Medical

Is farting in the OR transmitting germs?

May 8, 2013 by GruntDoc 1 Comment

From the BMJ:

“It all started with an enquiry from a nurse,” Dr Karl Kruszelnicki told listeners to his science phone-in show on the Triple J radio station in Brisbane. “She wanted to know whether she was contaminating the operating theatre she worked in by quietly farting in the sterile environment during operations, and I realised that I didn’t know. But I was determined to find out.”

via Hot air?.

Yes, it’s a 2001 article, but I wasn’t blogging then, so missed it.

Brought to my attention by Glen in West Texas, thanks Glen!

Filed Under: Amusements, Medical

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

April 14, 2013 by GruntDoc Leave a Comment

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.

Filed Under: Medical

Physicians: Don’t take UAE jobs

April 12, 2013 by GruntDoc 1 Comment

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.

Filed Under: Medical

How Doctors Die | The Saturday Evening Post

March 29, 2013 by GruntDoc 2 Comments

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.

Filed Under: Medical

Some studies that I like to quote

March 12, 2013 by GruntDoc

Wow! Very nice.

Filed Under: Amusements, Humorous, Medical, Medicine

BS Study*: Doctors Feel Patients’ Pain | Empathy | LiveScience

January 29, 2013 by GruntDoc

Been a while since I pulled out the BS flag, and this seems entirely appropriate:

Good doctors really do feel their patients’ pain.

Hmm. ‘Good’ doctors?

A study, published today (Jan. 29) in the journal Molecular Psychiatry, shows that when doctors see their patients experiencing pain, the pain centers in the physicians’ own brains light up. And when the doctors give treatment to relieve pain, it activates the physicians’ reward centers.

The doctors were then instructed either to use an electronic device that they believed would relieve the patients’ pain, or to withhold the pain relief. In response, the patient-actors either grimaced in pain or maintained a neutral expression to suggest their pain had subsided.

via Doctors Feel Patients’ Pain | Empathy | LiveScience.

Umm, what? These ‘good’ doctors were told that an electronic device would either relieve or not relieve pain, and then they reacted to their patients’ acting with activity in their own pain or reward centers by fMRI.

My first question: did these docs really buy into this magical electronic pain-relieving device, and if so, why? I have to wonder if it was their amusement areas lighting up and not their pleasure centers…

Second, at no time is ‘good’ established in this article. Were there a subset of docs whose fMRI’s didn’t change, and thus they’re ‘bad’?

Not buying it (would buy one of those magical electronic pain relievers, though).

*I say this is a BS study based on this writeup. If it’s something else entirely, okay, but this is just awful.

Filed Under: Amusements, Medical, Rants

CDC – Seasonal Influenza (Flu) – Situation Update: Summary of Weekly FluView

December 3, 2012 by GruntDoc

Go get your flu shot, it looks like they hit it on the head (which is remarkable, at least to me). Picking the right antigens is always tricky.

From the CDC:

Since October 1, 2012, CDC has antigenically characterized 140 influenza viruses, including two 2009 influenza A (H1N1) viruses, 90 influenza A (H3N2) viruses and 48 influenza B viruses.

The 2009 influenza A (H1N1) viruses were characterized as A/California/7/2009-like. This is the influenza A (H1N1) component of the Northern Hemisphere vaccine for the 2012-2013 season.

All 90 of the influenza A (H3N2) viruses were characterized as A/Victoria/361/2011-like. This is the influenza A (H3N2) component of the Northern Hemisphere influenza vaccine for the 2012-2013 season.

Approximately 71% of the 48 influenza B viruses belonged to the B/Yamagata lineage of viruses, and were characterized as B/Wisconsin/1/2010-like, the influenza B component for the 2012-2013 Northern Hemisphere influenza vaccine.

The remaining 29% of the tested influenza B viruses belonged to the B/Victoria lineage of viruses.

Since October 1, 2012, CDC has tested two 2009 influenza A (H1N1), 122 influenza A (H3N2), and 81 influenza B virus isolates for resistance to neuraminidase inhibitors this season. Each of the viruses showed susceptibility to the antiviral drugs oseltamivir and zanamivir. High levels of resistance to the adamantanes (amantadine and rimantadine) persist among 2009 influenza A (H1N1) and A (H3N2) viruses. (Adamantanes are not effective against influenza B viruses.)

So, Tamiflu should help (some).

Filed Under: Medical

Dr Seuss Does Malaria « Contagions

November 24, 2012 by GruntDoc

Terrific!

