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!

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.

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.

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.

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.

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.

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"!

New Post

It has been a while since I have made a new post, but working a lot in the ICU again. Also, I am thinking of going to a new concept on the blog in general. I will fill you many loyal readers in on this in the future. The world awaits with baited breath. As part of this new concept, I would ask all the people who casually follow the blog (if there are any) to add themselves to my official reader list, or whatever it is called. Being a follower will facilitate moving to the new style of blogging. You will understand when I unveil the new plan. Thanks for staying posted!

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.

First Case Post By Red

Hi everybody! My name is really Arthur, but some people call me "Red". Hope you like the case format. These cases are not complete and are not intended to really teach, but are just for fun.....A three month old girl presents with profound muscle weakness, and "Floppyness". On exam, hepatomegaly is noted. The chest X-ray is shown. Note Cardiomegaly. There has been no exposure to honey or home canned goods. .....The child has Pompe disease......An autosomal recessively inherited lysosomal storage disease. The deficient enzyme is alpha glucosidase, which is needed for glycogen breakdown.......The disease was first characterized by Johann Pompe in 1932. Pompe was danish, and was executed in 1945 by Nazi Germany for espionage.....The disease is also featured prominantly in the upcoming film Extraordinary Measures, which I believe is a statement against big pharama, and Bristol Myers Squib in particular. ......Besides Botulism (alluded to in the pertinent negatives of the case), a differential would include Werdig Hoffman disease. ...Stay tuned for more cases in the future. I hope to do atleast one every couple of weeks. Thanks!

And Speaking of Dogs...

A nurse in the ED recently saw her grandfather pass away. He was old and chronically ill, and he was admitted through our ED and died several days later on the floor. I told the nurse I was sorry. She said thanks, but the worst part was that she had to pay the money to have the old man's dog euthanized. That Bitch!