Sunday, November 13, 2011

Uodate on Baby Dolls

The baby doll owners had recently moved into town, and I had a feeling at that time they would soon be frequent visitors. They have been back a few times since then, and I saw them a few days ago. It turns out they have a new baby, who was abused, and has bruises and injuries all over. They have her as foster parents, and are trying to adopt her out (50$).

Friday, August 19, 2011

A must Post

Had to come here and post about the pt I had recently who was about 50 and a little strange during interview, but then I noticed this nice new, fancy Graco stroller sitting by his wife with two little pink bundles. "who are these little one?" I asked, and only when I stepped a little closer did I realize they were life like hand painted dolls, one even had a "stork bite", later when I came back, he was actually holding one in bed, they even had battery powered heart beats....Mady and Danielle....

Saturday, June 25, 2011

seat belt sign!

Driver ? His drunk buddy tried to say he was! Unless we are no longer in United States, I don't think So!

Friday, May 27, 2011

Bullet From Body

This looks just like the jacketed Hollow point I dug out of a guys leg today. Of course I would never actually take a picture of the real bullet, so I found a similar pic! This guy was shot for flipping off another driver who was driving erratically,

Trauma again

Another weird month is ending on the trauma service. These people are really weirdos, trauma disproportionally affects the poor, the weird, the gangsta, and the insane! They are driving me crazy too!

Monday, May 23, 2011

Fake MRI

A news story about fake MRIs to use while doctor shopping! there are many articles like this out there, just google it, they also fake any other thing you could imagine, they do things like prick a finger to put blood in urine, etc.

Sunday, May 15, 2011

Florida Gun Law

The proposed new florida gun law that has been spoken of at length on Grunt Doc's Blog is featured in this months EM News. The law would make it (potentially) a felony to even ask a patient if they have a gun in the home. You know my feelings on this issue, Docs should not be silenced, or muzzled as it were, on this issue. It is a standard child safety question to ask if there is a gun in the home of a child, then if the answer is yes, we can offer safety info, nothing more. Get a grip freaks!

Wednesday, May 4, 2011

Pea in Lung

Another unfortunate case of plant aspiration! This case is a pea plant

Tree in Lungs

This is of a russian man who had a pine tree grow in his lung, apparantely after aspirating a seed. He ended up with a lobe resection. This is a well published case.

Motorcycle Accident

Another Bike wreck photo, this from the web.

Emergency Codes

We are all familiar with the ubiquitous code blue, so much so that we refer to it as "a code" or "coding". However, there are lots of codes, sometimes a little strange. fire may be Code red, or it may be Dr. Red, Dr. Pyro, or Dr. Firestone. I recently saw a pediatric arrest code, "Code Sesame", violent pt may be Dr. Strong, Dr. Allcome, code violet, Dr. Armstrong, etc. Then, there is the colloquial Code Brown to indicate a shitty mess. wringsa

Wednesday, April 20, 2011

Earth Getting Windier

Here is a beautiful picture from a fairly recent article, National Geographic, I believe, used to illustrate recent increases in high winds around the globe. As thunderstorms and tornados tore across the south recently, this fact was brought home. The tornados were the deadliest since 2008. Did you know that the vast majority of tornadoes in the world occur in North America? Only a very few have been reported on other continents, although they have been reported on every continent except antartica.

prescription drug abuse

White house unveils new plan to curb prescription drug 15% in 5 years! I applaud the first step, but doesnt the goal seem rather modest? With pain pills killing more people than car accidents, we need to get this under control!

Sunday, April 17, 2011

Health Care Literacy in ED

According to a recent report in Annals of EM, our patient population in the ED is such that 40% have below an 8th grade level of health care knowledge. The article goes on to state that much of our patient oriented literature is focused towards at least a 9th grade level of health literacy. We should remember this carefully when constructing discharge instructions and we as physicians as well as the nurses should work to ensure the patient understands. It is so easy for us to regress to words and phrases and trains of thought that we take for granted, that the average ER patient may not understand. Nobody likes to feel like you are talking down to a pt, and we will run the risk of doing that to some patients, but we have to work to catch that bottom 40% and make sure all of our patients understand. It is easy to start out very slow and judge from the patients reactions how well they are in fact understanding and adjust from there (however, be aware that often a pt will lead you to believe they understand, simply to be amicable, when maybe they actually don't)

Tuesday, April 12, 2011

Prescription Drug Abuse

A recent article in Emergency Physicians Monthly, "The Joy and Wonders of Prescription Drug Abuse", found here; is an interesting look into the world we as emergency Physicians interact with daily. Fascinating descriptions of the lengths narcotic seeking patients can go to. I really enjoyed the article until the last few paragraphs which read

 "One day later, Hannah A’s leg has been surgically repaired and she is receiving excellent, high quality American health care services at a Top 100 hospital. The doctors and hospital, of course, will never receive any compensation for their efforts and costs. This excellent care is guaranteed to all Americans at no cost to them (but enormous cost to doctors, hospitals, and other paying patients) compliments of EMTALA.

