October 4th, 2009 by DrWes in Better Health Network, True Stories
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It was midnight and the Emergency Room door opened like a curtain on a Broadway. A lone man sat in blue at the countertop, writing. Behind him, the chorus, working feverishly on the protagonist – the script rehearsed a thousand times before.
Clothes off, Story?, facemask, C-collar, endotracheal tube, breath sounds, telemetry, IV’s, blood work, pulse ox, Stop.
Resume, Pulse?, patches, register, call the lab, Allergies?, epi, atropine, Pressure?, twitching, NG, x-ray, Stop. Pulse?
Resume, pacing wire, max output, capture?, not quite, “potassium?”, not ready, blood gas, foley, Capture! Stop.
Resume, blood gas, no capture, damn, tweak, better, pulse?, yes. Lab?, no, Which meds?, cardiologist, Go.
Vent, hoist, prep, stick, contrast, open, shock, balloon pump, a-line, movement, labs, blood gas, peep, transport, c-spine, CT, Go.
Then intermission. Read more »
*This blog post was originally published at Dr. Wes*
October 3rd, 2009 by Toni Brayer, M.D. in Better Health Network, Health Tips
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This little girl accidentally got Super Glue onto her eyelid. She came to the doctor without pain and she was able to move the eyeball under the lid but could not open it.
Her doctor in Decatur, Ala gently irrigated the eye area with normal saline and applied antibiotic ointment and a gauze patch over the eye area but the lid remained stuck together. The next day he was able to gently pull the lid open.
If you should ever glue parts of your body together with Super Glue (cyanoacrylate), the treatment is easy. Acetone, the ingredient found in nail polish remover will dissolve Super Glue. A Q-tip with acetone, gently applied to the area, will dissolve the bond without damaging the skin. Don’t pull the skin apart, but gently roll or peel it.
If Super Glue gets in the eyeball, the eye protein will disassociate from it over time. A warm sodium bicarbonate solution eyewash will help remove the adhesive.
Photo/story credit: Consultant
*This blog post was originally published at EverythingHealth*
September 28th, 2009 by Shadowfax in Better Health Network, Health Policy, Opinion
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A thoughtful and (dare I say it) balanced look at medical malpractice in today’s NYT:
Malpractice System Breeds More Waste in Medicine – NYTimes.com
The debate over medical malpractice can often seem theological. On one side are those conservatives and doctors who have no doubt that frivolous lawsuits and Democratic politicians beholden to trial lawyers are the reasons American health care is so expensive. On the other side are those liberals who see malpractice reform as another Republican conspiracy to shift attention from the real problem. […]
The direct costs of malpractice lawsuits — jury awards, settlements and the like — are such a minuscule part of health spending that they barely merit discussion, economists say. But that doesn’t mean the malpractice system is working.
The fear of lawsuits among doctors does seem to lead to a noticeable amount of wasteful treatment. Amitabh Chandra — a Harvard economist whose research is cited by both the American Medical Association and the trial lawyers’ association — says $60 billion a year, or about 3 percent of overall medical spending, is a reasonable upper-end estimate. If a new policy could eliminate close to that much waste without causing other problems, it would be a no-brainer.
Read more »
*This blog post was originally published at Movin' Meat*
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 19th, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Tips
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This past month, I saw a couple of patients in the emergency department who suffered from gout. When I was a medical student at Duke in the early 1970s, we commonly encountered patients with this disease, because of epidemiological factors that clustered in the southeastern U.S. Today on the west coast, we don’t encounter it as commonly. However, for those persons who suffer from gout, it’s a big deal. An acute attack of gout, caused by uric acid crystal formation and the attendant inflammation and pain, can ruin a few days of activity, or even cause a trip to be terminated.
There are a few approaches to treating a person with an acute flare of gout. The current mainstays are administration of nonsteroidal antiinflammatory drugs (NSAIDs), such as naproxyn, or antiinflammatory drugs in the form of corticosteroids. Colchicine is less commonly used.
How does a person prevent gout? The basic tenet is to minimize uric acid production in the body, and/or to prevent its precipitation into crystals within the body’s tissues and fluids. There are risk factors associated with suffering from gout, so doing one’s best to mitigate these is the proper approach. Here are some of the commonly accepted risk factors:
1. Being obese or overweight
2. Eating purine-rich foods, although there is some controversy about this, since some researchers have identified certain purine-rich foods that, in their assessment, did not seem to be associated with an increased propensity to gout.
3. Drinking excessive quantities of alcohol. This has been recognized for centuries.
4. Elevated blood pressure
5. Lead poisoning. This is one of the reasons that we saw a certain form of gout, known as saturnine gout, when I was a medical student. Persons in the North Carolina region who manufactured moonshine whiskey using an apparatus (still) that included leaded radiators from cars suffered from gouty attacks.
6. Genetics – not much you can do about selecting your parents…
7. Kidney insufficiency or failure
8. Medication use that promotes increased uric acid in the bloodstream
9. Certain blood disorders, such as leukemia or lymphoma
10. Low thyroid function
There was recently a very interesting article that appeared in the Archives of Internal Medicine, entitled “Vitamin C Intake and the Risk of Gout in Men. A Prospective Study,” authored by Hyon K. Choi and colleagues (Arch Intern Med 2009;169(5):502-507). They sought to determine whether or not higher vitamin C intake significantly reduces serum uric acid levels, and therefore the risk of suffering from gout.
Adapted from the abstract to the article: We prospectively examined, from 1986 through 2006, the relation between vitamin C intake and risk of incidents of gout in 46,994 male participants with no history of gout at baseline. We used a supplementary questionnaire to ascertain the American College of Rheumatology criteria for gout. Vitamin C intake was assessed every 4 years through validated questionnaires. During the 20 years of follow-up, we documented 1317 confirmed incident cases of gout. Compared with men with vitamin C intake less than 250 milligrams per day (mg/d), the multivariate relative risk (RR) of gout was 0.83 for total vitamin C intake of 500 to 999 mg/d, 0.66 for 1000 to 1499 mg/d, and 0.55 for 1500 mg/d or greater.
The conclusion is that higher vitamin C intake is independently associated with a lower risk of gout. Supplemental vitamin C intake may be beneficial in the prevention of gout. This is, of course, only a single analysis, so warrants further investigation by others before the assumption can be completely made that this will bear out across a larger population. Vitamin C may not really do anything to prevent a “cold,” but perhaps it is useful to prevent gout.
This post, Gout Prevention And Vitamin C, was originally published on
Healthine.com by Paul Auerbach, M.D..
