Archives for February 2012

Happy Traction. »

A way to improve the Visual Analog Scale…

In a innovative project to improve on our management of mild to moderate pain in the emergency department, and to provide alternate therapy modalities (particularly in response to potential analgesic sourcing issues following the recent multi-drug shortages from pharmaceutical companies), we are trialling these new happy traction kits.

via Happy Traction. ».

Texas Pharmacy Database now searchable

Texas docs (and pharmacists, etc…) you can, after a registration, look up an individual and see what prescriptions they’ve had filled.

Texas DPS Prescription Access Texas (PAT):

Here’s your power tip: have your Texas DL in hand, as it’s not just your DL# they want, but that long, goofy number that’s aligned vertically alongside your photo. (Which you’ll need every time you log in).

Yes. Texas has caught up with West Virginia. Come for the info, stay for the snark.

Why did it take me this long

…to add a ‘follow me on Twitter’ button to this site?

I think the answer is either I’m losing it, or I’ve lost it.

Fort Worth Stock Show Midway, a cool video

Via a good local blog Fort Worthology,  a video by Erik Clapp.

Worth watching, very cool. ABout the time I was ready to say, ‘yeah, if I had a slowmo camera I could do that, too, the pictures start to pan. Nice….


Shoot the Lights Out from Erik Clapp on Vimeo.

The music’s not for me, but it’s fun to watch.

Our unrealistic views of death, through a doctor’s eyes – The Washington Post

I know where this phone call is going. I’m on the hospital wards, and a physician in the emergency room downstairs is talking to me about an elderly patient who needs to be admitted to the hospital. The patient is new to me, but the story is familiar:

via Our unrealistic views of death, through a doctor’s eyes – The Washington Post.

Very Well Done. #fb

A Death Knell for Press Ganey? | WhiteCoat’s Call Room

Not only does “satisfaction [have] little or no correlation with Health Plan Employer Data and Information Set quality metrics,” but, according to the results of this study, hospitals that push to have the highest satisfaction scores may be harming or even killing their patients.

via A Death Knell for Press Ganey? | WhiteCoat’s Call Room.

I’m not ever going to get tired of this.

Skeptical Scalpel: Patient satisfaction and reality

You. Don’t. Say.

Christmas came early for us skeptics this year. In a landmark study, certainly one of the most interesting and thought-provoking of the year-to-date, researchers from the University of California-Davis found that the more satisfied patients were with their physicians, the higher their hospital admission rates, prescription costs and total costs were. And patients with the highest level of satisfaction with their doctors had higher mortality rates compared to those patients least satisfied with their doctors.

via Skeptical Scalpel: Patient satisfaction and reality.

Anecdotally, I think that the push for higher patient satisfaction has led directly to underperforming docs doing things they wouldn’t normally do. This isn’t good medicine, it’s playing a very dangerous game.

Grand Rounds: February 14th, 2012–Valentine’s Day version

To those who submitted posts, I say thanks. I appreciate that you did. Medical Grand Rounds keeps going because of you, the medical blogger. Your voice, your impressions, your passions and your human stories make our field such a great canvas.

via Grand Rounds: February 14th, 2012–Valentine’s Day version.

I actually submitted this time around.

Anyone know the ongoing volume/edition number?

CARPE DIEM: Do Medical School Acceptance Rates Reflect Preferences for Preferred Minority Groups?


1. For those students applying to medical school with average GPAs (3.40 to 3.59) and average MCAT scores (27-29), black applicants were almost three times more likely to be admitted than their Asian counterparts (85.9% vs. 30%), and 2.4 times more likely than their white counterparts (85.9% vs. 35.9%). Likewise, Hispanic students…

via CARPE DIEM: Do Medical School Acceptance Rates Reflect Preferences for Preferred Minority Groups?.

Pride is a Fall Risk

Stick with it.

I’m good at intubating (the procedure by which a tube is passed through the vocal cords into the trachea to assist ventilation). I’m not the world’s expert, and I haven’t written a book about it, but I know what I’m about. I was trained by people who knew what they were doing, and I (and my patients) owe them a debt of gratitude. (Lotta I’s there, sorry).

Very occasionally, I get to help out my partners in Emergency Medicine practice when they’re in a bind with this procedure, and I do.  It’s always fun, and a little gratifying, to ‘get the tube’ when a colleague (and their patient) is in trouble.

As Ron White says, “I told you that story so I could tell you this one…”

Pride goeth before the fall.

I have come to learn that one of the worst sins of a physician is Pride. This is strictly different and separable from confidence, in that confidence is a normal and rational belief in ones self and abilities whereas Pride is based in ego, irrespective of confidence. Or logic, for that matter.

The worm turns, and I’m the one who cannot get the tube in the trachea. I’ve preoxygenated, sedated, RSI’d, and taken 3 tries. I’ve changed tubes, blades (the laryngoscope has differently sized and shaped blades), and patient positioning which are among the things that should be adjusted in the event of intubating failure. The good news? This patient can be oxygenated and ventilated easily with the bag valve mask. The bad? I’m now no closer to getting the airway secured with a cuffed tube than I was when I started.

This is where not having Pride came in: I asked for help. The Prideful EM doc (or the one in solo practice, and I respect the heck out of all of you) will keep trying, and will eventually help the patient and assuage their ego (or their situation) by getting The Tube. This can come at a cost to the patient in airway trauma or worse, and it’s desirable to avoid that.

