First, don’t do this:

In what is being billed as “rationalism's Kool-Aid moment”, a mass “overdose” is being planned next week in protest at the marketing of homoeopathic medicines.

More than 300 people who style themselves as “homoeopathy sceptics” will each swallow an entire bottle of homoeopathic pills in protest at the continued marketing of homoeopathic medicines by Boots, the high street chemist chain.

via Homoeopathy sceptics plan mass ‘overdose’ – Health News, Health & Families – The Independent.

Second, I’m with them in spirit!

Kevin, MD continues his takeover of the media, with another very good editorial in USA Today:

Doctors ignore Internet at their own peril

By Kevin Pho

Raise your hand if you've ever left a physician's office without fully understanding what the doctor just told you. According to The New England Journal of Medicine, half of patients admit to not understanding what their doctor told them during an office visit.

As a primary care physician, being unable to clearly communicate with patients is frustrating. The typical, 15-minute office visit often is not sufficient for a thorough discussion. A better way to connect with patients is needed.

Perhaps that is why more patients are turning to the Internet…

via Column: Doctors ignore Internet at their own peril – Opinion – USATODAY.com.

The 2009 Medical Blog Awards

After a careful analysis and consideration by Medgadget editors, we are pleased to present the finalists of the sixth annual Medical Weblog Awards. But first, a few notes.

Voting will begin this coming Wednesday, January 27, 2010 and will close 12 midnight on Sunday, February 14, 2010 (EST). We will have instructions, voting booths, and further details here at Medgadget.com.

via The 2009 Medical Weblog Awards Finalists.

Many worthy blogs in that group.  Go There, vote every day, and may the best Medblog win!

Several good articles in this Months’ Emergency Physicians’ Monthly (sadly, I read the dead-tree version first…it was in my reading room…)

My favorites for now:

Greg Henry on closing the ALS drug box, and Ronald Hellstern on Why Democratic Groups Fail.

Fun reading, well done. 

EPMonthly has really taken off recently.  Enjoyable reading.

Oh, WhiteCoat’s Call Room is not to be missed, either…

Welcome to the LOL edition of Grand Rounds!

via Grand Rounds – the LOL Edition! // Emergiblog.

It’s up!

The eyeballing game.

No, it’s not about creeps.  It tests you ability to ‘see’ distance, angles, etc. on your screen.  Very fun.

I turn out to be very good at bisecting angles and right angles, and to think parallelograms should be outlandishly wrong.

Good for 10 minutes of fun.

HT: Aerospace Genius

Oh, good.  Everything’s under control.  The Scientologists are there.

Amid the mass of aid agencies piling in to help Haiti quake victims is a batch of Church of Scientology “volunteer ministers”, claiming to use the power of touch to reconnect nervous systems….

Some doctors at the hospital are skeptical. One US doctor, who asked not to be named, snorted: “I didn't know touching could heal gangrene.”

When asked what the Scientologists are doing here, another doctor said: “I don't know.”

Do you care? “Not really,” she said, wheeling an unconscious patient out of the operating room to join hundreds of others in the hospital's sunny courtyard.

via Scientologists ‘heal’ Haiti quake victims using touch.

It boggles the mind.  Surreality in the midst of actual disaster.

We left the Mythbuster confronted by the evil Dr. Fish the urologist in the Saint -We Never Change Anything in Years hospital. The Mythbuster doesn't lose a step in dealing with a threatening urologist armed with a 100 french cathether.

“Urologist, Huh? Still think you get anything by hydrating renal colic patients? Well look at the Journal of Endourology 20(10) 713 . Flooding patients does nothing for pain perception or lessening of narcotic needs. Sure if the patient is vomiting or dehydrated, but this practice does nothing for stone passage”

Dr. Fish flinched.

via EM Blog – EM-Blog – Our Mythbuster Confronts Dr. Fish by Joseph Leibman, MD.

Pretty good!

The roads in DFW are apparently deserted. I’ve never seen all green before during the day.

It’s possible the person who updates the map was watching the game…

Hmmmm:

Emergency spine immobilization may do more harm than good, study says
January 11, 2010 | 3:57 pm
When emergency responders reach a gunshot or stabbing victim, they try to immobilize the spine to reduce the danger of paralysis upon movement of the victim. That effort, however, can have a fatal toll.

