Blue Monday

First Monday of the last full week of January is the most depressing day of the year. This is for various reasons including distance from Christmas , etc. this year in the Ed I saw two suicide attempts, and two completed suicides, including a hanging and a shotgun wound to the face ( who did survive a couple weeks) and had a flap over his face, a Tracy, a peg, etc. he shot himself because he was brought up on child sex abuse charges. There is actually a formula for calculating this day. Including days since christmas, days since failing new years resolutions, weather, motivational level

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$).

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....

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!

Another Motorcycle Injury

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!

Fake MRI

http://www.google.com/url?sa=t&source=web&cd=4&ved=0CEYQFjAD&url=http%3A%2F%2Fwww.naplesnews.com%2Fphotos%2Fgalleries%2F2010%2Fjun%2F09%2Flee-county-fake-mri-scans-pain-pills-bust%2F&ei=3_baTYnDNIrCsAPZr-WmDg&usg=AFQjCNGPXUipXq6AQxF3Jo02_5qAOJ9j0Q&sig2=FwVrJwoPauBCJPjarxNNKg

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.

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!

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

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 abuse....by 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!

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)

Prescription Drug Abuse

A recent article in Emergency Physicians Monthly, "The Joy and Wonders of Prescription Drug Abuse", found here; http://www.epmonthly.com/features/current-features/the-joy-and-wonder-of-prescription-drug-abuse-/ 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

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.

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.

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.