Thanks very much to all of you for reading, and I hope to keep going for a long time.

My 4th birthday, for a retrospective of the design.

I wonder if I get to meet John Malkovich now…

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Make sure and read to the end, then ask if this is particularly safe.

I remember vividly trying to survive the drive home post-call several times as an intern. I never fell asleep, but I did drive for miles with the parking brake on because I’d forgotten I’d set it, and was so sleep-addled I didn’t recognise it.

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CHANGE OF SHIFT, Vol. 1, No. 18

Well, I’ve been luck enough to reprise my first time hosting Change of Shift on December 14, 2006, and though there were slightly fewer submissions this time around, the writing does Change of Shift justice and is testament to the amazing people out there working long shifts and then coming home only to do more work by blogging about their experiences.

An aside: sites like this make me glad I have a java color-killer (makes black text on a white background), the second down on this page.

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ResortMed now employs eight Vail-area doctors and four more in the Aspen area, and their 24/7 service hits the road in three specialized Jeeps. Far from the classical house-call doctor’s black bag, these Jeeps come armed with everything an emergency doctor needs, including IV fluids, meds, oxygen and even a hyperbaric chamber, when necessary.
“We can distinguish between what is routine and what is truly an emergency – with our equipment and training, chances are good we can handle 99 percent of problems in a hotel room or home,” Davis said. “It’s a dramatic shift when you think about it. A guest comes to the valley, and they spend a lot money to be in a resort property. The idea of replacing those moments with a hospital stay or time in a waiting room is not good. This is a good substitution. The idea of watching TV in their comfortable hotel room when the doctor comes to them became very appealing once guests became aware that the service exists.”
…

It’s written by one of their entertainment reporters, which (I suppose) explains all the name dropping, though I’d have thought discretion would be the better part of valor in such a business.

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me: No.  I’ve never written a prescription for it in my life.

Charge Nurse: “What is it, anyway?”

me: It’s THC, the active ingredient in marijuana.  Why?

CN: “There’s a parole officer on the phone, who says that one of their parolees tested positive for marijuana, but they have a prescription for marinol from you to explain it.”

me: Nope.  Not from me.

The prescription was faxed to us.  Yes, it’s written on one of our current Rx pads, yes my name is circled.  No, it’s not my hand writing or my signature, and the DEA number is way off (and doesn’t follow a basic convention every pharmacist would look for, and which I won’t give away here).

CN: “The parole officer wants something written out that this prescription wasn’t written by you.  They wanted it typed on letterhead, but I said we were a little busy for that.” 

me: (Again noting how our charge nurses are smart and save me a lot of work): Okay.  Handwritten note disclaiming the forged prescription goes off to the Parole Officer.

Now this parolee has two problems, at least: testing positive, and having a forged prescription for a Schedule III drug.

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(Photo originally here; be sure to check out the captions in the comments).

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From the CNN article, the only part to describe the clinical picture:

Johnson spokeswoman Julianne Fisher said the senator was in the Capitol on Wednesday morning conducting a conference call with South Dakota reporters when “his speech pattern slipped off.” (Listen to Johnson’s difficulty speaking during a WNAX radio interview — MP3, 749 kb)

Fisher said the senator was able to walk back to his office in the Hart Senate Office Building, then began having problems with his right arm. He thought he was all right, she said, and went to his desk, but came out a few minutes later and “it was apparent he needed help.”

Several hours later he’s in the OR.  Subdural hematoma springs to mind given the description of both a speech and one-sided arm difficulty, but only time will tell.

Update @ 8:31AM:

A U.S. Capitol physician says Sen. Tim Johnson underwent successful brain surgery for an arteriovenous malformation, a condition which causes arteries and veins to grow abnormally large.

That would do it, as well.

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Swab a clear liquid onto a gaping wound and watch the bleeding stop in seconds. An international team of researchers has accomplished just that in animals, using a solution of protein molecules that self-organise on the nanoscale into a biodegradable gel that stops bleeding.

If the material works as well in humans, it could save thousands of lives and make surgery far easier in many cases, surgeons say.

Molecular biologist Shuguang Zhang, at the Massachusetts Institute of Technology in the US, began experimenting with peptides in 1991. Zhang and colleagues at MIT and the University of Hong Kong in China went on to design several materials that self-assemble into novel nano-structures, including a molecular scaffold that helps the regrowth of severed nerve cells in hamsters (see Nano-scaffolds could help rebuild sight).

Their work exploits the way certain peptide sequences can be made to self-assemble into mesh-like sheets of “nanofibres” when immersed in salt solutions.

In the course of that research they discovered one material’s dramatic ability to stop bleeding in the brain and began testing it on a variety of other organs and tissues. When applied to a wound, the peptides form a gel that seals over the wound, without causing harm to any nearby cells.

…

Ed Buchel, who teaches general and plastic surgery at the University of Manitoba, in Winnipeg, Canada, sees equal potential for treating trauma and burns. “If this works as well on humans as it does on rats, it’s phenomenal,” he says.

Still, they caution that extensive clinical trials are needed to make sure the materials work properly and are safe. The MIT researchers hope to see those crucial human trials within three to five years.

Their research will appear in the 10 October 2006 edition of online journal Nanomedicine.

This is a far-horizon thing, but if it works as described it’d help, for a zillion or so patients and their doctors.

via Slashdot

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