big things grow. Emergency Department

» project N: from little things big things grow. Emergency Department

And so Project N is born. Payback time.I am asking you to make a small donation to go towards purchasing some supplies of Textbooks. They are looking for Medical-Surgical nursing, Anatomy and Physiology as well as books on evidence based nursing.
Use the ‘gift me’ link over on the right there where you can make your donation via PayPal. All donations made until the end of this project will go to purchasing textbooks.

One of our excellent blogging  ‘down under’ nurses (no, Australia) has a mission, raising money for nursing texts for parts of the world that could put them to really good use.

I’d ask you to consider giving to his project.

Good on ‘ya, Ian.

Twin Brothers Share Identical Injuries In Baseball Game

Twin Brothers Share Identical Injuries In Baseball Game – News Story – KXAS | Dallas

nbc5i.comIdentical twin brothers showed up at a Fort Worth hospital with what doctors said may be a first: twin traumas.The McGraw twins were both injured while playing for the same team in the same baseball game. Right-handed Nathan dislocated his right kneecap in the second inning. Then his left-handed brother, Ryan, dislocate his left kneecap.

High-riding patellas?  Very interesting, anyway.

There’s a video at the link, which I cannot figure out how to embed.

Health Policy & Communications Blog

Health Policy & Communications Blog

Welcome to the Health Policy & Communications Blog. This blog is to foster discussion and analysis about how health policy and communications issues affect clinical and economic outcomes.

Health policy affects everyone who reads this blog (or any other for that matter, perhaps less directly).  A well-written blog, worth reading.

Realist vs. Cynic

I was recently accused at work of being a cynic (who, me?).

This made me wonder what the real difference between realism (from a health-care point of view) is versus cynicism. I’m of the opinion the two terms lie on a continuum, but others I asked disagreed.

I’ve looked up the dictionary definitions of both terms, but wonder if one of you nine can explain whether or not they’re stops on a continuous thought/reaction line, or are separate and distinct states of thought. I can see how someone can be a realist and a cynic, but have trouble with Pollyanna being a cynic; I have no trouble with a realist not being a cynic.

Perhaps they’re intersecting subsets. Perhaps one of you can help me sort this out.

My Brainscanner

MedBlog Addict, Scalpel and Emergency Emily dd it, so it’s officially a fad.

Here’s mine:

Close.  If I’m not at work.

MedBogs Grand Rounds – Vol 4, No. 22 |

Grand Rounds – Vol 4, No. 22 |

I really should write something for Grand Rounds, I haven’t even submitted anything in months.

Things that make me wonder

Take this, as an example:


Every hospital I’ve worked in does the same thing: spend thousands on computers and nothing on installation, or maintenance. Computers are set directly on the floor, not maintained until they fail, etc. This one is apparently being used to clean the air on the desk (and I chuckle when I hear about ‘hospital clean air’ after seeing these).

It makes me wonder if someone has done the math on installing computers off the floor (less ingested dust), vacuuming the things twice a year, and found it’s just not cost effective: the time and labor required don’t add up on the balance sheet? Or, is it just neglect a failure to consider all the possibilities?

This, and a thousand other things a day make me wonder. Welcome to my world.

Texas Party of Medicine Slate

Early voting begins February 19th. Here’s the TEXPAC Party of Medicine endorsements:

Texas Party of Medicine slate (.pdf file) : Updated for better readability

Query about how to rank three EM training programs

From an anonymous emailer:

I’ve got a random question for you that I hope your experience might
help with. I’m a 4th year medical student, matching into EM. …
I’m working on my rank list… Can
you by any chance give me any insight into the residencies at UT-Houston
(Hermann), UTMB, or Shreveport, LA? I’ve got a very strong reason to match
in the area…but I don’t necessarily have a good feel for how well grads
of the programs are trained. If you can help, thanks. If not, thanks for
the great site.

I have no personal knowledge of any of these; any suggestions?

One of Many

There are cases every physician has that are unforgettable. Most are learning experiences, when time stood still due to the situation, and a lesson was imparted, sometimes with a happy ending for all, sometimes not. The patients aren’t the only ones with scars.

Some of the others don’t impart lessons but are recalled for their sheer drama. Not the fake drama that’s more common (and not memorable), but the real drama of life and death; the ones that stay with me are the ones who ‘talk and die’, the ones I take care of who are awake and alert enough to talk to me and are dead very shortly following. I remember the talk-and-dies.

