Subaqua Sternal Rubs

Welcome to a new category: stories of my adventures in an Emergency Department in New York's Capital District. (And for those of you from out of state, that's not New York City.)

Just in case you didn't know, evidently crack rock mixed with cocaine is extremely flammable. (Or is it inflammable - Dr. Nick) At 3 am, a 50 year-old female was delivered to the Emergency Department complaining of a sore throat after being in a house fire. The ambulance drivers (side note: I hate this term, but these guys really earned it) (another side note: they were actually firefighters) brought her in BLS, even though they had ALS available. Not even any oxygen, just a taxi ride.

The woman presented with pain in her throat, some shortness of breath, and soot on her face, down in her nares, throat and on her hands. She said that she was the victim of a stove fire. However, due to a phone call from the patient's daughter, we found out that the patient was "free-basing" crack/cocaine, and thus started the stove fire after the rock blew up in her face.

The burns to the patient's face and airway caused swelling to the larynx so that less air was getting to the patient's lungs. Upon arrival, the patient's oxygen saturation was 90%. While not horrible, this value should be above 97%. Due to the increasing laryngeal swelling, the physician opted to use rapid sequence intubation, in which medications are given to relax all muscles and make the patient unconscious, and then a tube is passed into the airway to protect it and keep it open. The ventilator was then connected to the tube to breath for the patient, as medications keep them unconscious.

Upon getting the labs back, looks like our patient was having a little too much fun. The urine drug screen came back positive for methadone, barbituates, tricyclic antidepressants, marijuana, benzodiazapenes, and crack/cocaine. Actually, estimate is that the patient was in the fire for half an hour because she was so "wacked-out," she didn't recognize that the house was on fire and she should probably leave.

Now remember kids, crack/cocaine is flammable, so always practice good fire safety.

Not only did Vioxx not work for me, it has now has been shown to have an increased risk of heart attack and stroke:

Pharmaceutical giant Merck & Company is pulling its blockbuster arthritis drug Vioxx from the market worldwide because new data from a clinical trial found an increased risk of heart attack and stroke.

Whitehouse Station-based Merck said Thursday that data from the trial showed the increased risk of heart attack and other cardiovascular complications began 18 months after patients started taking Vioxx.

The data comes from a three-year study aimed at showing that Vioxx at a 25 milligram dose prevents recurrence of polyps in the colon and rectum. The trial was stopped after Merck discovered the higher heart risk compared to patients taking dummy pills.

Seen at:

Kevin, MD
DB's Medical Rants
Rangel, MD
Blogorygmi

Finally, a little reprieve from George W. Bush's police state:

Judge blocks part of Patriot Act
Secret searches unconstitutional, he rules

NEW YORK (AP) — Declaring that personal security is as important as national security, a judge Wednesday blocked the government from conducting secret, unchallengeable searches of Internet and telephone records as part of its fight against terrorism.

The American Civil Liberties Union called the ruling a "landmark victory" against the Justice Department's post-September 11 law enforcement powers.

"Today's ruling is a wholesale refutation of excessive government secrecy and unchecked executive power," said ACLU attorney Jameel Jaffer.

U.S. District Judge Victor Marrero struck down a provision of the Patriot Act that authorizes the FBI to force Internet service providers and phone companies to turn over certain customer records. The companies are then barred from ever disclosing the search took place.

In his ruling, the judge called national security of "paramount value" and said the government "must be empowered to respond promptly and effectively" to threats. But he called personal security equal in importance and "especially prized in our system of justice."

CNN.com - Judge blocks part of Patriot Act - Sep 29, 2004

CHRISTCHURCH, New Zealand (CNN) — Imagine a computer program so clever, it senses the level of pain a patient is in and measures the exact amount of pain relief and sedative drugs they need.

A team of New Zealand engineers and medical experts is working on a device that will be able to do just that.

They hope their development will eventually be available for commercial use, potentially saving hospitals throughout the world billions of dollars in wasted drugs. It will also help speed up patient recovery.

The project began two years ago when University of Canterbury student Andrew Rudge, 25, began searching for a subject for his PhD in mechanical engineering.

His lecturer, Dr Geoff Case, had earlier met with Dr Geoff Shaw, an intensive care specialist at Christchurch Hospital, who had told him about the inherent problems in managing critically ill patients' sedative and pain relief drug dosages.

Shaw told Case that current methods of assessing pain and agitation in patients were very subjective and often resulted in over-sedation.

The two main consequences of this were extended stays in intensive care units and increased drug use — both of which were costly.

Rudge, along with a group of other students, set to work on seeing if automatic detection would be possible, using complex mathematic formulas.

Once he established the science behind the idea was possible, he built a prototype, which involved a sensor that detects what level of agitation a patient is experiencing, using a digital video camera.

His research group is currently perfecting the sensor and the science that measures the amount of drugs that should be administered.

Read more at CNN.com

Not only would this device save money by reducing the amount of wasted medication, but it would hopefully solve the medical establishment's problem of creating narcotic junkies out of people that become addicted to the pain medication as a result of over-dosing. Maybe drug-seekers would think twice of calling an emergency ambulance at 2 in the morning to give them a taxi ride to the Emergency Department for their "hit," if this computer determined that they were in no more acute pain than me after lifting and carrying them, and thus denied them their narcotic fix. One can only hope.

