Healthcare Update Satellite — 12-16-2014

Answering the important questions … why does the flu vaccine suck this year? Keep a lookout for next month’s issue of EP Monthly which will tell you everything you need to know about influenza diagnosis and treatment.

Of course, if you had read the backboard article in EP Monthly’s November issue, you’d already be doing this … Florida fire department abandons use of backboards for most trauma patients.

4 year old boy develops carotid artery dissection and left sided hemiparesis after riding a roller coaster. Fortunately, he had made significant recovery by six months. How scary is that, though? Can you imagine calling the neurologist and vascular surgeon telling them that you have a four year old child with an acute stroke?

A patient suffering from a rare condition called ossifying fibromas had lost the structural integrity of two bones in her back. Normally, the vertebrae are removed and replaced with artificial bones, but the process is difficult because the artificial bones must be filed down during surgery to make sure that they fit. Surgeons in Zhejiang University used CT scans and a 3D printer to create a titanium implant that exactly matched the patient’s spine.

A lot of insight about emergency medicine wrapped up into a few paragraphs from a Florida Times-Union columnist who went to the emergency department with his wife.
“Most [patients] probably shouldn’t have been there, but the poor and uninsured use emergency rooms for all their illnesses, from a head cold to a sprained ankle …”
“Nearly everyone at the ER was surly because of the wait, and they took it out on the staff.”
“Emergency room patients get outrageous bills even for simple ills. Many just toss them in the trash and the rest of us pay through higher bills. American health care is a mess. I’ll be really grateful when someone finds a cure.”

Using ground coffee to stop bleeding from wounds? I never heard of this one before. After reading this letter to the editor, I did a little internet searching and found other recommendations including powdered sugar, corn starch, and cayenne pepper. Don’t know if any of these work, so don’t try them without contacting your personal physician first. Direct pressure for at least 5 minutes always worked best for me.

After miserably failing to pass Proposition 46 in California, a medical malpractice plaintiff, supported by an amicus brief from a consumer watchdog group, have now successfully petitioned the California Supreme Court to review the state’s medical malpractice caps.

Emergency department visits on the rise … again. Latest estimates from ACEP are that there will be about 140 million emergency department visits in 2014. Thirty percent of those visits were for injuries – many in patients 75 and older. Nearly 75% of hospitals continued to board patients in the emergency department, showing how hospitals are operating at or above capacity.

In medical malpractice cases, expert witnesses are usually required to practice in the same specialty as the defendant physician. A malpractice case against a prison physician in Indiana was thrown out because a plaintiff’s medical expert was not a prison physician and was therefore deemed unqualified to testify about “correctional medicine.” The Appellate Court stated otherwise, holding that the standard of care for doctors practicing in prisons is no different from the standard of care for doctors practicing in the general population. Allowing this distinction would “empower prison physicians to determine for themselves what standard of care should apply for each individual case.” The 19-page opinion is here (.pdf file) and incidentally presents a fairly in-depth discussion on management of patients who have undergone a sex change operations.

Innovative new research shows how chronic neuropathic pain can be relieved by activating a receptor in the brain by using either adenosine or a drug invented at the National Institutes of Health. Bonuses are that no tolerance develops, there is no potential for addiction, and the “protective” actions of acute physiological pain (such as pulling your hand away from a hot stove) are not affected. How long until patients develop allergies to this medication?

Healthcare Update Satellite — 12-01-2014

More health related news from around the web on my other blog at DrWhitecoat.com.

This edition begins with another installment of the Ebola Chronicles … perhaps the last in the short-lived series now that the media has stopped whipping the public into a panic.

New York City actively monitoring 357 people for symptoms of Ebola – most of whom came to the US from the three Ebola-affected countries.

Arizona man returns from Sierra Leone after being involved in “Ebola response” then decides he doesn’t feel well the following day and calls 911. Brought to Maricopa Integrated Health Systems by firefighter in hazmat gear and part of the emergency department was shut down to accommodate the patient.

