Archives for December 2010

Darvocet is banned, Primatene mist still available

FDA is therefore illogical. At best.

Tats and lacs

I like lacs (lacerations).  It’s bread and butter in EM, and it’s a way to demonstrably help a patient immediately and visibly.

Visibly is where the tattoos come in. While I don’t have any skin art, many of my patients do. It’s interesting how many lacerations go through my patients’ tats.

While with the USMC in Okinawa, a patient went through a window. Whether he jumped or was pushed was a point of contention, but that mattered not to me. What did matter was the roughly 2 foot long, razor-straight laceration of an upper-through-to-lower arm, going through an ornate tattoo.

Due to the natural stretch of skin (Langhers’ lines) when skin is cut it doesn’t fall one side to another like a steak, but will ‘spring’ into different directions…. which makes deciding what to tie to what a little complicated.

Unless there’s a picture embedded into the skin. Then, it’s a relatively easy ‘connect the dots’, putting the picture back together.

I spent the better part of a couple of hours doing my best, and in the end even the patient was happy with the result. He did say that he’d get it touched up after it healed… (Someone educate me here, how do scars take tattoo dye)?

Yes, lacs happen, and we try to make the resulting closure first functional and then as cosmetic as we can. The tats make it a lot more interesting.

Dr. Arafiles arrested – Winkler County

Jailed and bailed as the person who sent he the link says…

KERMIT The ongoing saga of the whistle-blowing Winkler County nurses took a turn for the karmic Tuesday with the arrest of Dr. Rolando G. Arafiles on charges of retaliation and misuse of official information. Both are third-degree felonies.

Arafiles left the Winkler County Jail on a personal recognizance bond and had his passport revoked, CBS 7 reported. (Arafiles is a native of the Philippines).

Arafiles arrest results from the criminal investigation of nurses Anne Mitchell and Vicki Galle.

They were fired from Winkler County Memorial Hospital and were indicted and arrested by local authorities in 2009 in connection with misuse of official information after they sent an anonymous letter to the Texas Medical Board with examples of 10 patients they believed Arafiles had not properly treated.

Arafiles’ criminal charges come from the Texas Attorney General’s Office. In the arrest warrant affidavit, Arafiles is accused of giving patient information to Winkler County Sheriff Robert Roberts, Arafiles’ friend and also a patient, so that Roberts could investigate the source of the anonymous accusations against him. After determining the patients themselves hadn’t made the complaints, Roberts identified Galle and Mitchell as the whistleblowers, setting into motion all future events that brought national attention to the small community.

via Winkler doctor arrested | arafiles, winkler, county – Local News – Odessa American Online.

I had hoped this wasn’t over.

Solstice eclipse family fun

Our family is odd.  Avert your eyes if the idea of a family joke is too harsh for your gentle retinas.

So, tonight came not only the Winter Solstice but additionally a lunar eclipse.  Astronomic fun.  Not enough fun for the family.

The responsible party will rename anonymous, but it was decided: Darling Daughter (DD) will be brought to believe the following:

  • the solstice and eclipse are tonight (true)
  • the eclipse is visible with the naked eye (true)
  • doing so is dangerous due to the excess of UV rays bouncing off the moon during the eclipse (false)
  • viewing the eclipse is made safer for the eyes by wearing sunglasses (false but funny).

A comically large cardboard box with a pinhole in it (to be worn on the head) was initially thought to to be the tease, but was eventually discarded for the more practicable sunglasses.

DD was initially very hesitant to believe, but the other four of us, wearing our sunglasses, proved too much even for her highly developed skepticism.  So, she happily donned her shades, and we all watched the lunar eclipse together.

At some point, a photograph was in order (we were in on it, that’s why we’re shadeless):

Live long, and prosper.

About 5 minutes after this we let her off the hook, but not before the pic.

Showing good sport, DD insisted I blog this as “It’s really funny.  Mean, but funny”.

Nobody loves you more, sweetie.  Thanks for playing along with us. – Will Tuesday Be the Darkest Day in 456 Years?

Break out the flashlights. When a full lunar eclipse takes place on the shortest day of the year, the planet may just get awfully dark.

The upcoming Dec. 21 full moon — besides distinguishing itself from the others in 2010 by undergoing a total eclipse — will also take place on the same date as the solstice (the winter solstice if you live north of the equator, and the summer solstice if you live to the south).

via – Will Tuesday Be the Darkest Day in 456 Years?.

Flashlights, indeed.

Update: Oh, and I missed this pet peeve of mine in the first sentence.  It’s not the shortest day of the year.  It’s the day with the least amount of sun, it’s still a 24 hour day.  It’s understood, I think, but seems kind of sloppy.

Captain Atopic : Degranulated: Full Time.

Sunday, December 19, 2010 by Captain Atopic

So this is it; During the course of this wee blog, I had several ideas about how to wrap it up- the range from just disappearing to a protracted series of farewell posts.

Like a long list of medstudent bloggers, I’m pulling the pin now that I’m finished. My aim with Degranulated was to blog weekly until graduation, and, well, that’s where I am.

via Captain Atopic : Degranulated: Full Time..

It was a good ride.  I predict Captain Atopic will return, though in the Residency form.  And if not, we still got the free entertainment.

Thanks, Captain Atopic!

I was born at night, but not last night

Recently, saw a patient I’d seen the day before in the ED.  Chief complaint: lost their prescription.

Me: what happened?

Pt: I lost my prescription for the pain medication.  I think it was called hydrocodone.

