An open letter to central line packaging engineers

Dear Sirs,

First, thank you for putting all the tools I need into one sterile package, minimizing the amout of running around finding little pieces to start central lines on my patients. (A central line goes into the central venous circulation, allowing the use of hypertonic medications and monitoring of venous pressures to guide fluid resuscitation).

Now, to my gripe: apparently none of you have thought about the order in which these devices are used when starting a line. Yes, everything has a special place, but it tells me you haven’t thought out the actual use of the kit when I have to dig the Seldinger wire out of the bottom of the kit despite its use being necessary very early in the process, and getting it out dislodges many of the other items from their pockets, then making the whole shebang a mess.

Therefore, I offer my assistance in designing a kit that makes more sense when it’s used.

Respectfully,

GruntDoc

FYI, here’s a nicely done animation of how to place a central line:

I do mine a little differently (direct sonographic guidance usually), but this is good for the gist. (The wire is there, but it’s really hard to see…).


What to Say to a Friend Who’s Ill – WSJ.com

Well done.

‘A closed mouth gathers no feet.” It’s a charming axiom, but silence isn’t always an option when we’re dealing with a friend who’s sick or in despair. The natural human reaction is to feel awkward and upset in the face of illness, but unless we control those feelings and come up with an appropriate response, there’s a good chance that we’ll blurt out some cringe-worthy cliché, craven remark or blunt question that, in retrospect, we’ll regret.
via What to Say to a Friend Who’s Ill – WSJ.com.


Health-Care Costs: A State-by-State Comparison – WSJ.com

Nice graphs of spending by state, then another breakdown of where the money goes per state. Click through and enjoy the graphics.

Health-care spending in the U.S. averaged $6,815 per person in 2009. But that figure varies significantly across the country, for reasons that go beyond the relative healthiness, or unhealthiness, of residents in each state.

via Health-Care Costs: A State-by-State Comparison – WSJ.com.


Physicians: Don’t take UAE jobs

Via @Skepticscalpel on Twitter:

JOHANNESBURG — For Dr. Cyril Karabus, it was a routine job, albeit in an exotic location. For six weeks in 2002, he filled in for another doctor in Abu Dhabi, lured like many other foreign professionals by the big paychecks that doctors, bankers, lawyers and architects can earn in the United Arab Emirates and other Persian Gulf nations.

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A decade later, while Dr. Karabus was passing through Dubai on his way home to South Africa after attending his son’s wedding in Canada, officials abruptly arrested him, calling him a murderer and hauling him away from his stunned wife.

via United Arab Emirates’ Laws Ensnare a Doctor – NYTimes.com.

Just say no. Australia and NZ are supposed to be nice, civilized places to practice.


An open letter to UnitedHealth Group CEO Stephen Hemsley about my family’s canceled COBRA insurance | Mike Holden’s blog

It’s stuff like this that makes even trying to support the idea of private insurance untenable.

Mr. Stephen Hemsley:

I made an honest mistake, wasn’t given a fair opportunity to correct it and now my family’s COBRA coverage has been canceled by your company.

via An open letter to UnitedHealth Group CEO Stephen Hemsley about my family’s canceled COBRA insurance | Mike Holden’s blog.

UnitedHealth, fix this!


Obamacare Incompetence | TIME.com

I link to Ezra Klein approvingly about one a decade, so…

Let me try to understand this: the key incentive for small businesses to support Obamacare was that they would be able to shop for the best deals in health care superstores — called exchanges. The Administration has had three years to set up these exchanges. It has failed to do so.

This is a really bad sign.

via Obamacare Incompetence | TIME.com.


Bubba Watson’s Hovercraft Golf Cart Will Fill You with Intense Jealousy | Bleacher Report

They’ve made a hovercraft golf cart. Very cool.