A study published in the Journal of Trauma has found that, among these types of trauma victims, those whose spines are held still are twice as likely to die as those whose spines aren’t immobilized.

Read the news article, but they’re talking only (apparently, I don’t get this journal) about penetrating trauma. Those discussing the article wonder if the reason for the increased mortality is “Stay and Play” vs “Load and Go”, the two basic precepts of transporting the ill and injured in prehospital medicine.

While I would agree a collar and backboard on a neurologically intact GSW patient is probably overkill, I suspect it’s a surrogate in this study for injury severity.

Anyone read JOT and want to help us out? I wonder if Injury Severity Scores were compared, in addition to transportation times.

And, my unrelated but sort-of related rant: we’re now getting, as policy, patients packaged for transportation like we’re going to sling them from helos and airdrop them into Afghanistan. Straps, zippers, tape, collars, etc. Very often applied to patients who were walking when EMS arrived on the scene. (I have given up asking EMS why, they just rote-repeat “Policy”), and have so far restrained from asking patients ‘why did you let someone strap you down like Hannibal Lecter’?)

Worrisome spinal tenderness, AMS, or an abnormal neuro exam? By all means. But a lot of it seems to be because they have a hammer, so every trauma patient is a nail…

Peel a banana so you have a handle.

Really. That’s it.

How I know the hospital census.

My way to work goes through one of our myriad basement areas, the one where empty beds are stored.  I’ve seen literally none, and a lot.

The other night there were so many I couldn’t believe it:

Our count is down. This, too, shall pass.

Except, of course, that it did…

A patient comes in with the entirely understandable complaint of “I have a fishbone lodged in my throat”. Came straight from dinner to the ED. When I ask a stupid question I’m given a stupid answer: “It feels like…a fishbone…”. Duh on me.

Now, I went to a pretty good EM residency, and while there I learned two things: the books say fishbones don’t show up on x-rays of the neck, and, fishbones sometimes show up on x-rays. I’m about 70% positive in my career…

So, I got an xray. See if you can spot the fishbone (hint: there’s an arrow pointing at it…)

So, it’s there… Now what… There are very few wrong answers. Call ENT, etc. My answer: go get it.

With another doc giving the Propofol (I was going to say Milk of Michael, but the visual on that is just awful), pt asleep and relaxed, I did a direct laryngoscopy and pulled out a nice 2″ fishbone with the magill forceps. I bagged it for the patient, who was glad to have a souvenir (and probably a conversation starter with a restaurant manager). Patient awake and alert 5 minutes later, out before the x-ray reading came back.

“…no foreign body…” on the official x-ray interpretation. Sometimes it’s good not to have the reading immediately. Heh.

Congrats!

FORT WORTH — Some of the most seriously injured and ill patients will no longer have to be flown to Dallas or Lubbock for treatment now that John Peter Smith Hospital has been granted approval to become a Level 1 trauma center, allowing it to provide the highest level of emergency care.

The American College of Surgeons recently granted accreditation for the upgrade to Tarrant County’s taxpayer-supported public hospital from its current status of Level 2. Tarrant County had been the largest urban county in Texas without a Level 1 trauma center.

JPS is out County hospital, and by all accounts their attention to detail / patients has improved dramatically since last years’ multi-story expose in the Star Telegram.  They have to get State approval for something or other (having to do with billing), but that won’t change the way they operate, which is at a high level.

Kudos to them!

…to remind me I have one of the coolest jobs in the world.

I came in to start my shift, and the department was abuzz.  Thoracotomy!  Some kind of trauma, open chest, etc.  Big mess is all I saw, and thought about the low yield and hazards.

That’s what I thought about: big futile mess.

Later, as I was getting coffee (yes, I’m back on the sauce), I asked two EMT trainees, in passing, if they’d seen anything interesting.

Their enthusiasm was palpable, and it was because they’d seen the spectacle.  They were completely energized, exited about Emergency Medicne, and will easily finish their studies solely on adrenaline.

It made me consider my first thoracotomy (fear and perspiration, mostly, with the awesomely frightening yet thrilling ‘am I actually doing ths’ moment).  Something I take for granted (and even dislike a little, as I have yet to have a positive patient outcome), but their viewpoint made me realize I’m jaded, and reminded me I have the coolest job in medicine.