This Malaria map was illustrated by Theodor Seuss Geisel, better known as Dr. Seuss, during World War II to educate young GIs. According to the Naval Department Library, this map was printed on the back of a Newsmap (two sided poster) that showed the five war fronts in 1943: Russia, Italy, “air offensive”, southwest Pacific and Burma.

via Dr Seuss Does Malaria « Contagions.

Excellent primer on Malaria (and Ann!).

via ~~@doctorgrumpy~~ @docgrumpy on Twitter

Filed Under: Amusements, Humorous, Medical

ACEP 12 tweeting: Bukata and Hoffman

October 13, 2012 by GruntDoc

Those who don’t follow me on Twitter probably have calm, productive lives. Those who do wonder why I twitter at all. Because it keeps me busy and engaged, that’s why.

Here’s an edited compilation of two of the American College of Emergency Physicians Scientific Assembly 2012 lectures in tweets by me from Denver. These encompass about 3.5 hours of lecture by the same two legends, Jerry Hoffman and Rick Bukata reviewing the medical literature as it applies to EM.

I used Storify to put these together (it couldn’t have been easier). I left out a lot of comments from others, not as they weren’t interesting but as I’m trying to tell the story of this lecture.

At the end there’re some pictures of the Twitterers and Bloggers who get together after ACEP. Nice how we’re birds of a feather. For a bonus, at the end are Joe Lex’s 4 Rules of Emergency Medicine, which deserves its own compilation.

View the story "ACEP 2012 Tweets by me: Hoffman & Bukata" on StorifyACEP 2012 Tweets by me: Hoffman & BukataI went to the American College of Emergency Physicians Scientific Assembly held in Denver in October, 2012. I live tweeted some of the lectures I attended. Here they are.First, I’m going to combine the tweets from Hoffman and Bukata’s 2 lectures, as they’ll make more sense that way. Then pictures!Storified by GruntDoc · Sat, Oct 13 2012 12:55:37I’m going to start with my general Twitter disclaimer. I mean it. Disclaimer: my tweets from #ACEP12 were paraphrasing, errors mine, don’t change practice based on reading tweets, do your homework.GruntDocAnd, off to the lectures: HofKata: Trauma surgery is dooming their specialty going to the ER over and over for nothing surgical for them. #ACEP12GruntDocReferencing a European paper citing very very few went to the OR emergently from the ER to the OR, recommended calling TSS when the ER doc needs them, not a routine event.
(Will not catch on for a long time, Trauma needs their Activation Fee). This following one had to do with ?whatever to do with those very tiny occult pneumothoraces we’re finding on trauma CT’s of the chest. Long, meandering discussion; sizes of the PTX weren’t defined, no criteria for getting a thoracostomy tube were made, just ‘did they get a chest tube or not’. HofKata: discussion muddied as there is not a clear definition for want made the doc put in the tube to start with. #ACEP12GruntDocNot much was gotten from that article. Perhaps I missed the point. HofKata: docs caught between doing what’s right for pt and right for doc; for doc getting test is right answer, not always for pt. #ACEP12GruntDocThis next one tried to determine, in a ‘pan-scan’ for trauma ED, if there were some agreement on what trauma scans the ED attending and the Trauma Surgery attending could prospectively agree they didn’t need.

All the scans trauma wanted were gotten with a prospective form filled out by both about which scans they didn’t want. In the end the ED…

HofKata: wanted 30% fewer, and the TSS and EM in the end couldn’t decide about the value of the discovered incidentalomas. #ACEP12GruntDocThey found a bunch of incidental things, and in the end couldn’t reconcile whether finding completely incidental things that didn’t affect management was worth the CT. HofKata: factor VIIa is 10k for a 70kg pt in trauma and it didn’t help ( the non hemophiliac). Stop it. 97% uf use was off label. #ACEP12GruntDocHofKata: if you have 1 CT the likelihood is that you’ll have 5 in the next 5 years. Found a pt w 57 CTs. Wow. #ACEP12GruntDocThe first CT is a gateway study to more, apparently. HofKata: but when docs look at the same problem for themselves they typically choose less awful treatment, even if means pal care#ACEP12GruntDocDoctors will err on the side of survival in recommendations to patients, when they themselves often look at the data and decide they’d rather forgo some or all treatments and skip the unpleasant effects. Interesting. HofKata: DC instructions. Pts have to understand, and they have to know when to come back. Ethical prob sending self limited prob #ACEP12GruntDocHofKata: to a referral, when its more cost for no benefit. #ACEP12GruntDocBukata felt sending things like ankle sprains to PCP’s as a routine thing was ethically bad, as ‘it’s self limiting’ and costs the pt more for no benefit.
I disagree, many needs some Physical Therapy to have a more stable ankle that doesn’t recurrently sprain.