Number of Ebola cases in West Africa doubling every 2-3 weeks. Among factors contributing to the increase are 60% of Ebola patients remaining undiagnosed, terrorist groups such as ISIS attempting to weaponize Ebola, and Ebola’s nonspecific symptoms. The article’s author calls Ebola a “slow-motion atomic bomb.”

Interesting insight into why half of the doctors in Liberia have died. Liberia had two civil wars between 1989 and 2003 and still has no centralized h
ealthcare system leadership.
This quote really puts things in perspective:“People are giving up their sick dying and dead family members to people wearing anonymous white space suits, in most cases never to see them again,” Moran said. “Give them the benefit of the doubt that, just like Americans, if people in your family are sick, you want to take care of them.”

Clipboards visit UC San Fransisco on their national tour to tell medical providers how to prepare for patients with Ebola.

Oh, and the Ebola nurse from Maine wants everyone to stop calling her the Ebola nurse. Did I mention that she was the Ebola nurse?

—————————–

Can EKGs predict risk of death in patients with syncope? The GESINUR study shows that 65% of syncopal patients had abnormal EKGs but that only a few findings were predictive of all-cause mortality at one year. Of 524 patients, 6.3% died within 1 year, but only one patient died from a sudden cardiovascular cause. Presence of atrial fibrillation, intraventricular conduction delays, LVH and paced rhythm were all associated with increased all-cause mortality at one year.

Woman and her husband go to emergency department after woman begins having “serious internal or abdominal pains,” thinking she may need surgery or something. Twelve hours later, doctors found the source of the patient’s problems: a 7 lb 14 oz baby boy. The patient and her husband had no idea she was pregnant.
Every time I hear about a case like this, it reminds me of this story from many years ago.

Study in the American Journal of Public Health shows that drinking sugar soda affects length of telomeres and can shorten your life. Drinking one 20 ounce bottle of sugared soda per day is estimated to shorten one’s life by 4.6 years – which approximates the effects of cigarette smoking.

Started taking NSAIDs recently for aches and pains? Your risk of dying if you have a stroke just went up an average of 42% – depending on what type of NSAID you’re using. According to this study recently published in the journal Neurology, etodolac (Lodine) (which may have been discontinued) creates the biggest risk of the medications studied.

Think hand dryers are more “sanitary” than using paper towels? Think again. Bacterial counts in the air around jet air dryers were 27 times as high as those around paper towel dispensers and stayed around for up to 15 minutes after the drying ended. Bacterial counts for warm air dryers were about 6 times as high as those around paper towel dispensers. In other words, using a public bathroom with electric hand dryers is likely causing you to inhale the bacteria on other peoples’ hands … after they have used the toilet.

Then again, if you live near this defecating dwarf, you probably don’t have to worry about airborne germs – just those on the steps.

Finally, the video of the week takes one final look at the media coverage of Ebola in the US versus that in the UK. There is some profanity, so probably NSFW. Also note that the one person being filmed discussing “Ebola ass-ness” is a comedian doing a comedy spoof. Still pretty funny, though.

Healthcare Update Satellite — 12-01-2014

More health related news from around the web on my other blog at DrWhitecoat.com.

This edition begins with another installment of the Ebola Chronicles … perhaps the last in the short-lived series now that the media has stopped whipping the public into a panic.

New York City actively monitoring 357 people for symptoms of Ebola – most of whom came to the US from the three Ebola-affected countries.

Arizona man returns from Sierra Leone after being involved in “Ebola response” then decides he doesn’t feel well the following day and calls 911. Brought to Maricopa Integrated Health Systems by firefighter in hazmat gear and part of the emergency department was shut down to accommodate the patient.

Number of Ebola cases in West Africa doubling every 2-3 weeks. Among factors contributing to the increase are 60% of Ebola patients remaining undiagnosed, terrorist groups such as ISIS attempting to weaponize Ebola, and Ebola’s nonspecific symptoms. The article’s author calls Ebola a “slow-motion atomic bomb.”

