Archives for October 2009

Bumped: Project Valour-IT Today through November 11th

Victory! Team Marine got to the Goal first! (But keep giving…) 11/10/09 @ 1524

Bumped to the top.  Still a good idea.

Give Here.  Pick any team

(but I’m on the Marine team…)

Here’s a worthy project, supporting wounded troops with technology to help their recovery.  Soldiers’ Angels has been running this for at least the past 3 years (and somehow I didn’t participate last year, for which I am duly ashamed).

Please read about what they do, and how you can contribute.

Soldiers'_Angels Project Valour-IT, in memory of SFC William V. Ziegenfuss, helps provide voice-controlled/adaptive laptop computers and other technology to support Soldiers, Sailors, Airmen and Marines recovering from hand wounds and other severe injuries.  Technology supplied includes:

  • Voice-controlled Laptops – Operated by speaking into a microphone or using other adaptive technologies, they allow the wounded to maintain connections with the rest of the world during recovery.
  • Wii Video Game Systems – Whole-body game systems increase motivation and speed recovery when used under the guidance of physical therapists in therapy sessions (donated only to medical facilities).
  • Personal GPS – Handheld GPS devices build self-confidence and independence by compensating for short-term memory loss and organizational challenges related to severe TBI and severe PTSD.

I joined the Marine Team.  Yeah, my Uniform said US Navy, but 4/5 of my AD time was with the grunts, and that’s where my interests lie.

Should you want to participate, there are other services represented, and you can join any team here.

And give to whichever team you wish, jut give.

Tulane surgeon stabbed to death in French Quarter home that was set fire

By Ramon Antonio Vargas, The Times-Picayune

October 31, 2009, 4:50PM

 http://www.nola.comA Tulane University plastic surgeon — known for healing the disfigured limbs and facial features of trauma victims and skin cancer patients with his scalpel — was knifed to death inside of his French Quarter home early Saturday.

      An arsonist then lit his home on fire in an apparent attempt to destroy any clues leading to his killer, according to authorities.

Dr. Ralph Edward Newsome Jr.,  45, died after being stabbed to death multiple times inside his three-story town house in the 900 block of Toulouse Street about 3 a.m. His body had no burns, and he had not inhaled any smoke, meaning someone set fire to the home after he was stabbed, New Orleans coroner’s chief investigator John Gagliano said.

Holy cow.  Condolences to his family.

CNN Political Ticker: Senate confirms Benjamin as surgeon general

CNN Political Ticker: All politics, all the time Blog Archive – Senate confirms Benjamin as surgeon general « – Blogs from
Posted: October 30th, 2009 10:13 AM ET

WASHINGTON (CNN) – The Senate has formally confirmed Dr. Regina Benjamin to be the U.S. surgeon general, making her only the third African American to hold the position as the nation’s top doctor.

Congrats to Dr. Benjamin.  Time to order some uniforms…

Tim Schickedanz Day

It’s October 31st, 2009, and it’s officially Tim Schickedanz Day in Saginaw, TX.  Well deserved, unfortunately it’s Posthumous. Tim S day

I was fortunate enough to know Tim for about eight years, as a nurse in our ED.  Hard working, friendly, funny and competent, we were nearly instant work-friends due to our military backgrounds.

We weren’t really close, and that’s my loss.  A really terrific guy, with a loving wife and four kids.

TimSAgain proving the ED cynicism, such a good person with a job and a loving family and a lot of friends died quickly when he fell ill.  He’s missed, by all of us.

There’s a Facebook page for him (Friends of Tim Schickedanz). 

Terrific people touch our lives daily, and you don’t notice until they’re gone.  I’ll try to do better.

Do not text while driving

Seems very simple: concentrate on what you’re doing, and you lessen (but not eliminate) the risk of car crash.  How much higher is the risk of accidents from texting?  Twenty Three times, that’s how much (VTTI, .pdf).

That’s just not worth the risk.

Unfortunately, apparently it’s hard to resist…


Locked iPhone ICE information: an App to fix

Recently I asked if people were still putting ICE (In Case of Emergency) information in their cellphones.  (The surprising answer was yes, showing that it’s an idea that resonates, at least with my audience).

I lamented that I have that information in my iPhone, but since it’s passcoded no rescuer would be able to access my dutifully entered ICE contact information.  (I then had delusions of retiring on just such an app).

There is a solution.  It’s brilliantly simple, and works. Polka have written an iPhone app called “Close Call” that fits the bill perfectly.  And it’s free!

I made one for this review, using a picture in my camera:


Many thanks to Ramona for finding this!


FTC disclaimer: this was completely voluntary.  I paid for my own free app.

[Read more…]

Reviewing the Great ER Caper: Just to be sure.

Kevin, MD linked to this, and I really must comment.

Here’s the abstract, and I hope you’ll read it all:

200910290120.jpg For years I’ve heard friends describe experiences of being caught in a web of excessive and unnecessary medical testing. Their doctors ordered test Z to investigate a seemingly incidental finding on test Y, which had come about because of a borderline abnormality on test X.

I often wondered why test X was done in the first place. As a primary care physician, I would have treated them for the likely diagnosis and done diagnostic tests — especially a series of diagnostic tests — only if they didn’t respond as expected….

Naturally, I’d express sympathy or outrage, whichever the speaker seemed to expect, but internally I’d pat myself on the back. I felt fortunate that there was absolutely no way I’d ever be stuck in such a scenario. After all, I’m not only an experienced physician but also an advocate — in fact, a teacher — of standard-of-care practice. When I get sick, I told myself, they’ll have to do it by the book.

That was before last Easter.