Several years ago, in my first year out of residency we got a very odd EMS report, the gist of which was ‘we’re coming in, be ready’ without any other details. We rolled our eyes and wondered about the panic that would cause such a report. Now I wish it’d been nothing.

Burned patients engender a visceral response in everyone, and medical personnel are no exception. Every one of us stood back from the EMS stretcher and took in the sight and smell while the report started and ended: 17 years old, flash fire in a closed environment that he got out of himself, hoarse voice, no IV because there wasn’t any skin unburned.

It took a determined effort to step forward and grab the EMS stretcher sheet to move my patient to the ER gurney, and that snapped the group to action, though I was only trying to get myself to do something, anything. As has happened every time I’ve been in a room with a critical patient all the hands moved with a speed and skill you couldn’t choreograph with a week of practice, while voices were muted and only what needs to be said is spoken aloud. The conversation among the team with eye contact was also unmistakable; everyone recognized this patient was most likely doomed, but there’s always a chance, and…

Thin, fit, and as burned as I’ve ever seen anyone. Awake and able to speak hoarsely the AMPLE history was negative, and the E part I didn’t have time to worry about. I told him I was going to have to knock him out and put a tube in his throat to keep him breathing because of the burns in his throat: he made eye contact and said “okay”, and I hoped it wouldn’t be his last spoken word.

The nurses and techs had completely disrobed him, and thickened, dusky gray skin went from forehead to feet, with only three areas of exception: a two-inch area at his wrists where his shirt sleeve cuffs had been, a bikini area where there’d been two layers of clothing, and his feet where his leather shoes had been.

Miraculously a nurse had gotten a peripheral IV at the wrist, which allowed us to give the medications to get him intubated, but the circumferential burns on his arm started to choke off the IV almost immediately.

A femoral central line, then an A-line went in quickly, the first for fluids, meds and access, and the A-line because I didn’t want to have a BP cuff constricting his completely burned arm. Analgesia was the order of the day, and I didn’t have to ask for pain meds to be given: knowing how I feel about liberal pain meds and not wanting our patient to feel any pain, the angels of mercy provided just that.

A quick call to the Regional Burn Center, and they agreed to take my patient, knowing as I did I was transferring them an exercise in futility. The flight team guaranteed a safe and pain-free flight, and my patient left. He died that night.

As he left the Fire Marshall had been waiting to ask me how he was going to do, and filled me in on the ‘E’ part: a 15×30 cinder block building with a door on each end and one window had had carpet on the floor. After the carpet was removed there was adhesive residue on the concrete, and someone other than the patient had the bright idea to pour 5 gallons of xylene on the floor and use an electric floor buffer to get it off. The buffer ignited the vapor when it started.

It’s the only time I’ve ever asked for a Critical Incident Stress Debriefing, not just for me but for the whole staff. I don’t know if it helped any of us, but I tried.

I think about this one. One of many.

Nurse Comic « WhiteCoat Rants

Nurse Comic « WhiteCoat Rants

Double Heh.

Discovery Health Channel Wants You

Or, more specifically, your stories.

Quoted with permission:

To you (and your readers) — my name is Jon and I’m a TV Producer for the
Discovery Health Channel. I’m working on the second season of a show named
“Mystery ER”. I’m looking for some true stories involving interesting
cases that have come through the ER.

We’re looking for true stories — of patients that come in with symptoms
that have TRULY baffled the ER doctors.

Immediately we’re hoping to get a story that has a criminal root (not
malpractice per se, but rather — for example — a poisoning).

But we’d be interested in hearing ANY of your tales that involve an
extended mystery in the ER.

I look forward to hearing from you! Please feel free to contact me with any
questions you may have.

Jon Maas
Mystery ER
Discovery Health Channel
Mike Mathis Productions

I cannot think of one, but maybe you can.  Here’s your big chance!

HealthBlawg: Grand Rounds Vol. 4 No. 21: The Valentine’s Day Edition

HealthBlawg: Grand Rounds Vol. 4 No. 21: The Valentine’s Day Edition
Grand Rounds Vol. 4 No. 21: The Valentine’s Day EditionHappy Valentine’s Day (almost), and welcome to Grand Rounds, “the weekly rotating carnival of the best of the medical blogosphere,” hosted improbably this week by — horrors! — a health care lawyer and consultant.