Interesting insight into why half of the doctors in Liberia have died. Liberia had two civil wars between 1989 and 2003 and still has no centralized h
ealthcare system leadership.
This quote really puts things in perspective:“People are giving up their sick dying and dead family members to people wearing anonymous white space suits, in most cases never to see them again,” Moran said. “Give them the benefit of the doubt that, just like Americans, if people in your family are sick, you want to take care of them.”

Clipboards visit UC San Fransisco on their national tour to tell medical providers how to prepare for patients with Ebola.

Oh, and the Ebola nurse from Maine wants everyone to stop calling her the Ebola nurse. Did I mention that she was the Ebola nurse?

—————————–

Can EKGs predict risk of death in patients with syncope? The GESINUR study shows that 65% of syncopal patients had abnormal EKGs but that only a few findings were predictive of all-cause mortality at one year. Of 524 patients, 6.3% died within 1 year, but only one patient died from a sudden cardiovascular cause. Presence of atrial fibrillation, intraventricular conduction delays, LVH and paced rhythm were all associated with increased all-cause mortality at one year.

Woman and her husband go to emergency department after woman begins having “serious internal or abdominal pains,” thinking she may need surgery or something. Twelve hours later, doctors found the source of the patient’s problems: a 7 lb 14 oz baby boy. The patient and her husband had no idea she was pregnant.
Every time I hear about a case like this, it reminds me of this story from many years ago.

Study in the American Journal of Public Health shows that drinking sugar soda affects length of telomeres and can shorten your life. Drinking one 20 ounce bottle of sugared soda per day is estimated to shorten one’s life by 4.6 years – which approximates the effects of cigarette smoking.

Started taking NSAIDs recently for aches and pains? Your risk of dying if you have a stroke just went up an average of 42% – depending on what type of NSAID you’re using. According to this study recently published in the journal Neurology, etodolac (Lodine) (which may have been discontinued) creates the biggest risk of the medications studied.

Think hand dryers are more “sanitary” than using paper towels? Think again. Bacterial counts in the air around jet air dryers were 27 times as high as those around paper towel dispensers and stayed around for up to 15 minutes after the drying ended. Bacterial counts for warm air dryers were about 6 times as high as those around paper towel dispensers. In other words, using a public bathroom with electric hand dryers is likely causing you to inhale the bacteria on other peoples’ hands … after they have used the toilet.

Then again, if you live near this defecating dwarf, you probably don’t have to worry about airborne germs – just those on the steps.

Finally, the video of the week takes one final look at the media coverage of Ebola in the US versus that in the UK. There is some profanity, so probably NSFW. Also note that the one person being filmed discussing “Ebola ass-ness” is a comedian doing a comedy spoof. Still pretty funny, though.

An Argument With No Clear Winner

Fingertip Amputation“You’re going to the hospital.”
“I’m NOT going to the hospital. There’s nothing they’d do and it would cost us thousands of dollars for nothing. Besides … we have to leave. We’re already late.”
A husband was attempting to attach the family’s camper onto the trailer hitch of the family’s truck when the trailer slipped. His middle finger didn’t make it out of the way and got caught between the ball of the trailer and the top of the hitch. When family members helped him pull the camper back off of the hitch, they saw a lot of blood. Then the last portion of his middle finger dropped from inside the trailer hitch onto the leaves.
“Dammit.”
The wife raised her voice. “Get in the truck. We’re going to the hospital.”
The husband wrapped his bleeding finger in a Brawny paper towel he had retrieved from inside the camper. He raised his voice louder. “YOU get in the truck. We’re going to the CABIN.”
“Paul, don’t be silly. You’re bleeding. The tip of your finger is sitting on the ground. If we get to the hospital quickly, maybe they can reattach it.”
“They’re not going to do anything except sew this up and charge us thousands of dollars to do it. I’m NOT going to the hospital. I’ll have Doc Welby call me in a prescription for antibiotics. We can pick it up on the way out of town.”