Me: I see you have two medications in their bottles there.  Those are the antibiotics I prescribed you yesterday?

Pt: Yes.

Me: You realize all three of those prescriptions were printed out on the same piece of paper, right?

Pt: …

Me: Enjoy your tylenol.

I mean, really.

12 STI’s of Christmas, 2010

My yearly Christmas favorite, reposted:

Courtesy of the British National Health Service:


NSFW. Funny, but Unsafe for work, unless your work involves STD’s in which case it’s required.

It’s my seasonal favorite post, and I hope it’s one of yours.

Not the STD’s, the funny song with equally amusing illustrations. The backstory, from a previous blog post:

I have seen several searches of this blog for the British National Health Services’ “12 STI’s of Christmas“, and wondered why. The answer: the NHS site no longer carries the wonderful show, for reasons unknown to me. As for the searches, I guess the Christmas season has people thinking about sexually transmitted infections (diseases on this side of the Pond) set to Christmas tunes.

Merry Christmas!

Want To Avoid Unnecessary Tests? Stick To One ER, Researchers Say – Kaiser Health News

On a recent Friday night at the Boston Children’s Hospital ER, Dr. Fabienne Bourgeois was having difficulty treating a 17-year-old boy with a heart problem. The teen had transferred in  from another hospital, where he had already had an initial work-up – including a chest X-ray and an EKG to check the heart’s electrical activity. But by the time he reached pediatrician Bourgeois, she had no access to those records so she gave him another EKG and chest X-ray. He was on multiple medications, and gave her a list of them. But his list differed from the one his mother gave doctors, neither of which matched the list his previous hospital had sent along.

via Want To Avoid Unnecessary Tests? Stick To One ER, Researchers Say – Kaiser Health News.

This is excellent advice.

Every ED has seen a patient, probably today, with “they saw me at the ER across town, but they didn’t do anything and I’m still sick”.  While it makes some sense not to return to a restaurant that gave you a meal that wasn’t to your tastes, medicine is quite different.

If a patient gives me this history, I now have a blank slate, and need to essentially start at zero with them.  So, I will do the correct workup to exclude the life threats based on the history and physical exam, which may be exactly the tests they had yesterday.  I’m not going to assume they did the same tests, or that they were normal.  It’s the standard of care at this time, and I have very very few alternatives.

Let’s flip this around: it’s a patient we saw a day or three ago who comes back to us and says “I’m not better”, that’s so much better for the patient, and us!  We have immediate access to their records and tests, and will not have to repeat studies we already know the result of.  Therefore, the patient avoids unnecessary testing, and gets better care.

Yes, you say, you could get the records from the other hospital, and the answer is, maybe, someday, better during M-F business hours (when hospitals are set up to work, still), less on Sunday AM on a 4 day weekend.  Someday EMR’s will be inter-operational, but frankly that’s going to require legislation as hospital systems want to own ‘covered lives’ and they see contro of medical records as proprietary information as theirs and theirs alone.  (Also, who’s going to spend money to give away their information)?

So, stick to one ED.  Yeah, sometimes you have to go back a couple of times.  That’s okay.  It’s the right thing for you.

The Milwaukee Rabies Protocol

In case you wondered what was required to diagnose, and how to treat potentially successfully, rabies.  This is from the place that had a neurologically intact survivor (some damage but functional, which beats the norm).

The Milwaukee Rabies Protocol (.pdf)

via Notes from Dr. RW

The Nativity, in modern times…

Awseomely done.

Thanks to @doc_rob Business News : One in two emergency care doctors will suffer a burnout during their career

One in two emergency care doctors will suffer a burnout during their career, according to a survey of French physicians, published online in Emergency Medicine Journal. The research was funded in part by the NEXT NURSES’ EXIT STUDY (‘Sustaining working ability in the nursing profession – investigation of premature departure from work’) project, which received more than EUR 2 million under the ‘Quality of life and management of living resources’ Programme of the EU’s Fifth Framework Programme (FP5).

The responses showed that the prevalence of burnout was high, with 1 in 2 emergency care doctors identified as suffering from it, compared with more than 4 out of 10 of the representative sample. Physicians had the highest burnout rate in the two age groups, between 35 and 44 and between 45 and 54.

via Business News : One in two emergency care doctors will suffer a burnout during their career.

Expectedly, it’s International…

» Features » Jessie the chopper dog.

Following recent heavy flooding to some areas around our hospital,  a husband and wife presented for assessment after they had been winched from the roof of their house by chopper.

They were accompanied by their dog Jessie who was rescued with them (after she alerted the sleeping couple to the rising water level).

via » Features » Jessie the chopper dog..

Very Neat.

Wife of slain doctor pleads not guilty –

A woman suspected of stabbing her husband, a respected Navy surgeon, to death before stabbing herself several times at their North Park home pleaded not guilty to murder Wednesday in an arraignment at her Scripps Mercy Hospital bed. She was then ordered held on $2 million bail.

Jennifer Trayers, 42, a bank employee, is accused of killing Lt. Cmdr. Frederick John Trayers III, 41. San Diego police homicide Lt. Kevin Rooney would not say when the attack likely occurred, but he said neighbors did not report hearing any disturbances at the couple’s home.

via Wife of slain doctor pleads not guilty –

LCDR Trayers was reportedly the Chief Resident in Emergency Medicine at Naval Medical Center San Diego.


Mom | The Blog That Ate Manhattan

We tried, Mom. We tried so hard.

via Mom | The Blog That Ate Manhattan.

A Beautiful, Loving Tribute.  I mourn your loss.