Short version: Easter Sunday an experienced physician realized he was breaking out with shingles on his face, and decided that instead of bothering his internist with it he’d go to the ED. What he got there was, to put it mildly, terrible. After the obvious diagnosis (which the patient no doubt gave everyone from the triage nurse up, he’s smart and knew the problem):

“Before you go,” my colleague mused, “just for completeness’ sake, maybe we should have an ophthalmologist and a neurologist take a look at you. What about it, just in case?”

“I don’t know . . . I don’t think so . . . well, okay . . . maybe it’s a good idea.”

No, it turned out to be a terrible idea. Acquiescence to this obvious weakness on the part of the EM doc resulted in two senseless consultations (three if you add in the residents’ time) and a pointless MRI, then read as abnormal, though there was no significant abnormality.

Eventually the patient went home with the correct medications, but with a 9,000 dollar bill. Which was, and is, terrifically stupid.

After an EM doc’s period of contemplation, here’s my opinion:

First, if you have a regular doctor, call them (especially of you are a doctor and know what the problem is. Rx called in, see me Monday, problem solved). However, as most people aren’t, and my patients don’t have regular doctors…

Second, I’m at a loss to explain the actions of the EM doc. All the blame lies with them. Yes, I’m taking issue with the EM doc.

I’m of two minds about this weird consultology on the part of the EM doc. Right diagnosis, sounds like a thorough exam, so where’s the problem? Either it’s fear of suits, or it’s a junior EM doc taking care of a Senior doc.

Fear of suits: New York is rated “F” by the ACEP EM Report Card for their medical liability climate. That’s not an excuse, but a reason. I personally am guilty of getting tests for my lawyer (which were also medically indicated). Mea culpa.

The Junior doc taking care of a Senior doc is also at work here, and is magnified at an academic center (where there are always more tongues clucking about the idiotic decisions / misses in the ED). Add in any perception that the ED is a scapegoat, and there’s going to be a tremendous amount of testing on ‘one of their own’ to preclude an awkward and embarrassing Morbidity and Mortality meeting. Trust me, docs will go a long way to stay away from that spotlight.

I have no idea which drove this horrible decision. I hope everyone involved, especially the EM doc, learned a lesson.

By the way: “Just to be sure“. Therein lies half the evils in medicine. Get a test, just to be sure. Get another test, a consult or two, and admission, just to be sure. Look, if you’re unsure, then fine, do what it takes to care for the patient. Just to be sure, though, is the path to ruin for our profession, and our country.

CommShift for Symtym

The and blogs are now closed, their content has been moved and consolidated here— I want to thank you for your attention over the years and apologize for any inconvenience in this move. Previous links are now broken and the feeds have been changed.

Fresno EM Grad, and terrific EM blogger…how could I not announce this?

code blog – tales of a nurse » Blog Archive » Grand Rounds Volume 6, Number 6

code blog – tales of a nurse » Blog Archive » Grand Rounds Volume 6, Number 6
Welcome to Grand Rounds! This is volume 6, number 6…. and the 6th time I am hosting… during the week of Halloween. Does anyone else find that creepy coincidentally satanic fascinating?!

Geena joins me as a 6 time host (and I admit I’ve lost interest in MBGR, more my fault than theirs), and jolly good for her!

Free Zippy!

Zippy the Lobster was here in the Great State of Texas (for a nice trip to the Bahamas), then went to India to see Scanman.

Zippy hasn’t been heard from since March.

I cannot help but wonder if foul play has occurred, or if he/she/it is being held against their will.

Therefore, please help me in the exhortation: Free Zippy!

Zippy Must Be Free.jpeg.jpg

Really. Don’t make us send Hillary.

Update: follow this on twitter: #freezippy

M.D.O.D.: I’ve got it!

M.D.O.D.: I've got it!
Sometimes I amaze myself.

I had an epiphany this morning. Here is my solution to the health care "crisis": whenever doctors refer to anything about health care, include DENTAL CARE as part of the discussion.

While I don’t know about dragging yet another honorable profession underwater in the Service of the State, it seems like goring their ox (or even threatening to) wold get them off the sidelines.

If it doesn’t, well, they haven’t been paying attention.

BlogWorld 09 Thursday lunch

Blogworld 09 Thursday Lunch: good salad, chewy armadillo, terrific dessert.

The sound system was not up to the drill, so I cannot comment on the Keynote address. The 12 who could hear took offense at the 500 who couldn’t, so instead of fixing the audio we were told to sit quietly while Charlie Brown’s teacher and principal had a chat. Then we were asked to leave.

I can take a hint. So I did.

Fortunately the breakout group sound is good. I like my group. BlogWorld!

BlogWorld Medblogger Track

There are several of us twittering the medblogger track now. We’re on Twitter. @gruntdoc @doc_rob @doctorwes most active now.

Ending a shift with a bang. []

EM at its finest:

Ending a shift with a bang. []
I write a nice note trying to capture the essence of what I did and why I did it. Can't write "decided to go big or go home" so I wrap it up in that nice, sterile and intentionally understated medicalese which makes it seem like the decisions were clear cut, and based on solid information, when the truth is that they were largerly judgement calls based upon spotty and/or inaccurate information.

I sign out and then I punch out.

In EM we often don’t get to wait for the test result, or for a period of observation. Curse, and beauty, of the job.

Sudden cardiac death in a teen athlete prevented with AED (and a smart team)

Sudden cardiac death prevented:

Coaches, trainer honored for saving teen | Latest News |
FORT WORTH – A North Texas teen athlete is alive thanks to his coaches and school trainer who brought him back to life by restarting his heart.

Nearly one month after the close call, the teen's lifesavers were honored Tuesday night.

That’s how it’s supposed to work. Kudos.