Via Doximity, a nice review of inflight medical emergencies:
We conducted a study of in-flight medical emergencies involving large commercial airlines, characterizing on-board assistance provided by flight crews and other passengers and identifying the outcomes of these events, including ambulance transport to a hospital and hospital admission. On the basis of our findings, we suggest a practical approach to the initial management of common in-flight medical emergencies for medical personnel who may be called on to render aid.
WE DON’T HAVE TO SEND MESSAGES THIS WAY ANYMORE, the Navy has decided.Word went out from the Navy’s Fleet Cyber Command on May 8 that the Navy’s internal messaging system now had the ability to transmit in lower case as well as the traditional upper case letters.“Therefore, it is not necessary to limit Navy messages entirely to upper case,” said the directive, first reported by the Navy Times.Of course, the message saying that upper case was no longer needed went out this way: “THEREFORE, IT IS NOT NECESSARY TO LIMIT NAVY MESSAGES ENTIRELY TO UPPER CASE.”
At first blush, the mascot’s name is rather endearing: Mr. Balls.But for those who might find that descriptive title offensive, the scrotum-shaped character also answers to "Senhor Testiculo" in Brazil, where he is a spokes-thing for a group that is seeking to raise awareness of testicular cancer research.
At the Fort Worth Municipal building, a gathering of AED/CPR survivors. I was told 10 of them; they came with their families, and there were a lot of lay rescuers and EMS, who as usual deserve the credit for a ‘save’, as if they don’t get the heart restarted in the field there’s not a lot we can do in the ER.
I was also told I was involved in the care of 4 of them. Crazy odds.
Two patients knew of me (probably from billing, frankly, none were awake in the ED), and they were 100% neurologically intact. We had nice chats, and I got my photo with both, but as I didn’t ask their permission to post them, I won’t.
It’s incredibly humbling to have follow-up on a happy ED case, and when it’s neurologically intact CPR survivors, it’s the equivalent of a Moon shot for an ER guy, and today I got four. Four.
(It’s an occupational hazard in the ED that we meet/greet/diagnose/stabilize and disposition, and what that individual patients’ medical future holds we have no idea unless we go out of our way, and we’re busy enough nobody I know goes out of their way to follow up cases).
I am renewed. I’m not a Pollyanna doc (read the blog), but this has my attention: the practice has changed, and it works.
What he said. Even Docs have to come to terms with this.
Does the doctor love going into the hospital to see a patient in the middle of the night? Does the firefighter love entering a burning building? Does the teacher love trying to control a classroom full of disrespectful children? Not likely. But the work is performed with a sense of purpose that "love" doesn’t capture.We don’t all have to become first responders or social workers. And we can’t all find jobs with such obvious benefits to society. When diplomas are being handed out, though, it might be worthwhile for graduates—and the rest of us—if the popular "do what you love" message were balanced with a more timeless message to find work that, even in some small way, truly matters.
I’ve been blessed with people in all stages of my life who supported me, and even when situations didn’t warrant it, they kept believing. My parents are alive and healthy, three terrific kids, two grand kids, a most excellent and accomplished son-in-law (and another in the wings).
Professionally I’m on plane, and keep finding new things to be curious about, and sometimes fix, the lifelong learning continues.
My wife deserves the majority of the credit for survival to this point. She kept me from dying of malnutrition in med school, and refrained from killing me when I gave her the opportunity, and she’s The Best.
We all die. Here’s just a snippet from this doctors’ experience:
…Sometimes an estranged family member is “flying in next week to get all this straightened out.” This is usually the person who knows the least about her struggling parent’s health; she’ll have problems bringing her white horse as carry-on luggage. This person may think she is being driven by compassion, but a good deal of what got her on the plane was the guilt and regret of living far away and having not done any of the heavy lifting in caring for her parent.
I’ve seen this many, many times in my ED; the child of the nearly-deceased who has been doing all the caring comes in, says essentially ‘let them die comfortably’, then come in the ones who haven’t been doing the work, haven’t seen the daily decline, and they browbeat the first into a retreat. ‘I think I misunderstood, we need to do everything’ they say to me while watching the floor; my job is nothing compared to the needless suffering they’ve consigned their dying parent to experience.
Shame on us for making dying foreign, and not the end of a life well spent.
“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.”
Many scoff at the term “death panel” — Sarah Palin’s morbid, if misleading description of the powers contained in U.S. government health-care legislation back in 2009. Yet there was a grain of truth in that infamous noun phrase. The fact of the matter is that all health-care systems have “death panels” of one sort or another. It’s just a question of who sits on them — bureaucrats, insurers or doctors — and what label we put on their functions.
Yes, I’m a terrible human being. I turned off my Amber alerts. (You can too).
Here’s the thing: If I were on the road a whole lot, Amber Alerts would be much more relevant: X is missing in Y vehicle from Z town. As I’m nearly always a) asleep or b) in my very remote near hideaway where nothing scary or even interesting happens, it’s literally alarming when these alerts come screaming through my iPhone. Disturbing, actually, in a literal sense. I feel like I should apologize more for this decision, so, I cannot imagine the heartbreak and fear involved in wondering where your child is, and I mean that. I apologize for opting out.
But, it’s the right thing for me, and it might be for you, too.
Here’s how, and it’s brutally simple:
iPhone: Notifications -> Government alerts
Just so you know, even if you turn all the Government Alerts off, you’ll still get Presidential Level alerts.
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 our 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.
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…).
‘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.
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.
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.
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.
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.
Yours Truly shows up on this list, for the first time.
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.
“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.”
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.
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.
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.