September 21st, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Tips
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This is the next post based upon a presentation given at the Wilderness Medical Society Annual Meeting held in Snowmass, Colorado from July 24-29, 2009. The presentation was about trauma and orthopedics. It was delivered by Douglass Weiss, MD of Teton Orthopaedics in Jackson Hole, Wyoming.
Utilizing some fabulous images, including those of Lanny Johnson, Dr. Weiss made some important points. Many of these are familiar to seasoned medical practitioners, but they merit repeating. First, when approaching a victim, always attend to the “ABCs” first – airway, breathing, and circulation (including bleeding) – so that a life can be saved. Then, if possible, take into account other injuries, including those of bones – save the limb, save the joint, and restore function.
Here are two good pointers. First, your field evaluation of the victim may be the only complete one, so do your best to examine the entire victim, and also to document in writing what you discover. Examine and establish the airway, listen for breath sounds, observe chest movements, feel for pulses and observe skin color, etc. Within the constraints of the situation and environment, “expose” the victim in order to evaluate bony and other injuries. The, move on to the “secondary” survey, which will include examination of the neck, back, pelvis, arms and legs, looking for swelling, bruises, scrapes, cuts, bleeding and deformities. If you feel inappropriate motion (e.g., broken or dislocated bones or joints), be prepared to apply splints.
Always try to roll the patient (using a logroll technique if necessary) to examine the victim’s back.
For the benefit of doctors reading this post, remember that if a fracture is identified, suspect an injury to the joint above and below the fracture, and be sure to splint these for the comfort and protection of the victim.
The application of splints is an art form, so should be practiced prior to your expedition. Any limb that is obviously deformed or that demonstrates excess motion (where there should be none) should be immobilized immediately. If a helper(s) is available, use assistance. Be sure to pad all splints very well to avoid pressure injuries to the tissue underneath. Depending on the rescue, the splint may be in place longer than you anticipate.
If a broken bone (fracture) is “open” (the bone has poked through the skin), then apply a wet (preferably normal saline or disinfected water) dressing and apply a splint. If you have an all-purpose antibiotic (e.g., cephalexin, amoxicillin or ciprofloxacin) and the victim is capable of purposeful swallowing, administer a dose.
Fractures of the pelvis generally imply that a very significant force was applied, so they carry a high risk for associated life threatening injuries. The victim should be evacuated as soon as possible. It is commonly taught that a broken femur (the long bone of the thigh) can cause bleeding in excess of a liter into the limb. This can be dangerous, so these injuries should be promptly splinted, preferably with a pre-fashioned or improvised traction splint.
Compartment syndrome occurs when tissue pressures within inelastic soft tissue compartments of the limbs (commonly the forearm or lower leg exceed perfusion pressure, that is, the pressure necessary to allow blood to circulate freely through the tissues and provide energy and remove waste products. Symptoms include extreme pain, loss of pulses, pale skin color, weakness or paralysis of the muscle, and numbness and tingling. If the pain is severe and the skin feels tight, a compartment syndrome may be developing. If a compartment syndrome is felt to be impending or present, keep the limb elevated and seek immediate medical attention, because an operation may be required to open the compartment and release the pressure before the onset of permanent tissue damage.
Thanks to Dr. Weiss for his contribution to wilderness medicine education.
This post, Tips For Evaluating Injured People In The Outdoors, was originally published on
Healthine.com by Paul Auerbach, M.D..
September 21st, 2009 by DrWes in Better Health Network, Opinion
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Here’s a dumb thought: If you want to save costs on medical devices to the federal government, require a tax fee concessions of $4 billion dollars from the medical device companies to fund a health care overhaul.
Now either that $4 billion will get added to the cost of devices (and the patient/insurer’s tab) or the device companies will decide that they must pay the fee to maintain their current pricing.
Government pressures hospitals and doctors by paying less, so hospitals keep the heat on medical device makers to lower costs so they can make their margins.
It all sounds good, right?
