Subaqua Sternal Rubs

In a sad story coming out of Canada, a 2-year-old child died while waiting to be seen in an Emergency Department:

The Ontario coroner's office is investigating the death of a two-year-old child in a hospital emergency room waiting area this week.

The boy died in his father's arms while waiting to see a doctor at Toronto East General hospital early Monday morning.

The Toronto Sun reported yesterday that the child was brought to the hospital by his parents around 5:30 Monday morning. He had reportedly vomited and had diarrhea the day before, and when his condition did not improve his parents tried to have him seen by an emergency room doctor.

They told the Sun that they waited for an hour without being seen by a doctor. Then, their son stopped breathing.

Source/Read more at: The Globe and Mail

While I feel tremendous sympathy for the family, and the loss of their child must be extremely difficult, I don't think it could have been avoided, based on the limited information in the article. With the current state of overtaxed emergency departments, waiting an hour to see a physician would be quick by most standards, especially for something as seemingly-innocuous as an episode of vomiting/diarrhea the day before. Unfortunately, triage guidelines do not rate vomiting/diarrhea high on the list of what qualifies as an emergency, unless signs/symptoms of severe dehydration/electrolyte imbalances (i.e. lethargy) were present. I wasn't there, so I can't comment on that. Since death by acute diarrhea is virtually unheard of in developed countries (Mortality rate: 0.0002 Source), there must have been some other undiagnosed underlying disease processes at play. It would be interesting to see what the coroner's report turns up, which hopefully can improve triage guidelines so this doesn't happen again.

Hat Tip: Kevin, MD

I am currently reviewing physiology for the upcoming final exam on Tuesday, when I came across a concept that reminded me of an interesting encounter the other night. We were leaving the restaurant after an EMC Executive Board dinner meeting, (which I am not officially on, I was simply providing transportation), when the security guard stationed in the parking lot came up to us. He asked:

You see, the guy's name is Henderson, and this is how he introduces himself, to everyone, everytime. I don't know how it is working out for him, but I can't imagine introducing oneself with a chemisty equation impresses women.

If you're curious as to what the equation is, click on "Read the rest of this entry."

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Did I tell you how much I love electron micrographs? (Yes, I know, I am a dork.) Anyways, recently came across this image in my medical school classes:

Click for larger image

So anyone want to take a stab at what that is? The funnier the better And this time, I actually know the right answer (the original image is labeled.) Let's say the answer will be revealed Monday or Tuesday.

A few jokes to brighten your day… I know I need it - I have finals coming up next week.

A woman brought a very limp duck into a veterinary surgery clinic.

She laid her pet on the table; the vet pulled out his stethoscope and listened to the bird's chest. After a moment or two, the vet shook his head slowly and said, "I am sorry, your duck Cuddles has passed away.

The distressed owner wailed, "Are you sure?"

"Yes, I am quite sure. The duck is dead," he replied.

"How can you be so sure," she protested. "I mean, you haven't done any testing on him or anything. He might just be in a coma or something."

The vet rolled his eyes, turned around and left the room and returned a few moments later with a black Labrador Retriever.

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Today, at around 16:00 hrs, two guys from the sub-contracted A/C repair company showed up at my door. Sweating through the night all week, (What am I saying? It's Grenada - Month is more accurate), I couldn't have been happier.

After about 10 minutes of staring at it, feeling the air coming from it, noting that no error lights were illuminated on it, yet still of the opinion that something wasn't right, one of the maintenance guys decided to take the entire unit apart, down to every last screw. Upon finally getting down to the back of the A/C unit, the problem was as clear as day - the cylindrical blower fan was so clogged with crap, since it probably hadn't been cleaned since installation, that it was a wonder any air was getting through at all. After 15 minutes of scrubbing the blower fan, filters and everything else in the airway path, the amount of cold air coming out of the unit was increased at least 10-fold.

Watching the maintenance guys trying to put the unit back together though, was quite amusing.

"Does this look like I should use a long screw or a short screw?"

In the end, the A/C unit is still hanging on the wall, and only one small part (the central processing unit) is missing a screw and loose in the innards of the unit. But I don't care - it's blowing cold air, and lots of it! I was so happy that I offered the maintenance guys a drink: "Soda, beer, or water." Of course they chose the beer - Heineken, since it's imported. (All the way from St. Lucia, but still somehow tastes better than the local stuff.)

After the maintenance guys left, I stood under the A/C for a while just basking in the Artic cold front now moving through my room. I got a nice case of sinus congestion from indulging myself, but nothing a healthy dose of hot sauce with tonight's dinner (tacos) couldn't fix.

In a follow-up to a previous post, Justices Accept Oregon Case Weighing Assisted Suicide, a new poll out yesterday proclaims "Majorities of U.S. Adults Favor Euthanasia and Physician-Assisted Suicide by More than Two-to-One."

ROCHESTER, N.Y., April 27 /PRNewswire/ — More than two-thirds of U.S. adults think that the law should allow medical euthanasia for dying patients in severe distress who ask to have their lives ended. Two-thirds of the public would like their states to allow physician-assisted suicide as it is currently allowed in Oregon. Furthermore, most people feel that if they were unconscious and unlikely to recover they should not be kept alive on a life-support system. The majorities in favor of Euthanasia and physician-assisted suicide have increased over the last few years.

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One student posted the following query in the discussion forum of our on-line Course Management Software:

Why do we hiccup?

Another student posted a link to the following article, and I thought to myself: "Who is paying for hiccup research? Wouldn't those funds be better spent researching diseases that actually have negative influences on human morbidity and mortality, rather than a phenomenon that is, at worst, a minor annoyance and barely noticed?"

Considering the fact that almost everyone experiences hiccups at one time or another, remarkably little is known about them. The name itself is onomatopoeic, which is appropriate considering that the only common understanding of the hiccup is of the characteristic sound. Hiccups can be predictably elicited in some individuals by overindulgence of food, alcohol, or both, sometimes providing evidence of such behaviour and making them a common object of humour. There are, however, instances in which hiccups become intractable (singultus) causing insomnia, wasting, exhaustion, and even death, prompting scientific scrutiny of this otherwise harmless curiosity. In this issue Fass et al (see page 590) present original investigative work on the afferent limb of the hiccup reflex.

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Slightly old news, (ok, a day) but I couldn't add my two cents, since my site was down:

Hundreds of thousands of poor people across the nation will lose their state-subsidized health insurance in the coming months as legislators scramble to hold down the enormous — and ever-escalating — cost of Medicaid.

Here in impoverished southeast Missouri, nurses at a family health clinic stash drug samples for patients they know won't be able to afford their prescriptions after their coverage is eliminated this summer. Doctors try to comfort waitresses, sales clerks and others who will soon lose coverage for medical, dental and mental healthcare.

"I don't know what cure to offer them," Dr. Hameed Khaja said.

Lawmakers say they feel for those who will lose coverage. But they say also that they have no alternative.

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