At least four people – Ann L. and her husband, Hannah A., and Ashley M. – will be charged and arrested. If one more person is found to be involved then this becomes a Federal case with even more severe consequences to the criminals and even more cost to society.

This is a sad but true story of prescription drug abuse unintentionally enabled by the U.S. Medicaid program. This broken system fosters extreme fragmentation in health care delivery and sticks doctors and hospitals with the costs and liabilities of providing care without hope of remuneration.

We can and should do better. "

In this conclusion to the article, the author's tone turns decidedly more bitter. He is no longer just telling a fun, entertaining, and educational story. He is railing against what he sees as the problems in our society. While the things he said may well be true, they are not helpful here, and they represent a foul attitude of a few that does not need to be fomented and spread amongst the medical community. Does not need to be encouraged as acceptable thought, particularly not for an emergency physician. We (theoretically) do what we do as emergency physicians because we (largely) believe in access to care for all in their time of need, no questions asked. We already practice universal health care, and this is how it should be. EMTALA is the best thing that ever happened to emergency medicine. Even if you dont agree with the social and economic implications of the law, it has been responsible for the exponential growth of our field, and the high demand and high salaries we all enjoy. Should Hannah A with her tib fib fracture have received sub par care because she is a drug addict and a criminal? The author seems to suggest so. She didn't deserve excellent care at his "top 100" hospital. While I grow tired of dealing with the drug seekers, the crime in my city, and the drug related deaths the community has to contend with, I would caution against this kind of thought. It is dangerous, and there is no room for it in the emergency department

Saturday, April 9, 2011

Qat and bath salts continued

Here is Qat, a mildly hallucinogenic form of speed, chewed throughout africa, parts of asia, and oceana. As for the case i saw recently, the woman had been out partying at the bars all night and called the squad for severe pelvic pain. She was found in bed with two men. She complained that her vagina hurt and her rectum hurt, and "I have cum all over my leg". She was a ridiculously difficult and aggressive patient. She thought I was a "prick". Oh well, my first case of bath salt abuse anyway.

Thursday, April 7, 2011

Bath Salts

Recently saw my first patient using Bath Salts to get high. Been reading about this for some time, but Hadn't had a pt admit to using them. These synthetic amphetamines are marketed as bath salts and sold at 75 dollars a gram (who would pay that to bath in something? ). These designer amphetamines are commonly called synthetic cocaine, or meth. In reality, most are more akin to the african plant, Kat (or Qat) and contain Mephedrone. They produce more than the hyperactivity and euphoria of Cocaine and meth. They have much more affect on psyche, and cause hallucinations. Recent Case reports have included a man in Tampa who tore a radar out of a cop car with his teeth and required several officers to subdue, a woman who attacked her mother with a machete, and another who attempted to extract his own liver with a mechanical pencil (case reports come from EP Monthly article by Timothy Erickson) Wow! More on these substances and on the case i saw in my next post.

Wednesday, April 6, 2011

Drive Through ER

The Drive Through  Emergency Room. An idea I discussed when it was first trialed back in fall 2009 during early stages of the Swine Flu Scare. After reading several articles discussing this trial, it seems that it worked smoothly enough, particularly would be good to break out during a pandemic, or even yearly flu epidemic. This would keep infectious people out of the crowded ED waiting room and speed through put times during a taxing period.

Sunday, April 3, 2011

central arkansas

Check out the new field for UCA! I hear no new extreme fields are allowed in D1, everybody else can go crazy! also check out eastern washington if haven't seen it.

Saturday, April 2, 2011

A Brief Foray

A quick sally into a realm I do not dare attempt conquer. A lady arrived in my ED today, status post her second elective abortion, about six weeks ago. She was obviously poor and uneducated. She was having some lower abdominal cramping. She had also experienced some spotting after her bleeding had stopped from the abortion. She was concerned, but didn't want to see her OB, because she felt ashamed of what she had done with her last pregnancy. After a thourough evaluation, the only abnormality I could find was a positive HCG. Ultrasound confirmed a gestational sack, and I took her the news. Your pregnant.

Friday, April 1, 2011

Gun Debate from The Grunt Doc

Check out the Grunt Doc Blog, if you haven't already, probably the most nationally recognised blog in EM. A recent post there about the following Florida debate as posted below led me to comment, and posted at bottom is the comment I made in reply to others. Please see Grunt Doc page for full story.

The National Rifle Association and other gun rights groups had pushed for a much stronger bill that would have precluded doctors, in many cases, from asking patients about whether they own guns. Backers of the measure, sponsored by Sen. Greg Evers, R-Baker, had said patients were being harassed over gun ownership.

But citing the confidentiality of what is said between doctors and patients, and a broader desire to protect other members of patients’ families, doctors had pushed back hard against the bill (SB 432). The issue had promised a fight between two of the most powerful lobbies at the Florida Capitol.