Bubba Watson, owner of brilliant pink golf clubs and provider of epic shots around trees, has a hovercraft golf cart. Yahoo! Sports spotted this video of Watson hanging out on the course in his very own hovercraft. Apparently, the vehicle is a collaboration between Watson and Oakley in an effort to make something better designed for the intricacies of the golf course.

via Bubba Watson’s Hovercraft Golf Cart Will Fill You with Intense Jealousy | Bleacher Report.

Video at the link.


2013 Top Docs | FWTX.com

Yours Truly shows up on this list, for the first time.

 TopDocTopper

 

Fort Worth, Texas magazine sent more than 4,500 local physicians a survey, asking them to voluntarily rate their peers and name the best doctors in Tarrant County. Medical professionals willing to participate went online to cast their votes.

While Fort Worth, Texas magazine provided the fields of specialty, the physicians identified the professionals they regard as being leaders in those fields.

The final results were submitted to a select panel of physicians for review.

via 2013 Top Docs | FWTX.com.

Things are going to start happening to me now, my name in print!

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3 of these fellow EM practioners I don’t know, and I am glad to count as working colleagues three of the others.

Humbling enough to blog about.


Defense Department says giving Purple Heart to Fort Hood survivors would hurt Hasan trial | Fox News

Appalling decision.

The document (from the DOD) reads in part:

“Passage of this legislation could directly and indirectly influence potential court-martial panel members, witnesses, or the chain of command, all of whom exercise a critical role under the Uniform Code of Military Justice (UCMJ). Defense counsel will argue that Major Hasan cannot receive a fair trial because a branch of government has indirectly declared that Major Hasan is a terrorist — that he is criminally culpable.”

via Defense Department says giving Purple Heart to Fort Hood survivors would hurt Hasan trial | Fox News.

But saying it’s not a terrorist attack doesn’t influence those same people? This is sophomoric at best, but bizarrely this is the Line from DoD officials.

Also, there’s a systematic robbing of the Fort Hood victims of benefits and now military awards, which is unconscionable.

For Shame.


How Doctors Die | The Saturday Evening Post

Well written, and I think correct.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

via How Doctors Die | The Saturday Evening Post.

 


Delusions of Benefit in the International Stroke Trial | Closer to the Truth

More TPa for stroke…

Delusions of Benefit in the International Stroke TrialResults of the largest and arguably most important trial ever of thrombolytics clot-busting drugs for acute stroke were published last week in The Lancet, and the study’s conclusions are breathtaking. Not because of the study results, which are unsurprising, but because the authors’ conclusions suggest that they have gone stark, raving mad.

via Delusions of Benefit in the International Stroke Trial | Closer to the Truth.

Well, that’s not good.


The Favor

As a medical student in the GYN clinic in El Paso, one occasionally needed both language and female standby assistance, at the same time.

Occasionally like 80% of the time*.

I asked one of the clinic technicians to assist me with an exam; after we were done, trying to be med student charming I said “Thank you, senorita!”

She said, laughing, with the clinic staff chuckling at my discomfort, “It’s Senora, it’s only senorita until someone does you The Favor”.

Education takes many forms. Sometimes when you don’t expect it or even want it.

(This is however a family point of amusement, which we sincerely enjoy).

*Medical statistics are made up on the spot: 75% are BS and the other 33% don’t add up.

 


NYC painkiller poster

From NPR:

Doctors who follow the advice will consider alternatives to opioids and prescribe only a few days’ worth of the drugs, if they decide that’s the best course for short-term pain relief. They’ll also avoid starting patients on long-acting opioids, like Oxycontin, and will refrain from replacing lost, or allegedly lost, opioid prescriptions without lots of due diligence first.

painkiller-poster_vert-41d783296ca44c5e35a435dd8c25bf5217907c5e-s3

 

I like it.


networking.answers.com

They found a dead link on the blog, alerted me to it, and asked for a little recognition if I changed it.

http://networking.answers.com/

So, there ya go.


Southwest Airlines mobile design fail

So, I was trying to sign up for the Rapid Rewards for Southwest on my iPhone.

I got nearly to the end before the design fail happened. I wonder what I should answer when I’m not sure of the question.

Heh

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