Giving Thanks

Repost from last year, with one UPDATE: Thanks also for modern technology and the blessing of perspective. (via Tasty Booze)

Here's to good friends, good health, a good meal, and a good nap.

I give thanks for the heroes who stand in harms way in the service of our country; I pray that you return home safely. I especially give thanks for those servicemen and women who have died for us, and I pray that their families know that their sacrifices are appreciated.

Thanks also for our policemen and firefighters who put their lives on the line to serve us, and especially for those who have given their all in the line of duty.

Thanks for the nurses, and the secretaries, and the paramedics, and the administrative staff, and the housekeepers, and the pharmacists, and the techs, and for all of those who are part of the healthcare team.

Thanks for all of you who have visited my blog, my family, and my friends for being a part of my life.

Thanks for my fellow bloggers who always keep things more interesting than television.

And of course a special thanks for the one who made it all possible.

Sling Tells the Story

...so you don't have to. Genius.

via Tasty Booze.

Scalpel's Texas Omelette

So tender you can cut it with a scalpel.
Now with EVEN MORE butter!

Red bell pepper slices
Jalapeno pepper slices
Diced ham or Canadian bacon
Bacon bits
Grated cheese
Red potato, pre-boiled
2 eggs ,well-scrambled
English muffin

Stir-fry the sliced red onions, red bell peppers, jalapeno peppers, bacon bits, and diced ham in a little butter over medium heat. Place aside on a plate and sprinkle with grated cheese. Cut the previously-boiled red potato into wedges and simmer it in butter with some sliced red onions over medium heat, turning occasionally until well-browned. Sprinkle with salt and pepper to taste, then remove onto a plate. Start toasting the muffin now because you're almost done.

Put another small dab of butter into the same Teflon-coated medium skillet and coat the skillet, still over medium heat. Pour in the egg mixture and allow to cook unmolested for 20 seconds or so, then lift up one edge of the omelette slightly and tilt the skillet so that the soupy uncooked eggs on top can flow around to contact the hot skillet underneath. This will cause one side of the omelette to be slightly thicker than the other. The thicker side will be flipped over the top.

Place the meat/veggie mixture on the thin side of the omelette and then fold the thick side carefully over the top with a spatula, trying not to tear the eggs. Cook for a few more seconds, then flip the omelette with a quick confident wrist action and cook the other side for a few more seconds. No guts, no glory when it comes to flipping omelettes. If you try to baby it, you'll mess it up.

I sprinkle the top with salt and pepper and a few shakes of Tabasco sauce. You'll notice the muffins aren't buttered. They don't need to be. They will absorb the butter from your mouth.

Enjoy.

More Emergency Medicine Links I like

Here are a couple more great ER sites I enjoy:

The National Center for Emergency Medicine Informatics,
ncemi.org doesn't appear to be formatted well for firefox, so check it out on IE. I especially like the calculators.

My Emergency Medicine Blog is very clinically oriented and impressive. And it's got a WhiteCoat-approved™ moniker.

Hats Off

Two of the things that make me happy are old comic books and the writing of James Lileks. So you can imagine my great pleasure to find this treasure trove:

Night Nurse - "She's about 70 percent legs"

Night Nurse - "She may be hot, and the cape's great, but she has no powers... except maybe to wait a few minutes after the patient started jabbing the call button."

Dr. Bobbs - "Performs a fist-assisted star-ectomy"

The Unicornisaurus Rex - "With Fingers!"

and my favorite so far:

Baldy has a point: word gets out that the Bat is on the injured list, you don’t assume he’ll come after you in a one-man copter. A large, multiperson Batcopter, yes. That’s a reasonable expectation, and you make preparations. But a one-man copter? You can’t blame a guy for not seeing that one. I mean, imagine the strategy session.

Okay, boys, this is the week we knock over the barn.

Uh boss? Why a barn again?

Because that’s where the blue bag is, you idiot. Remember: everyone wear suits, so we’ll stand out in a rural setting. Then we’ll meet up right under the big metal grain chute.

Maybe It's the Cat Pics

The genderanalyzer computes that there is an 81% chance that my blog is written by a woman. Another manly ER blog, MDOD, is surprisingly gender-neutral (even without cat pics).

UPDATE: Maybe if I eat some wasabi peas my blog will be as manly as GruntDoc's.

Or maybe I need to start posting about football.

via GirlyPundit

Megappendix

This was the largest appendix I have ever seen. This patient had symptoms for almost a week before presenting to the ER.

CT criteria for diagnosis of appendicitis include an appendiceal diameter of greater than 6mm. This patient's appendix measured almost 2 cm in diameter, with a visible appendicolith present.

The hospital course was unremarkable.

As usual, all identifying information has been removed from the image.

Ouch!

Who gets the last overtime shift? Nurse K and Monkeygirl battle it out.

Strangely addictive.

Via CollegeHumor.

Drama Signs

Patients who display any of these signs probably do not have an emergency medical condition, and they will be SHOCKED to learn that all of their tests are normal.

1) They keep their eyes shut during the entire interview. Sometimes life is just too difficult to face with open eyes.

2) They flutter their eyelashes rapidly as they explain how sick they are.

