Pea in Lung

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

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.

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.

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.

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.

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.

http://http//www.ncbi.nlm.nih.gov/pubmed/21141080 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?

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"!

White Wedding

At a nearby doctor's office, where an internal med friend of mine was doing his "rural med" rotation, a wedding occured recently. The receptionist was married on her lunch break, with the doctors and office staff presiding. A minister showed up and everything. The cake was a dairy queen ice cream cake. Two Avatar action figures were placed on top, with their faces lit up. It was beautiful! After lunch, the groom went home, and the bride returned to work! They have no plans for a honeymoon. It is the third marriage for her, not sure about him.

Rectal Foreign Bodies

The people who have worked around an emergency department for years have seen all sorts of rectal foreign bodies. everything from gerbels (often in weather men or local news anchors if you believe the urban legends) to coke bottle to vibrators, shampoo bottles, fruits and vegetables, and whatever else you can think of. I have only seen a vibrator, a condom half full of crack (crack in the crack), and most impressive, one of these long oil funnels that is big on one end and tappered on the other. The bad thing is, this guy (who was just changing the oil in his car naked and slipped and fell on top of this thing on accident), had it in his rectum big end first! HOW!? Good thing is, it was easy to remove. pass a foley through the hole, blow up the balloon and pull it out. Crazy guy!.......in other news, arthur "Red" Heirin is working on his first case presentation for the blog, and it should be up soon. Stay tuned.

Bad Weather, and the razorbacks season in review

With a patch of bad weather coming through the area lately, the ER has been busy. Car accidents, of course, and slips and falls with broken hips, and broken everything else, and hypothermic bums, and hypothermic little old ladies. And of course fires, which are the worst, and even people getting killed trying to make fire, like the two different guys we have seen killed cutting firewood this winter. I am certainly not a global warming naysayer, but this is the coldest winter since at least 1977 in many parts of the world. It is the coldest it has been in Key West for 131 years! I like the cold sometimes, but this is causing a lot of anguish, and is having all kinds of unseen effects like driving up fuel prices, and may even contribute to another flu (swine or otherwise) outbreak by keeping everyone jammed together in doors. ... (By the way, sorry to use all these dots and wierd punctuations, but it seems you can't start a new paragraph and indent on here.)..... Anyway, I have been using some of my extra time inside to reflect on the razorbacks. I am happy with the bowl we got, and I think we beat a tough team, from a tougher than most think conference. I am not Happy with Mallett, though. He looks like Gumby trying to play football, and he thinks he could have even thought about going pro? I doubt it. But the thing I hate the most is here he is, after his "sophomore" year, wanting to go. We know he doesn't care about the team. We can see where his selfish thoughts lie, and we have to spend the whole next season knowing he is leaving us early, and wishing he could have done it sooner. Oh well, I do think we will have an awesome season next year, maybe we actually will be a contender in the west?

New Year

New Year, same shit. Haven't had a day off since last year! I was thinking last night, well actually I woke up in a cold sweat last night, thinking about the guy that died, and was asystolic for about ten minutes, and we hade spoken to the family, and went back to work, when he suddenly sat straight up in bed, let out a blood curtling scream, and fell back, dead as ever! That shit will fuck with your head! ............Thinking about adding an author or two to the blog, like maybe my friend cade....I don't know/ Not that anybody actually reads this anyway, but if anybody does, what do you think about me adding an author, maybe two? It might create more posts, and add a different voice and viewpoint. Cade, I don't know what he would blog about....nonsense probably, but I am thinking about adding an author who is actually interested in medicine as well, who can provide some case scenarios and pictures and (cool?) stuff like that. I mean, I do put some cases on here, but just when it is gruesome or gory or sad or something, maybe he could come on and just do some medical teaching

The lounge

I did forget to mention the one improvement I have contributed to the lounge. I stuck a random picture of bisphosphonate related osteonecrosis similar to this on the bulletin board right above the lunch table. This is a totally rare and irrelevant disorder as EM is concerned, but the pic is so nasty I had to hang it.

Christmas Muzak

The Muzak that is piped into our floors, much like in the house of god is noramally very annoying, but it was even more so this christmas. For one thing, it had been turned off for nearly six months after the "Highway to Hell" by ACDC was playing overhead during a nasty ED code. When they did turn it back on it was christmas music. When the same christmas songs are looped through an average of 4 times during the course of a 12 hour internal medicine shift, it can be very annoying, to say the least. It starts to be very depressing as well. Particularly when you see a 90 yr old parkinsonian gomer lying in bed, Q sign on face, staring at the ceiling, and twitching, seeminly to the beat of deck the halls.

Resident Lounge

The lounge, as I have said, has been a special project for my friend Cade. Now he has had his set backs, but, he has done a great deal to improve it. Miss Ann Thrope, and others have put time into making the place feel more comfortable and home like as well. Now, Darshita, one of the new first year residents has decided to take a collection to put in a video gaming system. Everyone has agreed and it sounds like a great idea. I have refused to contribute the first red penny, even after Darshita had to inform everyone that the price per person would be rising just because I was the one person who would not pitch in. I feel like Yossarian when he refused to contribute to the building of the officer's club. "Actually there were many officer's clubs that Yossarian had not helped to build, but he was proudest of the one on Pianosa. It was a sturdy and complex monument to his powers of determination. Yossarian never went there to help until it was finished; then he went there often, so pleased was he with the fine, large, rambling shingled building. It was truly a splendid structure, and Yossarian throbbed with a mighty sense of accomplishment each time he gazed at it and reflected that none ofthe work that had gone into it was his. " Actually, as my residency experience drags on, I begin to relate to Yossarian, trapped on Pianosa, more and more. And I see the awful similarities between the military beurocracy described in the book and the sphere of academic medicine. I think the infamous hang up is actually written into our own by laws somewhere, or evrywhere. At least nobody is trying to kill me, at least that I know of.

The Penis Surprise

I Gave a lecture today, and as a policy I always try to sneak a Nasty Penis picture into every presentation. I always spring it when people least suspect, like right in the middle of a series of slides depicting all the images of the FAST exam. This picture of circumate balanitis (for those who wish to know) was the one I snuck in today. Just as I moved from ACute mountain sickness with High Altitude Pulmanary Edema and transitioned to High Altitude Cerebral Edema, I flashed the picture. I should start offering bonus points for the first person to name the various penis pathologies.