But an amendment adopted before the committee’s vote on Monday would now generally allow doctors to ask questions about gun ownership, as long as the physician doesn’t “harass” the patient, and doesn’t enter the information into the patient’s record without a good reason. That leaves enough room that doctors now support the measure, as does the NRA.

via Doctors, Gun Groups Compromise on Gun Ownership Questions
Sunshine State News

5.doc hog Says:

April 1st, 2011 at 9:42 am

Drug, gang violence, maybe. Kids for sure. Professor Hale, I have no trigger locks either, but that is a standard safety question that can be found in many pediatric text books right there with car seats, toxic materials in home, etc. It is just to allow parents to think about safety, there is no law that says they have to have the locks, and we wouldn’t pursue it any further. Doctors are in a unique place at the crossroads between science and the humanities, and we have always been directly in the “social change lane.” See Howard Dean, Rand Paul, Ron Paul, Jean Paul Marat, Bill Frist, Che Guevera, Anton Chekov, Arthur Conan Doyle, W. Somerset Maugham, William Carlos Williams, Oliver Wendall Holmes, James Mchenry (US Constituition signer), among many, many others. We are an integral part of social change. Like I said, I own multiple guns, and they would have to pry them from my cold dead hands to get them, but we are not talking about gun control here.

Thursday, March 31, 2011

http://http// Here is the link to a new article about a plan at one seattle area Emergency Department that has greatly reduced the amount of narcotics prescribed. Pretty interesting, but really extreme. Maybe this is what we need now?

Wednesday, March 30, 2011

Bitemporal Hemianopsia

Bitemporal Hemianopsia
vision missing in the lateral, temporal half ofboth visual fields. Caused by compression of the optic nerve at the optic chiasm, affecting the bilateral medial retina. Most often due to tumors of the pituitary that are forced to expand upward because of the bony "saddle" they sit in, the sella turcica, or turkey saddle. Here you see an interesting example direct from the number one most frequently used medical resource, wikipedia. This example shows two views of Paris. The second obviously with bitemporal hemianopsia. Loved these pictures, and love wiki, so had to post them. Enjoy.

Back and Bigger and Better

We are back! Yes, I couldnt stand to stay in private mode any longer, nothing to post for. Screw the gestapo! Of course, I did have to delete several posts that I had posted during the time the blog went under the radar, but no matter. The Hog Blog is coming back and with more posts, more stories, more case reports, and more bullshit than ever. And I have a special, heart warming, story to celebrate with......Recently, a young lady with crohn's has made multiple visits to our emergency department. She has a jejunostomy, and she has had various episodes of cracking and bleeding around the ostomy site. After much prodding on her fifth visit for the same complaint, she admits that she is actually a prostitute, and she is selling sex with her ostomy site! We called her the "Ostitute"!

Friday, February 25, 2011

Paul Broun

Paul Broun, The doctor turned Congressman from Athens, GA who allowed rhetoric about assasinating Obama to go unchallenged at his own rally is a disgrace to both of the professions he represents. His inaction and complacence is no better than that of Sarah Palin or the silent under Hitler. Let me say, he does not represent all doctors. Unfortunatly, he does likely represent the majority, but definetly not the majority of ED docs. or is it spelled Paul braun?

Thursday, February 24, 2011

Primum non what?

Primum non nocerem (sp?) What about first do nothing, primoris, operor nusquam? I think that was the fat man's motto, and it served those guys well enough, not doing bad for me either.

Tuesday, February 15, 2011

Difficult Family

A particularly difficult family member was my problem recently. a real pain in my ass. His mother, an 89 year old bed bound nursing home pt, was dying. Shitting blood and bleeding out through the gut. She looked like a picture of death when she rolled through the door, and my first move was to look for a code status, which I fully expected should have been "Do not Resuscitate." It was not. We all began to mutter under our breaths and slowly began to work on the unfortunate woman. Torture her, we said. We were just preparing to intubate when they brought her son back. He was in tears. Didn't he expect this? Despite pointed questions and multiple attempts, he was adamant that the woman should be full code. We intubated her, put in a central line, and began dumping in fluids and uncrossed blood. Her initial hemoglobin was 4.4. She coded multiple times, and we collapsed her chest wall with our compressions. I made repeated visits to the son in the family room; updating, and occasionally pleading the case to withdraw support. He had family members on the way, could we just keep her going until they arrived? He was crying constantly. We worked for three hours, diverting care from younger, healthier patients who just had to wait. Finally, the grandchildren arrived, and slowly, after much talk with the chaplain, the nurses, and myself, the man decided to withdraw support. The woman went quietly, in a darkened room, surrounded by family. When it was over the man hugged me, thanking me repeatedly. He cried some more, and this time I cried as well. I had bought him the time he needed to come to grips with his mother's death. Maybe I still resented him a little for what I felt was prolonging her misery, but at that moment I felt understanding for his point of view, and I realized that often we feel family members are "difficult" or hard to deal with, largely because they just dont agree with exactly what we think should happen, and the decision does not rest solely with us.