But according to one analyst, it seems device makers would rather pay the fee than make their prices transparent:
But the mechanism for how devices companies might pay matters more than what they pay, according to Morgan Stanley analyst David Lewis. “A ‘flat tax’ is preferable, in our view, to targeted industry fees as our larger concern is the creation of more infrastructure intended to catalyze pricing transparency,” he said.
And so, with the fee, the government pays itself while the medical device prices continue to remain inflated.
Why do the patients always seem to lose with these government-mandated scenarios?
-Wes
*This blog post was originally published at Dr. Wes*
September 21st, 2009 by Emergiblog in Better Health Network, Health Policy, Opinion
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Well, I lead a double life but it isn’t out dancing in formal wear!
“There is time for only fleeting thoughts about that dance you’ll attend during off duty hours.”
There isn’t even time for that.
Besides, who attends a dance during on duty hours?
Well, I guess the most important thing is that our hands are “soft, smooth and free from redness” because “your patients like it and your date expects it”.
Oh yeah?
The day they use a hand sanitizer thirty times in a shift and wash their hands another twenty, they can talk to me about soft hands.
********************
My husband won’t watch football with me because I tend to get hyped up and throw things at the TV when I get upset.
That explains why there were Notre Dame pom poms and a Cleveland Browns jersey at the base of the set this weekend.
I also like to talk back at the President when he is speaking on TV. Usually it’s things like “Say WHAT?” or “Give me a break!” “Get. A. Clue!” is usually a good one. This last speech, the one to Congress about health care, was no exception. My first comment came a bit into the speech when I noted a few times that “I haven’t heard a single thing I disagree with yet” and “he’s right on that point”.
I was afraid hubby was going to need smelling salts.
But I’m like, “let’s hear how he is going to pay for this…let’s hear him out”.
And then I heard it.
And then he lost me.
*****
There were two comments that I could not let go. I looked them up in the text of the speech to make sure I had heard them correctly.
“…we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system a system that is currently full of waste and abuse.”
“The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud…”
Hundreds of billions of dollars? Billions? With a capital “B”?
Waste. Abuse. Fraud.
This means that in order to pay to the proposed health care reform, we have to find enough waste, abuse and fraud to cover expenses.
*****
But I have some questions.
What is the definition of “waste”? To the extent that “waste” means inefficient bureaucratic practices that use up monetary resources, I can get on board with that.
Abuse? What kind of abuse? Using the system inefficiently, like calling an ambulance for a stubbed toe? Remember, the President is using the term “abuse” to represent a potential income stream for the new system, so it would have to encompass behaviors that spend money that should not be spent. Money is spent on patient care, so is he talking about patients abusing the system?
And then there’s fraud…
That’s a crime, folks.
Hundreds of billions of dollars in waste and fraud?
The President must think that there are an awful lot of criminals in the health care system.
So what’s my point?
*****
My point is this: funding for the new proposed health care system (see “most of this plan…”, above) is based on finding waste, abuse and fraud.
What happens when all the waste is taken out, all the abusers are stopped, the fraudsters jailed and the system needs more funding? Does that not make it imperative that we keep finding waste and abuse and fraud? Does that not mean that what constitutes waste, abuse and fraud must be constantly expanded to make up for rising costs?
This can’t be good.
I am in total agreement that our system can be streamlined, big time.
And maybe we could find enough money in waste, abuse and fraud to make it pay for itself, but I doubt it.
If we could do that, wouldn’t we have done it already with Medicaid and Medicare? The budgets for both are getting slashed on a regular basis. Drop the waste, abuse and fraud in those programs and then come back and tell me how much better their budgets are.
If we can’t do it in an existing government-provided system, how on earth do you expect us to believe it can be done on a larger scale?
*This blog post was originally published at Emergiblog*
September 20th, 2009 by Nancy Brown, Ph.D. in Better Health Network, News
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There was a very interesting article in Reuters Health in June that has stayed with me all summer, and I finally decided to share it with my readers – in hopes that writing about it will help me quit thinking about it!
The data for this study came from more than 20,000 teens involved in the 1995 – 2002 National Longitudinal Study of Adolescent Health, a nationally representative school-based survey done with students in 7th through 12th grades.
