CME: Body-Mass Index and Symptoms of Gastroesophageal Reflux in Women
Top 10 Causes of Death Worldwide:
[Via WebMD Health Headlines]
Our Governor is quoted as saying that Pennsylvania's health care crisis has turned a corner. It has not and as evidence I point you to the following article about a Cardiology group in Philadelphia that will no longer provide coverage at one health center there:
Imagine you're, say, a plastic surgeon. There used to be fifteen of you on staff at a hospital so you took ER call only two days per months (as a precondition for maintaining staff privileges). Well, because of a malpractice crisis that has NOT turned the corner there are only three of you now. That's ten days of ER call each month. Kinda forces you to ponder whether maintaining staff privileges is worth is, doesn't it? And if you decide it's not, then patients loose access to yet another specialist at the hospital. See where this goes?
Bird flu has been very much in the news, but now another type of virus is also threatening: chikungunya virus (named with a Swahili word meaning 'bent up').
With only a little over 200 deaths it's not near as big a killer as H5N1 might be, but it would wreak havoc nonetheless. Fevers over 102 and arthralgias. Yuck.
Texas enacted caps on medical malpractice awards in 2003. The debate there on whether these caps are good or have been responsible for the drop in new malpractice cases by 60%-80% continues.
[RangelMD]
Wet taps are accidental dural punctures that happen while attempting to place a needle into the epidural space. The published frequency of wet taps is about 1 in 800 epidural placements, depending on the experience of the operator. If I'm placing an epidural catheter in a pregnant woman and get a wet tap, she has a greater than 50% chance of a dural puncture headache (unless, of course, she is morbidly obese, in which her risk is almost zero).
It seems my wet taps come in three's (hence the title of this post). I remember as a third year anesthesiology resident being on call on OB for the first time after spending three months on the transplant anesthesia service and getting three consecutive wet taps that night on OB. Bam, bam, bam (or should I say 'splash, splash, splash'). I felt terrible, of course, but could not recall doing anything different that would have caused them! My grandmother used to say that accidents happen in threes. She was referring to airplane crashes, but I have to wonder, is it true of wet taps?
In the last ten years of doing anesthesia I've had no accidental dural punctures that I know of. That all changed about a month ago. I did a lumbar epidural steroid injection on a co-worker's husband and must have scored the dura. That's one. I had a wet tap during a labor epidural on a patient who, in retrospect, had a non-union of the ligamentum flavum. That's two. I'm just waiting for number three. I'm on call on OB tonight. Is number three around the corner?
[here's a nice review, btw]
Most days are nice. Occasionally I get into a head-butting contest with a nurse or surgeon (but much less often than when I was younger). Of late, it seems to be an almost daily occurrence. Today's example? I arrived at a surgery center to start cases to find the oxygen failure alarm triggered on all our anesthesia machines. After telling colleagues and putting all rooms on hold, I figure out that a valve leak the day before had required a valve to be removed and the resulting system did not have enough oxygen pressure to keep the alarms from triggering. This was fixed in about 15 minutes and we proceeded.
Several hours later a nurse manager told me they were going to switch the oxygen system back to the way it was. I told her that, in my opinion, this should not be done until all cases for the day were finished. 'But it will only take a minute' was her reply. I told here once more that in my opinion as an anesthesiologist, no one should mess with a system that was presently working and that the safest thing to do was wait until rooms were down. She left and had the technicians make the switch.
She will now learn the hard way that you do not touch my oxygen while cases are under way. When it comes to patient safety, our opinions are not equal...
"The VeinViewer, a device that reveals the underlying venous anatomy for easy IV placement, is now being shipped, according to RedHerring.com....Note to nurses on the floor: call VeinViewer and not an on-call anesthesiologist.
Company website | Video of VeinViewer
"[Via Medgadget]
The facilities I work at use 'Time Out' and are gradually standardizing on the use of the word 'yes' to mark the site (which I believe to be the best). Administrators tend to add things to the Time Out so they can say they did something about a problem. Our time outs now require confirmation of a negative pregnancy test before GYN surgery as well as 'Implants Available' for cases that will use implants; a list which will no doubt get longer as more errors occur.
The article contains this jewel from a well known author on errors in medicine--James Reason:
Bruce Schneier, in Identity-Theft Disclosure Laws explains why pending federal legislation on protecting consumers form identity theft is a step backward from many existing state laws.
Seth Dillingham and I have created two modules for the Google personalized home page (http://www.google.com/ig): Allowable Blood Loss and BMI Calculator. Despite having been submitted a week ago they are still not included in their directory, but I thought it safe to post about them here....
 | BMI calculates the Body Mass Index using the US or metric system. Furthermore, it can be used to convert from one system to the other. |
 | The Allowable Blood Loss Calculator gives a fairly good estimate of how much blood a patient would have to lose to cause a drop in hematrocrit to a specified amount assuming euvolemia is maintained. |
The New York Times Online has an article titled 'Blasting of Kidney Stones Has Risks, Study Reports'. The article mentions the journal (The Journal of Urology) and the first author (Dr. Amy Krambeck). Would it have been so difficult to link to the abstract in the online version?
Before people panic (or call lawyers), please consider that this is one study, retrospective, with a 59% response rate, using older lithotripsy technology (as the NYT article points out, modern machines use less energy and are able to focus it more precisely.
I turned 41 years old today. Perhaps more significant to me, however, is that I finally paid off my last outstanding student loan! I finished medical school in 1992 and residency in 1996 so it took about ten years.
My total debt amounted to about $70,000 for college and medical school combined (without interest). Here are some interesting numbers from back then:
And here's the data from 2003:
One final note: If I'd stayed in academic anesthesia it would have taken at least another ten years to pay these loans off...
All Medical Articles Books CME Computers CRNA Practice Cub Scouts Data Medical errors Electric Vehicles Expert Medical Courts Health Care Finance Food HIPAA Humor Influenza iPhone Medical Malpractice Lego Mindstorms Movies News Policy Politics Anesthesia practice Regional Anesthesia resources Web Sites Software Technology Terrorism Anesthesia Tips Tort Reform Instructional Videos