Update 6/29/09 @ 12:36  This may all be a hoax.

NOPE. APPARENTLY THIS IS REAL.

British Media and News Reporting may actually not be related.

The shock findings of the Michael Jackson autopsy | The Sun |News
8st 1oz, no food just pills in his stomach, bald, bruised, his ribs broken by CPR, 4 needle wounds near his heart…

I don’t know if this is real or not, but it sounds … like I have some questions …(1 stone is 14 pounds)

There’s this:

SUFFERED several broken ribs as frantic rescuers pumped his chest after he collapsed in cardiac arrest.

That’s unfortunately normal.  No problems there.

And the (Emergency Medical) weirdness:

Four injection sites were found above or near to Jacko’s heart.

All appeared to result from attempts to pump adrenaline directly into the organ in a failed bit to restart it.

Three of the injections had penetrated the heart wall — causing damage — but a fourth missed and hit one of the 50-year-old star’s ribs.

What?  Intracardiac injections of epinephrine?  I thought that went out in the very early 80’s.  As for ‘causing damage’, needles do that, but the major problems with intracardiac epi are coronary artery lacerations (bad, but not the end of the earth, as the recipient was dead to start with and getting a return of circulation allows time to fix them) and intracardiac muscle injection, which causes intractable ventricular fibrillation, which is Bad.  Capital B Bad.  Usually Unrecoverable Bad.

Where does one even get epi with and intracardiac needle? I’ve been in the business for a good while and haven’t seen one since Paramedic school (82-83) and was then taught it was out of favor.

Nowadays if you don’t have an IV line during a code (it happens) you can squirt it down the endotracheal tube, or, failing that, an intraosseous IV line (shorter needle, not in the heart, works very well) through which all the resuscitation meds can be given.

Interesting.  Nothing to make of it now, but, who’s a) been watching too many Tarantino movies and b) did this?

(I doubt an emergency pericardiocentesis was the reason for the described wounds, as those if done without sonographic guidance are done from the top of the abdomen up, and with sono guidance would be through the chest wall, but with sono guidance you’d know if they needed it or not, and if there was a big pericardial effusion it’d have been in the report).

Better Health » Some of My Best Friends Are Doctors

Dr. Val does a nice Fisk!  Yes, docs make a decently good living.  No, it’s not why the health care system is in trouble.

A Happy Hospitalist: You Are Living In The Medicare Tomato
You want to know what the process is like for a physician to make a living as a physician.
Look only toward the Medicare Tomato. Imagine for the moment that you have been taken out of reality and into the alternate bizarro world of the Medicare Tomato. In this analogy, the Medicare Tomato represents a day in the life of a practicing physician.

An easy to understand (and mouthwatering) analogy of how we’ve gotten into the Medicare payment morass, and where it’s quite possibly headed.  We’re much nearer then end than the beginning.

Good writing.

Running a hospital: What a public plan is really for by Paul Levy of BIDMC.

Surprise: it’s not about access for patients.

Where have I heard that before….?

The by-line reads “The Editors” but it’s actually a compilation of Short editorials, two of which are by medical bloggers!  One is the usual suspect, Kevin, MD, and the other is Shadowfax from Movin’ Meat (his real name and a picture with hair is at the NYT).

They’re all good, and all presuppose that the system can be fixed without fundamentally changing the way people (patients) buy their healthcare.

Let patients see the menu, with the prices.  Let hospitals, doctors, and vendors compete, out in the open.  Lift the veil of secrecy about what company x pays vs y, and let’s let the rational consumer decide what they want to spend.  I would trust the wisdom of purchasers over those of government rule-makers every day.

Dr. Wes: An Open Letter To Patients Regarding Health Reform
Dear Mr. and Ms. Patient,

It has come to my attention that in order for your to enjoy success as patients in the new era of health care reform, you must start working now to prevent illnesses that might befall you. Do not, under any circumstances, eat or drink too much.

Nice…

Even when it crashes:

(it says “Cannot Quit”).

A.M.A. Opposes Government-Sponsored Health Plan – NYTimes.com

Wow. I really didn’t see that coming. I may have to hold my nose and join the AMA…

Musings of a Dinosaur: Resident Work Hour Restrictions: My Solution
I trained back in the dark ages, befitting a dinosaur, when there were no restrictions on the hours worked by resident physicians in training.

I think his answer has merit. I cringe at the experience awaiting residents as they get out to the Real World. I don’t think it’s got a chance in heck of being adopted, but it’s a good idea.

Townhall.com::Blog
We are simply heading for a healthcare disaster an a scale that you have never seen and at a cost you would never dream.

Read it all.

The article isn’t available yet.  Here’s the pre-publication take from Medwire news:

Crowded emergency departments pose increased risk for chest pain patients

By Mark Cowen

05 June 2009

Acad Emerg Med 2009: Not yet available online

MedWire News: Heart attack patients and those with other forms of chest pain are significantly more likely to experience serious complications after admission to hospital if they were initially treated in a crowded emergency department, US research shows.

“What shocked us is that these complications were not explained by what goes on in the emergency department,” said lead researcher Dr Jesse Pines, from the University of Pennsylvania in Philadelphia. “The adverse events occurred after the patient had been admitted to the hospital. Emergency department crowding is really more of a marker of a dysfunctional hospital.”

Hmm.  Delays are delays, but I’ll wait until I see the actual article to comment more.  My first question: are these different hospitals, or same ED with different censuses (which would be a better apple to apple comparison).

Don’t change where you go just yet.

The author was a Policy person in the Bush 43 White House, so you know the angle in the analysis:

KeithHennessey.com » Understanding the Kennedy health care bill
As the committee staff emphasized to the press after the leak, this is an interim draft. I assume things will move around over the next several weeks as discussions among Senators and their staffs continue. This is therefore far from a final product, but it provides a useful insight into current thinking among some key Senate Democrats.

Here are 15 things to know about the draft Kennedy-Dodd health bill.

I read his analysis, and no I didn’t read the full bill. It’s a starting point for the conversation, not the end.

via Ace

A Happy Hospitalist: It’s Time To Gut The Education Process

This is quite a good idea. Whether it’d have any effect on specialist pay is a different question.

Dynamist Blog: Medicare First!

Exactly right. Hey, I’ve said the same thing (though much less well).

Movin’ Meat: Health Wonk Wrap-up: The Good, the Bad, and the Ugly

Shadowfax is beginning to see the light at the end of the tunnel really is a train. Better late than never.