Archives for June 2009

The Michael Jackson autopsy | The Sun |News

Update 6/29/09 @ 12:36  This may all be a hoax.


British Media and News Reporting may actually not be related.

The shock findings of the Michael Jackson autopsy | The Sun |News
8st 1oz, no food just pills in his stomach, bald, bruised, his ribs broken by CPR, 4 needle wounds near his heart…

I don’t know if this is real or not, but it sounds … like I have some questions …(1 stone is 14 pounds)

There’s this:

SUFFERED several broken ribs as frantic rescuers pumped his chest after he collapsed in cardiac arrest.

That’s unfortunately normal.  No problems there.

And the (Emergency Medical) weirdness:

Four injection sites were found above or near to Jacko’s heart.

All appeared to result from attempts to pump adrenaline directly into the organ in a failed bit to restart it.

Three of the injections had penetrated the heart wall — causing damage — but a fourth missed and hit one of the 50-year-old star’s ribs.

What?  Intracardiac injections of epinephrine?  I thought that went out in the very early 80’s.  As for ‘causing damage’, needles do that, but the major problems with intracardiac epi are coronary artery lacerations (bad, but not the end of the earth, as the recipient was dead to start with and getting a return of circulation allows time to fix them) and intracardiac muscle injection, which causes intractable ventricular fibrillation, which is Bad.  Capital B Bad.  Usually Unrecoverable Bad.

Where does one even get epi with and intracardiac needle? I’ve been in the business for a good while and haven’t seen one since Paramedic school (82-83) and was then taught it was out of favor.

Nowadays if you don’t have an IV line during a code (it happens) you can squirt it down the endotracheal tube, or, failing that, an intraosseous IV line (shorter needle, not in the heart, works very well) through which all the resuscitation meds can be given.

Interesting.  Nothing to make of it now, but, who’s a) been watching too many Tarantino movies and b) did this?

(I doubt an emergency pericardiocentesis was the reason for the described wounds, as those if done without sonographic guidance are done from the top of the abdomen up, and with sono guidance would be through the chest wall, but with sono guidance you’d know if they needed it or not, and if there was a big pericardial effusion it’d have been in the report).

Treatment difference between Bird and Swine Flu

Via Dr. Val on Twitter:

RT @Doctor_V RT @bobfinn: CDC’s Cox: “What’s the diff btwn bird & swine flu? 4 bird flu U need tweetment, 4 swineflu U need oinkment.” [Ugh]

Hahaha.  Here’s hoping I can deliver both!

Michael Jackson, King of Pop dies

My first thought: I’m willing to bet drugs (legal, clean, prescribed by a doctor) were involved, and that a review of the records will show some questionable prescribing.  First Do No Harm, unless it’s a celebrity?  Why are docs willing to engage in this kind of horrible, destructive prescribing?  It’s reprehensible.

If it is doc-assisted, please relieve society of this doc’s license.

Anna Nicole Smith, anyone?  Elvis?  A string in between?  This doc-assisted destruction has to stop.

(All of this presumes the most likely, a doc involved; if not, Mea Culpa).  Oh, and Matt wants me to say: no actual individual doc, living or dead, is implied in this post.

Second: somewhere in Beverly Hills there’s a Plastic Surgery group applying for TARP funds.

Better Health » Some of My Best Friends Are Doctors

Better Health » Some of My Best Friends Are Doctors

Dr. Val does a nice Fisk!  Yes, docs make a decently good living.  No, it’s not why the health care system is in trouble.

Dead Blogs, Medical Edition.

Yes, it’s that time.  As a general rule either no posting for 3 months or an intentional abandonment will get you added to the heap of Dead Blogs (right sidebar, near the bottom).

Adventures in Medicine

Blogborygmi (this one hurts, and I suspect he’ll be back soon, but dead is dead) decided he wants to live!

Canadianmedicine, now Canadian Medicine News (a push)


Dr. Wannabe

Fat Doctor (again)

Fingers and Tubes in Every Orifice (again)

Glorfindel of Gondolin

Paging Dr Jess

Physicians, et al.

Pulmonary Roundtable (restarted at Facebook as a group.  Hmm.)