Sounds like a great new initiative to put humanism back in health care… right up to the point where student doctors sit in the waiting room with their patients. Surely, this is not the best use of the time of an extremely busy med student?

CAMBRIDGE, Massachusetts (AP) — Carolyn Casey's pager jolted her awake in wee hours of the morning: One of the Harvard medical student's patients had checked into the hospital and needed a Caesarean section. Casey rushed off, arriving just in time to help deliver her first baby.

Later, Casey visited the mother, Camila Santans, newborn Matthew and other family members in their room at The Cambridge Hospital, talking with them about breast-feeding and the gestational diabetes that had complicated the pregnancy. In the coming weeks, Casey will accompany Santans to follow-up appointments and checkups with Matthew's pediatrician.

It's all the kind of attentive, hands-on experience many assume is typical in a doctor's training. In fact, it's exceedingly rare.

At Harvard Medical School, as elsewhere, most students will see a dozen births or more during a three-week obstetrics rotation, but they rarely will meet a mother before she arrives at the hospital, or see her again once she leaves. On other rotations, they may see acutely ill cancer patients, but they may not be there to break the news, or follow them and their illnesses over a course of chemotherapy.

If the patients have specialist appointments, the students accompany them, even sitting with them in the waiting room. If they need surgery, students observe and assist. In some cases, they visit patients at home. And if patients die, as has already happened in the early months of the program, students will be there for that, too.

Read more at CNN.com - Hands-on training for med students - Sep 27, 2004

ALBANY, N.Y. — Volunteer fire and ambulance corps in New York want to study whether health insurance coverage could be an incentive companies can offer to keep current members and to improve the increasingly challenging process of recruiting new members.

Gov. George Pataki has signed legislation creating a commission to report by the end of next year on the feasibility of companies, local governments or the state itself offering full or partial coverage for volunteer firefighters and emergency medical technicians. The task force will be made up of government and volunteer services officials.

“We think that this type of thing would not only be a really strong retention item … but that it may get (recruit) the young 18-to-25-year-old who has a tendency to not have coverage," said Kirby Hannon, legislative director for the Firemen's Association of the State of New York.

Hannon said the task force will study a range of options that lower or eliminate health care coverage costs for the volunteers while being affordable for taxpayers and an effective inducement for people to stay in companies or to join them in the first place.

Over the last decade, FASNY estimates that membership in volunteer fire companies has sagged from about 175,000 to between 100,000 and 110,000 today. Volunteer EMT numbers have fallen from 70,000 to less than 50,000, Hannon estimated.

Read more here

I scored a 97… Now is that good or bad? I thought I would at least be in the Mega-Buff category, as I have spent 36 of the last 48 hours volunteering at the ambulance… Even when I had an offer to work my paid job, and earn money!

EMS Buff test

Directions: Give yourself 1 point for every question that you answer correctly.

If your score is You are
1 – 20 Brand new
21 – 40 Probie
41 – 60 Experienced
61 – 100 Buff
101 – 120 Mega Buff
121 – 160 Insane
161 – 200 Without a social life

Read the rest of this entry »

My apologies to my faithful readers, (all 2 or 3 of you) but it's been a busy time, so I haven't had time to post. To update you all, I am still at home and will be until January. I have decided to take a leave of absence from medical school for this semester, and I will be resuming my classes next semester. This was not a decision taken lightly, but the only con seems to be that I will have a few months less to study for the USMLE's, but then who can really study for 9 months anyways? I will graduate the same time, as I started in January, and I will avoid the chaos of a hastily put-together semester that's only purpose is get get people done. Having no books, clothes, or other essentials, going somewhere (even if it is in the same state) to study medicine would be tough. I would rather take this time to get everything back together, and go back in January when the full cirriculum is being offered. While the Registrar's Office tried to convince me that they weren't cutting corners, the revised syllabus is starting with endocrine. We were only halfway through hemodynamics and the cardiac cycle. Are these lectures just being skipped? Seems like important stuff to me. As I actually want to learn this stuff for the sake of knowing so that I can help my patients, and not only to pass the test, I want to be exposed to the full syllabus.

Anyways, in the meantime I will be volunteering at an ambulance and working in an Emergency Department, so my readers can look forward to thrilling accounts of emergency medicine in action. I am actually at the ambulance tonight (suprise!), which is the reason I am up at 4:45 am… No interesting calls tonight… just a drug seeking abdominal pain, and a chest pain "rule out MI (heart attack)" from a local doctor's office. Now this patient was having chest pain for several days when they coughed, bringing up sputum. Sounds like the classic MI story to me. However, this doctor was convinced it was a heart attack because off the "S-T depressions" that she saw in the 12-lead electrocardiogram. She even circled them all. Funny thing was though, that they weren't even the S-T segment, they were p waves!

Looks like her med school skipped over cardiac electrophysiology, which is exactly what I don't want to have happen to me.

Just to let everyone know, I am safely back home. I will be posting my experiences during the storm and therafter shortly, stay tuned.

Hi Everyone,

I survived Ivan!!! Thanks everyone for the well-wishes, I am doing ok. I am currently in the Barbados airport after being evacuated by the British (!), and I have a flight home tonight. I will write much more shortly, but I am running out of internet time.

Thank you all, and see some of you soon!