Also not a fan of these 9 page DC instructions we’re printing out.

HofKata: IO lines are great, and stop doing central lines because you can’t find a vein, use CL if need to measure things #ACEP12GruntDocHofKata: no need to give hydrocortisone if you use etomidate for induction. (Silly study). #ACEP12GruntDocHofKata: Tylenol w Motrin, and either alone. Point of treating fever comfort, not medical. No support to use both at the same time #ACEP12GruntDocHofKata: AAP specifically advises against using Tylenol then Motrin and alternating, confusing. Also, tells mom it’s a big deal. #ACEP12GruntDoctreating pedi fever is about patient comfort, not treating disease. making a big deal out of fever treatment tells mom it’s very important, when it’s for comfort only. HofKata: UTIs in small kids: can have asymptotic bacteruria and have a viral illnesses w fever and get dxd w uti. Cults have false+ #ACEP12GruntDocHofKata: 2-5% of kids have UTIs before puberty. Not happy about treating a ton. #ACEP12GruntDocMany of which were incidental findings, and the treatments can cause their own problems. HofKata: study of 1,228 acute scrotii showed +creamasteric reflex w dxd torsion! 7% had NL or increased flow on US!? #ACEP12GruntDocSeveral people disliked my plural of scrotums being scrotii. I believe scrotae is the correct plural. HofKata: test torsion, cont: advocates getting a iron consult for those w real sx’s and a negative w/u. Then cites anecdote. #ACEP12GruntDocuro(logy) got autocorrected here to iron, No idea why. HofKata: study of Canadian hosp quick response teams. No difference. Things that seem reasonable often don’t work. #ACEP12GruntDocHofKata: several papers, PCR tests didn’t change abx rxing, CRP in URI resulted in 6 hour ED stays and no change in abx Rx, etc #ACEP12GruntDocThings being tried to tailor or eliminate antibiotic prescribing don’t. At least not in these studies. HofKata: docs are reluctant to abandon disproven practices "ESP when lucrative". Most standards of care have never been studied. #ACEP12GruntDocHofKata: BNP for dyspnea in the ED. "Routine testing is of no benefit". Targeted okay. #ACEP12GruntDocHofKata: high sens Troponins: markedly higher positives, but 90% were causes other than AMI. (I don’t know want this). #ACEP12GruntDocJoe Lex ( @JoeLex5 ) commented on this later, ‘you mean low specificity troponins?”, rather than the as-spun high sensitivity. He’s right. Touché, I’ll remember that. “@JoeLex5: @gruntdoc You mean "low specificity troponins," of course.” #ACEP12GruntDocHofKata: stable angina, med mgmt vs stenting: medical therapy on top for everything x persistent pain. #aGruntDocHofKata: the US spends 150mil A DAY on angiosperm and stents, most never had a trial of med therapy. #ACEP12GruntDocOkay. for some reason the iPad autocorrect thought Angio meant angiosperm, which is weird. I don’t type well, things are flying by, and so I didn’t proofread that one before I hit send. (there were several comments later which I didn’t get, so didn’t play along)(It was busy in there, with all the tweeting and misspelling). HofKata: shocker: STEMI pts needing transfer for PCI didn’t get transferred within 30 minutes. Median time was 64 minutes. #ACEP12GruntDocBukata said they fixed this at his joint by having the same EMS crew that brought them in take them out, which was very fast, and with the right conversation EMS was all over it. HofKata: if you can get to the cath lab in less than 4 hours its better than TPa. The 60 min rule for TPa is based on no evidence. #ACEP12GruntDocHofKata: then says he’d rather have TPa than stenting. (Weird). #ACEP12GruntDocThe weird was mine. I don’t get that. HofKata: 124k STEMI pts w CABG capability did cath then CABG 3%, without very rare. CABG grps did worse. #ACEP12GruntDocWow, confusing tweet.
Issue was, is it safe to do caths in places that cannot do ‘rescue CABG”? In a study of 124K pt’s in centers with and without ‘rescue CABG’ ability, answer was yes, and in places that could do CABG it was done a whole lot more than places where it wasn’t; occasional pt had to be transferred to CABG place, but not many. HofKata: ABCD2 score for stroke after TIA isn’t reliable. Another data dredging tool fails in real life. #ACEP12GruntDocHofKata: redefinition of Tia w MRI findings of infarct to stroke makes both groups look better: makes studies over time hard #ACEP12GruntDocWay more ‘strokes’ are now very minimal (what we used to call TIA’s) so the ‘stroke category looks better, and the TIA category looks smaller. Will confound studies looking both directions. This next one it a review of IST-3, the never-ceasing