Pure Pedantry

Richard[Winters]MD (again)

Suburban Emergency

symtym (though planned) moved to quanta vie

Tales from the Emergency Room

The Doctor Blogger

The Physician Executive

Travel Nurse Aim

Tundra Medicine Dreams

Wait Time and Delayed Care

Wandering Visitor

What, Me Worry?

24 added to the Dead Blogs.  The circle (well, cliff) of blog-life continues.

If you’d like to be added to the ‘medical’ sidebar overe there, please drop me an email (not a comment here, an email, use the “Contact” page above).

I am sorry for your loss.

A Happy Hospitalist: You Are Living In The Medicare Tomato

A Happy Hospitalist: You Are Living In The Medicare Tomato
You want to know what the process is like for a physician to make a living as a physician.
Look only toward the Medicare Tomato. Imagine for the moment that you have been taken out of reality and into the alternate bizarro world of the Medicare Tomato. In this analogy, the Medicare Tomato represents a day in the life of a practicing physician.

An easy to understand (and mouthwatering) analogy of how we’ve gotten into the Medicare payment morass, and where it’s quite possibly headed.  We’re much nearer then end than the beginning.

Good writing.

Running a hospital: What a public plan is really for

Running a hospital: What a public plan is really for by Paul Levy of BIDMC.

Surprise: it’s not about access for patients.

Where have I heard that before….?

Day by Day: Don’t Mess with Texas

Mr. Muir at Day by Day

Don't Mess with Texas

Don't Mess with Texas

What my end of Hospital Credentialling looks like

Bad news? At least 47 different signatures.

Good news? It arrived mostly prefilled. Over 100 pages.

NYT Opinion: “Doctors’ Pay, a Key to Health Care Reform”

The by-line reads “The Editors” but it’s actually a compilation of Short editorials, two of which are by medical bloggers!  One is the usual suspect, Kevin, MD, and the other is Shadowfax from Movin’ Meat (his real name and a picture with hair is at the NYT).

They’re all good, and all presuppose that the system can be fixed without fundamentally changing the way people (patients) buy their healthcare.

Let patients see the menu, with the prices.  Let hospitals, doctors, and vendors compete, out in the open.  Lift the veil of secrecy about what company x pays vs y, and let’s let the rational consumer decide what they want to spend.  I would trust the wisdom of purchasers over those of government rule-makers every day.

Why does Apple suck at this so badly?

Today was the much anticipated roll-out of the new iPhone, and the newest OS for the iPhones (3.0).

It was entirely foreseeable there would be enormous demand for both.  Again, they’re unprepared.  (This was after enough tries I realized it wasn’t going to work today).

iphone_nonactivate Makes me wonder at their strategy.

Update: worked perfectly today (one day after the above).  Cannot tell a huge improvement, except the landscape mail view is more than welcome.

Dr. Wes: An Open Letter To Patients Regarding Health Reform

Dr. Wes: An Open Letter To Patients Regarding Health Reform
Dear Mr. and Ms. Patient,

It has come to my attention that in order for your to enjoy success as patients in the new era of health care reform, you must start working now to prevent illnesses that might befall you. Do not, under any circumstances, eat or drink too much.


Our EMR is very dedicated

Even when it crashes:

CannotQuit (it says “Cannot Quit”).

Wha? Was there just a breeze in Hell?

From the “I’ll believe it when I see it, but I’d like to see it” files, via Overlawyered:

Confirming earlier reports: “In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.


I’m not going to hold my breath, but…

A really excellent drug name

It’s a brand new drug formulation (injectable ibuprofen (motrin)) but check out the approved trade name:

FDA Approves Injectable Form of Ibuprofen

The U.S. Food and Drug Administration today approved Caldolor, the first injectable dosage form of the common pain medication ibuprofen, to treat pain and fever.

I’m no Latin scholar, but I do know that Calor = fever, and Dolor = pain.  Put them together in the name for a drug that is made to treat those?  Pretty cool!

And no, I won’t be using it for a long time, if ever (old medical dictum: don’t be the first, don’t be the last).


hat tip: Luis