My colleague physician came in, smiled, and helped my patient and me out of a bind. Colleague made it look ridiculously easy, with a first attempt intubation. Just like I’ve done before…

He was amazingly humble, and didn’t rub my nose in my failure to intubate. I truly hope I’ve been as nice to my colleagues in the same situation. Really, he was as nice as a human could have been while pulling chestnuts from a fire. Mine, to wit.

And I surprised myself by asking for help with a procedure I’m normally good at. No Pride, no Ego, just what’s good for the patient. I’m getting this Doc thing.


Last Known WWI Veteran Florence Green Dies at 110 – ABC News

Florence Green never saw the front line. Her war was spent serving food, not dodging bullets.

But Green, who has died at age 110, was the last known surviving veteran of World War I. She was serving with the Women’s Royal Air Force as a waitress at an air base in eastern England when the guns fell silent on Nov. 11, 1918.

via Last Known WWI Veteran Florence Green Dies at 110 – ABC News.

I had no idea there were any WWI vets left.

110 years old. Terrific run.

FBI warns of threat from anti-government extremists | Reuters

A fisking of a grossly awful article.

(Reuters) – Anti-government extremists opposed to taxes and regulations pose a growing threat to local law enforcement officers in the United States, the FBI warned on Monday.

These extremists, sometimes known as “sovereign citizens,” believe they can live outside any type of government authority, FBI agents said at a news conference.

Well, no! Nobody’s above the law (unless they’re elected).

The extremists may refuse to pay taxes, defy government environmental regulations and believe the United States went bankrupt by going off the gold standard.

Wait, defy environmental regs? Like not exactly calculating the amount of fertilizer per hectare to put on their lawn? I can see how that’s an FBI concern.

Routine encounters with police can turn violent “at the drop of a hat,” said Stuart McArthur, deputy assistant director in the FBI’s counterterrorism division.

“We thought it was important to increase the visibility of the threat with state and local law enforcement,” he said.

In May 2010, two West Memphis, Arkansas, police officers were shot and killed in an argument that developed after they pulled over a “sovereign citizen” in traffic.

That’s awful. Dangerous nutjobs are everywhere. Were Police not aware of that already? This needs FBI intervention?

Last year, an extremist in Texas opened fire on a police officer during a traffic stop. The officer was not hit.

An officer shot at but not hit. Terrifically bad for that officer, but this isn’t evidence of a tsunami of lawlessness. It’s one dirtbag who (fortunately) can’t shoot. I hope the Officer ended him (there’s no information in the article about that).

Legal convictions of such extremists, mostly for white-collar crimes such as fraud, have increased from 10 in 2009 to 18 each in 2010 and 2011, FBI agents said.

Wha? These are White Collar goofballs? So these (scarequotes) ‘sovereign citizens’ are lawyers and accountants and doctors and such? That would explain their not being good shots, but none of the rest of the story.

And, an INCREASE from TEN to (hold your breath) EIGHTEEN in twelve months? It’s a tsunami of lawlessness! Now I see why the FBI is in on this.

“We are being inundated right now with requests for training from state and local law enforcement on sovereign-related matters,” said Casey Carty, an FBI supervisory special agent.

FBI agents said they do not have a tally of people who consider themselves “sovereign citizens.”

So far you’ve described two dangerous morons and 28 non dangerous idiots. One killed two cops, and here’s for his dying in prison, dunno about the other ones. So, 30. 30 of these ‘sovereign citizens’ in a citizenry of about 300 Million. It should be easy to make a tally of them. Just sayin’.

J.J. MacNab, a former tax and insurance expert who is an analyst covering the sovereign movement, has estimated that it has about 100,000 members.

Sovereign members often express particular outrage at tax collection, putting Internal Revenue Service employees at risk.

Let’s give then that 30 of 100,000 are bad people. 3/100k= .0003 which means a 0.03% risk from these people.

via FBI warns of threat from anti-government extremists | Reuters.

Okay, I have family in Law Enforcement. I’m not Anti Law.

This doesn’t mean this alleged group (which they cannot even describe in a way to identify anyone in it) is a danger more than the general population.

Reuters fail. Weird there’s time spent putting this out.

Interactive: Who Are the Uninsured in Texas?

Nearly a quarter of the Texas population lacked health insurance in 2010, according to the most recent data released by the American Community Survey, which the U.S. Census Bureau conducted. That’s more than 5.7 million Texans.It’s likely that someone you know — and probably one you wouldn’t have guessed — doesn’t have health insurance. More than half of the uninsured are employed. More than a third have an annual household income above $50,000. And more than 1 million have college experience or post-secondary degrees.

via Interactive: Who Are the Uninsured in Texas?.

Very nicely done.

If I get a lesson from this, it’s “Stay in School. kids!” (If you live that long).

US Army: Brigadier general has died in Afghanistan

Natural causes.

FORT HOOD, Texas (AP) – A 49-year-old brigadier general who died Friday in Afghanistan of apparent natural causes is likely the highest-ranking military officer to die in that conflict, according to military records.

via US Army: Brigadier general has died in Afghanistan.

At 49. Wow.


Condolences to his family.

Worker Trapped Under Boeing 787 Tires

EVERETT, Wash. – Officials say emergency crews have rescued a worker who was temporarily trapped beneath the tires of a Boeing 787 jetliner at an Everett, Wash., airfield.

via Worker Trapped Under Boeing 787 Tires Is Rescued.

Yikes. Best wishes.


via Drudge.