So the patient shows up in triage with a blood soaked paper towel wrapped around his finger. It was obvious that he’d rather be about anywhere else than sitting in the emergency department at that point.
The finger was amputated just past the distal interphalangeal joint – meaning that the tip of the finger, the nail, and the end of the bone were missing. Clean wound. There were some extra flaps of skin to the sides of the finger which would make it easier to repair the wound. I did a digital block to numb the finger so that we could clean it and we used a commercial tourniquet to stop the bleeding.
The wife softly asked “Is there any chance that the end of the finger could be reattached?”
I started to respond “I don’t think so …” when the patient let out a loud “HEH” and smirked at his wife.
“You were saying, doctor?” She continued.
“I was saying that I didn’t think so, but I can ask the hand surgeon. Do you have the end of the finger with you?”
“Tell him what happened to the end of your finger, Paul.”
“We couldn’t find it.”
“Tell him what really happened to the end of your finger, Paul.”
“It’s gone.”
“Paul didn’t want to come to the hospital. I told him that you may be able to reattach the end of his finger. Paul had a temper tantrum, picked up the end of his finger, and threw it into a field. Isn’t that right, honey?”
Paul folded his arms and looked at the opposite wall, maneuvering his tongue to pick an imaginary piece of food from a tooth. He pretended he didn’t hear what she had said.

OK, then.
So I called the hand surgeon. He came down, looked at the patient’s finger, and arranged to send the patient to outpatient surgery to repair the injury.
Just as the patient had predicted, he was probably charged thousands of dollars to sew up his finger. He was discharged later that day.

For the rest of the day, I kept thinking how that husband and wife dispute ended up in a draw. They were both right. The wife was right that he needed to come to the hospital for evaluation, but he was right in that the surgeon probably wasn’t going to do much except sew up the injury.

OK, I also wondered how many times during their vacation that the husband held up his hand and waved the dressing on his injured finger in front of his wife’s face … as in “see which finger I injured, honey?” … but the irony of their argument was still pretty compelling.

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room please e-mail me.

Healthcare Update Satellite — 11-04-2014

Ebola PictureBack with more of the Ebola Chronicles …

Ebola fears causing discrimination problems all over the US. Thomas Duncan died from Ebola. Now his fiancee is having difficulty finding a place to live as landlords are refusing to rent to her. People of African descent are facing discrimination just because they are from Africa. Mothers of some school children told one African cafeteria worker to leave the school because she “might have Ebola.”

In Liberia, bleeding patients are often refused medical care due to Ebola fears. The picture at the link shows a picture of a woman who was bleeding heavily from a miscarriage and who was unable to find treatment at multiple clinics.

Hospitals developing policies on what care may not be provided to Ebola patients. Invasive procedures, hemodialysis, endotracheal intubation, and CPR are all being reviewed to determine whether the risk to health care workers is worth the benefit to patients. For example, if an Ebola patient suffers a cardiac arrest and it takes a half hour to don protective gear, will doing so benefit the patient?

The CDC says it is unlikely (.pdf file), but other infectious disease experts assert that Ebola can already spread by aerosols and droplets. Even vomiting creates an aerosol which can transmit gastrointestinal viruses.

Tori Spelling's Ebola Nervous Breakdown Picture Of The Week

But at least Tori Spelling is OK. She was hospitalized with “symptoms of Ebola” which ended up being a nervous breakdown caused by her husband cheating on her. Took selfies of herself in her hospital bed with Twitter hashtags written on a facemask she was wearing. We need to have a 21 day media blackout on any celebrities that pull this crap. Make that a 21 week media blackout.

And some other select news …

Support for California’s Proposition 46 drops almost in half once voters actually learn about the ballot language.

Patients gone wild. Former police officer gets drunk, gets brought to emergency department, assaults nurse, then tries to take Taser from the police who responded to the scene. He got a smackdown by police officers before being arrested for disorderly conduct and attempting to disarm a police officer.

Alabama jury awards family of patient $4 million for missed MI resulting in patient’s death. 40-year-old man went to the emergency department complaining of abdominal and chest pain after eating breakfast two days prior. He was diagnosed with gastrointestinal problem, was sent home, and died of an MI two days later. Plaintiff attorney argued that full cardiac workup should have been performed and hopes that the large verdict “sends a message to doctors, particularly emergency room physicians.”