3) They speak in a mousy whisper of a voice. If they tried to speak normally, the pain would be unbearable.

4) When I ask them what is the matter, they give me an exasperated look and a sigh, then they ask their spouse to tell me their story. Telling me themselves would just be too much to handle.

5) They come to the ER in a nightgown, especially if it's satin or silk.

You can bet that if any of the above patients require an IV or a blood draw, they are going to say they are a "really hard stick" requiring a "butterfly" or the "IV team," and during the procedure they are going to histrionically complain how painful it is, possibly even yelling and jerking away.

What's Wrong With America

No, not the potholes. Mmmmm, I think I just had a snarkgasm.

But wait, there's more:

"Within an hour, two dozen patients checked in, five of which shared the same last name. It didn’t take long to ascertain that all five patients — children ranging in age from fourteen months to twelve years — were from the same family. A cough prompted their mother to bring them in.

That’s right — a cough. Not a fire, not some sort of freak accident that incapacitated the lot of them… a cough.

Whatever happened to Robitussin and chicken soup?"

Right on.

Grazed (twice)

Chief Complaint: Leg Pain

HPI: Pt heard gunshots and ran away, felt pain in his right leg, thinks he was "grazed by a bullet." Hurts to walk on his right leg. Denies other complaints.

Exam: One cm open wound to right leg with localized swelling and tenderness. Dried blood extending inferiorly from the wound down to the ankle. Quick primary survey reveals no other wounds. Slight limp to right. Distal neurovascular status normal.

X-ray: bullet fragments noted in soft tissues of right leg. No fracture.

While cleaning the wound, I noticed a 2 mm scab on the opposite leg at approximately the same level as the primary wound. It initially appeared to be either an unrelated minor scratch or dried blood which had been transferred or splattered from the primary injury, but when it was cleaned there was clearly a tiny open wound present with mild adjacent tenderness but no swelling.

X-ray: bullet fragment noted in soft tissues of left leg. No fracture.

Morals: 1) Removing all of the dried blood from a patient is necessary to exclude occult wounds. 2) Distracting injuries can be distracting to both patient and physician.

Admittophiliacs

Some people really want to be admitted to the hospital. Here are some of their more common presentations:

1) They have a flare-up of their fibromyalgia, their chronic low back pain, or their migraines, and they "just can't take it anymore." Unfortunately, in the absence of intractable vomiting or acute neurologic deficit there really isn't a good reason to admit these patients. Nowadays, patients only get admitted if there is a reasonable chance that some harm will come to them if they are sent home. "My pain is worse than usual" just doesn't qualify, and there is nothing that I can do about that. If these patients have a personal physician who compassionately agrees to admit them, I'm happy to call their doctor to arrange it. If they expect the "no doc" physician on call for the hospital (or even the partner who is covering for their personal physician) to do the same, then they are likely going to be disappointed.

2) Their gastroparesis is acting up again. They have been admitted a dozen times this year for the same problem, and they usually only last a few days at home in between admissions. There is apparently no medical regimen that will keep these patients from vomiting and allow them to function outside of the hospital, so these unfortunate patients only go home for the occasional holiday. If you think you can actually discharge them from the ER, you are mistaken. You can't fix them - they will be back in a few hours or the next day at the latest.

3) It's cold, or hot, or rainy and the smelly unkempt homeless types with chronic pancreatitis want a clean bed, a TV, 3 meals a day, and a wait staff. Oh, and another pain shot, please bitch.

4) She's old and lonely and feeling weak. There are no specific complaints, but she "can't go home like this." Helloooo, megaworkup.

5) He fell off a ladder and broke his _________. Unfortunately, a broken ________ is not an indication to admit an otherwise healthy adult to the hospital, even if his mother gives me a hard time over the cellphone. Sorry.

6) She's been throwing up for 3 days and feels really bad. But through the miracles of good fortune and modern medicine, all her lab tests look good and she's not throwing up anymore. Bye.

7) He's got the flu and feels really awful. Unfortunately, he's going to feel really awful for several more days whether he's in the hospital or not. Here's a work excuse.

8) He's been up for 3 days, and now he's out of money for crack "suicidal." Again.

9) He's still drunk from his last bender, but he's afraid he's "going to go through withdrawals." This time he's serious about quitting. Again.

Let's hear your favorites....

A Couple of Great Blogs

Street Watch - Notes of a Paramedic is an old blog but it's new to me. Here is a great post on STEMI with evolving ECGs. I was going to do a post on the Autopulse but while researching it I found that Peter had not only found the same key studies that I had, but he beat me to the post by like a year and a half.

Dr. Whitecoat's favorite new blog title, Your ER Doc is unusual among our genre in that Dr. Brian Evans not only blogs without a pseudonym but he answers specific medical questions from readers. Hey man, you should charge a fee. Talk to the MDOD guys, they're floating the idea in a poll in their sidebar.

Thank You

To those who served our country, know that your service is appreciated.

Wart Hog

He's our president, warts and all.

Where do we sign up for our free gasoline?

He's a Cat....Flushing the Toilet

Pretty self-explanatory, really.

via CollegeHumor.