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Man Accidentally Shoots Nail Into His Neck, Narrowly Avoids Fatal Injury

According to Boston News, in early December 2011, a carpenter accidentally discharged a nail gun and embedded a 3.5 inch nail in the bottom of his neck. Based on the CT scan included here, it appears the nail entered the neck dead center given the clear appearance of the windpipe.

Based on the location, the anatomic sequence of nail piercing is as follows:

Skin –> Thyroid Gland –> Trachea –> Esophagus Back Wall –> Cervical Vertebral Body

The damage to skin, thyroid, and trachea is not a big deal… In fact, one can consider this a mini-tracheostomy. Minimal bleeding would be expected.

However, the hole between the trachea and esophagus is another matter which may heal well… or not. The esophagus Read more »

*This blog post was originally published at Fauquier ENT Blog*

When Public Health Legislation Is More Effective Than Physician’s Advice

Last month, my family was involved in a scary traffic accident en route to the Family Medicine Education Consortium‘s North East Region meeting. I was in the left-hand eastbound lane of the Massachusetts Turnpike when a westbound tractor trailer collided with a truck, causing the truck to cross over the grass median a few cars ahead of us. I hit the brakes and swerved to avoid the truck, but its momentum carried it forward into the left side of our car. Strapped into child safety seats in the back, both of my children were struck by shards of window glass. My five year-old son, who had been sitting behind me, eventually required twelve stitches to close a scalp laceration. Miraculously, none of the occupants of the other six damaged vehicles, including the truck driver, sustained any injuries.

Family physicians like me, and physicians in general, like to believe that the interventions we provide patients make a big difference in their eventual health outcomes. In a few cases, they do. But for most people, events largely outside of the scope of medical practice determine one’s quality and length of life, and Read more »

*This blog post was originally published at Common Sense Family Doctor*

Emergency Contacts In Your Mobile Phone: Let ICE Speak For You When You Can’t

A good friend and fellow physician sent me this notice. This is an important public service announcement.

An individual citizen, not the government, initiated the program.  If adoption of the program becomes a national standard, it will demonstrate people power and individual responsibility.

The key to Repairing the Healthcare System is individual responsibility. This program represents an opportunity for every individual to assume responsibility for themselves and alert everyone they know to be responsible for themselves.

A paramedic conceived ICE.  At the scene of accidents he found cell phones on an unconscious victim but he could not find whom to notify.

He thought it would be a good idea if there was a nationally recognized symbol to find a victim’s contact person In Case of an Emergency in the victims cell phone directory.

The ICE cell phone number could be Read more »

*This blog post was originally published at Repairing the Healthcare System*

Killed By TPN: A “Never-Ever” Hospital Event?

Recently, nine patients died in Alabama when they received intravenous nutrition that was contaminated with deadly bacteria. This type of nutrition is called total parenteral nutrition, or TPN, and is used to nourish patients by vein when their digestive systems are not functioning properly. It is a milestone achievement in medicine and saves and maintains lives every day.

What went wrong? How did an instrument of healing become death by lethal injection? What is the lesson that can emerge from this unimaginable horror?

This tragedy represents that most feared ‘never event’ that can ever occur – death by friendly fire. No survivors. Contrast this with many other medical ‘never events’ as defined by the Centers for Medicare and Medicaid Services, such as post-operative infections, development of bed sores in the hospital or wrong-site surgery. Under the ‘never events’ program, hospitals will be financially penalized if a listed event occurs. Many physicians and hospitals are concerned that there will be a ‘never events’ mission creep with new outcomes added to the list that don’t belong there. Medical complications, which are unavoidable, may soon be defined as ‘never events’.

Do we need a new category of ‘never ever ever events’ to include those that lead to fatal outcomes? Read more »

*This blog post was originally published at MD Whistleblower*

Why You Shouldn’t Take A Stroller On An Escalator

There’s an epidemic at our malls: parents taking their small children up and down escalators in strollers of all sorts of sizes and shapes. I ended up behind one such parent yesterday and found strollers heading up and down all afternoon. Some were small, some large. Some had bags dangling off of them, others not. Sometimes parents had both hands on the handles, other times they were balancing the stroller and a drink or cell phone. Read more »

*This blog post was originally published at Dr Gwenn Is In*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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