desire to give TPa to every stroke no matter the time elapsed. HofKata: IST-3 showed in a no blinded study using untrained family members as evaluators showed a tiny trend to improvement. #ACEP12GruntDocHofKata: IST-3 the first 300 pts evaluated by neurologists showed the tpa out to 6 hrs is much worse. #ACEP12 scathing editorials yesterdayGruntDocFamily members, who knew whether or not their loved one got the TPa were asked by postal mail to evaluate their loved ones’ recovery, trended better for those who got TPa. Bizarre study bias built it. To say they were unimpressed would be an understatement. HofKata: shocker: TPa for people with dissection causing their strokes do poorly. #ACEP12GruntDoc“@gruntdoc: HofKata: shocker: TPa for people with dissection causing their strokes do poorly. #ACEP12” surprise surpriseJennieHofKata: Geriatric and dizzy with a normal neuro exam will not have ICH. Based on a paper from 1998 w 4 pts found to have cblr bld. #ACEP12GruntDocThere’s a practice that’ll be hard to change. HofKata: no decent studies on ischemic stroke leaving BP up or the older lowering. Unless going to give TPa. #ACEP12GruntDocHofKata: kids w brain rumors typically represent w recurrent headaches, etc. authors rec scanning in kids w recurrent ha. #ACEP12GruntDocMeans, don’t scan a kid on first HA or first week of HA. HofKata:Canadian SAH CT study w 3rd gen scanner didn’t LP 50% of the pts in study. Gold std was pos CT. 30% lost to f/u. LP for SAH #ACEP12GruntDocHofKata: says Dr Newman who presented this paper yesterday as not needing LP is incorrect. #ACEP12GruntDocThis could be ACEP’s first Pay Per View smackdown, Hoffman vs. Newman on this Canadian CT for SAH study. HofKata: accumulating evidence quinolones can cause neuro sx’s. still safe drug as denominator is vast, but be aware. #ACEP12GruntDocHofKata: giving reglan over 15 vs 2 mins decreased the akathasia. 7% vs 26%. #ACEP12GruntDocTurkish study, makes sense. HofKata: CO poisoning. Hyperbaric didn’t help, showed no benefit over high flow o2. Small study. #ACEP12GruntDocHofKata: studied on neurosurgeon, 1/2 sit vs stand on first postop visit. Again, pts like the seated visit. #ACEP12GruntDocShocker here was that this was timed, it was these NS pt’s first post-surgical visit, and they lasted about a minute and 10 seconds. Wow. HofKata: 8% of German studies eligibility criteria weren’t included in the paper,13 published modified info. Can’t extrapolate1/2 .#ACEP12GruntDocHofKata: 2/2 those findings to groups that were excluded. Theme is that funded studies seem to play fast and loose w reporting. #ACEP12GruntDocThrows a lot of what’s published into doubt, and when they don’t report excluded groups we assume their results are applicable for the general population, which isn’t correct. What about the deep dive into the study information that’s given to the FDA from drug companies, that’s easily digestible, right? HofKata: Cochrane authors report that it would take 2 FTEs 14 months to analyze, and found things never addressed in the papers. #ACEP12GruntDocThe papers mean the studies that get publishe in journals. Not getting the whole story. HofKata: Cochrane cont: the US FDA wouldn’t give the data, had to get from AUS. puts a lot of the publications in doubt. #ACEP12GruntDocInteresting.This was about the new ‘high sensitivity’ troponins that are about to come out, for what reasons none of us in EM can discern, as it absolutely isn’t helpful… Touché, I’ll remember that. “@JoeLex5: @gruntdoc You mean "low specificity troponins," of course.” #ACEP12GruntDocThanks, but I just tweet it. The glory goes to the lecturers, some were phenomenal. “@fayazg99: @gruntdoc fantastic stuff!” #ACEP12GruntDocGreat coverage! RT @gruntdoc: That ends the lectures for me for today. Hope you enjoyed my coverage.Doc Gurley@docgurley Awww, shucks ma’am. *tips hat*.GruntDocMeeting the social media twitter and blog greats at #ACEP12 @emcrit @gruntdoc @drrwinters @movinmeat @EMDocBrett http://pic.twitter.com/D6dLKId3Alexei Wagner@JoeLex5 s 3 rules of emergency medicine:1) the nurse can hurt you way more than you can hurt themGruntDoc@JoeLex5 s 3 rules of emergency medicine:2) you will never waken someone with narcan that you will like more awake than asleepGruntDoc@JoeLex5 s 3 rules of emergency medicine:3) the LP target is always 1cm deeper than you think.GruntDoc@JoeLex5 s 3 rules of emergency medicine:4) bonus: if you really don’t want someone to elope, hide their shoes.GruntDoc“@gruntdoc: All the twitterers from #ACEP12 in one place. The rest of you are safe. For now. http://pic.twitter.com/j8i2uwb0” Wish I was there….realEDdoc