The results from this disturbing study suggested that about 15% of teens believed they were likely to die prematurely, which predicted increased involvement in risky behavior and poor health outcomes during young adulthood. The question apparently asks if teens think there is at least a 50/50 chance that they will die before the age of 35, and the students who believed they would die prematurely were more likely to report illicit drug use, suicide attempts, fight-related injuries, police arrests, unsafe sexual activity, and a diagnosis of HIV at subsequent data collection points.
I guess I am not sure what to do with this information. On one hand, it suggests that all of the adults in teenagers’ lives – parents, teachers, coaches, doctors, neighbors, and family members – should pay attention to what teens think about premature death, calling for more communication, which I am supportive of, but how exactly would this subject come up?
I do not think asking how long they expect to live is the answer, but instead I do believe that adults can focus more on staying connected with teens and promoting optimism and hope in youth. I do not believe this means not talking about youth in meetings, but actually spending time with those youth where they spend their time, teaching them skills, sharing a sense of accomplishment, and making a physical and meaningful connection with each of them. Every teen needs to have multiple adults they can talk to and spend time with, especially during times of stress or interpersonal conflict.
Listening to teens talk about their friends, their futures, and their insecurities is a window into their expected life course, and being present enough to hear comments reflecting a “why bother” attitude may be the key! Please listen to your teens and help them feel positive about themselves today!
This post, Many Teens Believe They’ll Die Prematurely, was originally published on
Healthine.com by Nancy Brown, Ph.D..
September 20th, 2009 by Toni Brayer, M.D. in Better Health Network, Opinion
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I read a good post from NYT about Health Care Reform and ‘American Values’ and it got me a thinkin’…just what are American Values when it comes to health care? Usually I get a little anxious when I see “American Values” in a sentence, because what usually follows is something about rugged individuality, pulling oneself up by bootstraps, getting the damn government out of our lives and those damn immigrants and welfare mothers who won’t work and want to live off others.
But I have listened to about ten thousand patients over the past 25 years, and I have a good idea of what these Americans want for health care. They are the silent majority…the people who work, study, raise their kids and seldom call into a radio talk show. They don’t have time to go to town hall meetings and shout slogans.
They range from age 17 to 101 and most of them are middle class. They come in all races…Asian, Black, White, Pacific Islander and mixes of all.
Some are wealthy enough to have multiple homes and private planes.
Some are uninsured and watch their health care spending very closely. Most were thrilled to get Medicare and I’ve never heard a complaint from a Medicare patient.
Here is my list of what these Americans think about Health Care:
- They do agree that everyone should be covered for basic health care and would pay higher taxes if they could believe that there would not be fraud and waste. (The recent banking meltdown has destroyed all confidence that government can regulate or be independent from special interests)
- They want choice of physicians and hospitals
- They are sick of insurance companies and all feel like they have been screwed in one way or another. They are shocked at how little insurance companies pay toward the doctor visit and the way those fees are discounted.
- They are technocentric and want tests, imaging, referrals and think “more is better” when it comes to health care. They think tests are cures. Because of the perverse incentives, the “more is better” philosophy benefits doctors and hospitals, but not necessarily patients.
- They fear losing insurance if they have it.
- They are confused about the current reform debate and mostly fear losing whatever coverage they now have, because they know how impossible it is to get by without any coverage at all.
There are no such thing as “American Values” because we are a diverse group of people. But we all have certain things in common. We want to be healthy. We don’t want to be screwed by anyone (big business or the government).
We want to be able to manage our own health care but we don’t want to have to decide between numerous health plans every year with pages of information that cannot be understood. We are tired of not knowing where all the $trillions really are being spent.
We want to know the price of a service up front, and we want a trusted physician to help us decide if that is how our money should be spent. We want smart, committed physicians to know us, and not hurt us.
Sounds American to me.
*This blog post was originally published at EverythingHealth*
This is the next post based upon a presentation given at the Wilderness Medical Society Annual Meeting held in Snowmass, Colorado from July 24-29, 2009. The presentation was about trauma and orthopedics. It was delivered by Douglass Weiss, MD of Teton Orthopaedics in Jackson Hole, Wyoming.