Remember, marijuana is a harmless drug. Adolescents who use cannabis were 63% less likely to complete high school, 62% less likely to earn a college degree, eighteen times more likely to develop cannabis dependence, eight times more likely to use other illicit drugs, and seven times more likely to attempt suicide.

Science journalist describes how she suffered a broken heart … literally. She was diagnosed with Takotsubo cardiomyopathy

British woman has cosmetic procedure performed during medical tourism trip to Thailand. She was unhappy with the results, so she returned to the clinic for corrective surgery and died under anesthesia.

Healthcare Update Satellite — 10-21-2014

More medical news from around the web on my other blog over at DrWhitecoat.com

Study from University of Maryland proves that emergency physicians are idiots … at least when treating pediatric extremity injuries. Splints were placed improperly in 93% of suspected pediatric fractures treated in emergency departments. “The researchers found that the most common reason for improper placement of a splint was putting an elastic bandage directly on the skin, which occurred in 77% of the cases. In 59% of the cases, the joints were not immobilized correctly, and in 52%, the splint was not the appropriate length. Skin and soft-tissue complications were observed in 40% of the patients.”
Of course, I’m sure that the orthopedists evaluated the patients immediately after the splints were placed to make sure that the patients had not readjusted the splints prior to their orthopedic follow up. That almost never happens.
This study makes a good case for requiring orthopedic evaluation in the emergency department for every pediatric patient suffering from any type of bone or joint injury – regardless of the time of day or night.

What no one is telling you about Ebola … from a Hazmat Trained Hospital Worker. The gear used to protect providers from Ebola is difficult to put on, difficult to remove, and can usually only be worn for 30 minutes at a time. The medical providers in Dallas who contracted Ebola had no protocols in place and this author believes that the “system failed them.”

Patients apparently believe that being in the same hospital as an Ebola patient is bad for their health. Patients at Texas Health Presbyterian Hospital are canceling outpatient procedures, no one is walking in the hallways, and the ED wait times have dropped from an average of 52 minutes to … zero.
“It feels like a ghost town,” said one vendor who recently visited the hospital.

Ketamine has almost immediate positive effect on anhedonia and depression associated with bipolar patients who are resistant to other treatments. The more remarkable thing is that the effects can also be seen on PET scans and effects from a single dose of medication last for over two weeks.

Another example of why doctors should be wary of treating VIP patients. Former NFL running back sues orthopedic surgeon after alleging that his Achilles tendon tore during Baltimore Ravens tryout. Alleges that the surgeon misrepresented the fact that the Achilles tendon had fully healed after his prior Achilles surgery.

Ambulances line up outside North Wales hospital waiting to drop off emergency patients. At one point the line was 13 ambulances long and the wait was hours just to get into the emergency department. One of the government administrators recommended that patients go to NHS Direct or pharmacies for speedy health advice.
At least the patients are covered by insurance, though — just like many of the patients in the US now.
Australian nurses want penalties to be imposed on hospitals if patients aren’t seen within four hours in emergency departments.

If this penalty materializes, a few things will happen. First, nurses will be penalized by hospitals for not effectively moving patients through the emergency department. Second, there will be massive fudging of statistics during busy times. Third, patients who have exceeded the four hour threshold wait will be passed over so that patients who have been waiting less than four hours can be evaluated within the threshold.
When you pay for a statistic, you get the statistic … not necessarily the intended benefits behind the statistic.

From comments at Overlawyered.com
Employee of a surgicenter goes to facility for a colonoscopy. When he wakes up, he was wearing pink underwear. As a result, he suffered extreme emotional distress, humiliation, loss of wages and loss of earning capacity. He is now suing.
While I probably would have laughed off a prank like this, I can understand why some people would have been upset. But suffering a loss of earning capacity from being dressed in pink panties as a prank? I’d like to see how that happened.