Filed Under: Emergency, MedBloggers

An Elegantly Icky Solution

October 3, 2012 by GruntDoc

Entertaining and medical!

I’d love to shield the identify of the patient in this story. But I can’t, and you’ll understand why in a minute. It’s not that I’m worried about a HIPAA violation or a law suit. After all, the patient was my mother-in-law. She and my father-in-law – Pop Pop – have moved in with us . . . so they aren’t going to sue anybody. And while I hesitate to embarrass my soft-spoken “Mom Mom” with the details of this tale, I have to tell this story straight. Here goes.

via An Elegantly Icky Solution.

Sounds like something we need to try earlier.

Filed Under: Amusements, EP Monthly, Medical

Clostridium difficile colitis and you, a video tutorial

July 29, 2012 by GruntDoc

Learning can be fun!

Just say no to antibiotics you don’t need.

The ultra-awesome ZDoggmd.com

Filed Under: Medical

How large is a British watermelon?

June 19, 2012 by GruntDoc

You’ll probably regret asking.

A Las Vegas man who suffers from a rare condition that made his scrotum swell to 100 pounds is basking in the fame that his giant organ has brought him.

…

The watermelon-size scrotum Mr Warren carries between his legs has landed him on the Howard Stern Show and the Comedy Central program Tosh.0 and made him a local celebrity in his hometown.

via Wesley Warren Jr: Man with 100-pound scrotum REJECTS free $1m corrective surgery | Mail Online.

Emphasis added.

Here’s a family safe pic:

Okay, how large are British watermelons, anyway?

Filed Under: Medical

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

February 17, 2012 by GruntDoc

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

Filed Under: Medical

HCC Blog calls it quits

January 10, 2012 by GruntDoc

Dear Readers,

It has been my pleasure over the last 4 years to blog on HCC-related topics and exchange ideas with many of you. I have learned a ton from everyone.

This is my last post and I anticipate retiring the blog by the end of the month.

via HCC Blog » hccblog.

Another good blogger taps out. Too bad.

Filed Under: MedBloggers

The Worst Quackery of 2011: Battlefield Acupuncture – Forbes

January 3, 2012 by GruntDoc

So: the 2011 winner of the worst quackery award is: battlefield acupuncture. This bizarre practice, invented just 10 years ago, offers a trifecta of ills:

It offers no medical benefit and carries a real risk of harm for some patients.

The U.S. government is wasting tens of millions of dollars per year on it, and plans to increase its spending next year.

The patients are wounded combat veterans who have no choice about where to get treatment.

In battlefield acupuncture, the “doctor” (no competent doctor would do this) sticks needles into the patient’s ear to relieve pain.

via The Worst Quackery of 2011: Battlefield Acupuncture – Forbes.

Incredible. And infuriating.

(Found on Twitter, but I cannot recall who tweeted it).

Filed Under: Deployed Docs, Medical

Ramblings of an Emergency Physician in Texas

Is farting in the OR transmitting germs?

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

Physicians: Don’t take UAE jobs

How Doctors Die | The Saturday Evening Post

Some studies that I like to quote

BS Study*: Doctors Feel Patients’ Pain | Empathy | LiveScience

CDC – Seasonal Influenza (Flu) – Situation Update: Summary of Weekly FluView

Dr Seuss Does Malaria « Contagions

ACEP 12 tweeting: Bukata and Hoffman

An Elegantly Icky Solution

Clostridium difficile colitis and you, a video tutorial

How large is a British watermelon?

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

HCC Blog calls it quits

The Worst Quackery of 2011: Battlefield Acupuncture – Forbes

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