6.03.2010
iSurgery
I have no idea what they are saying, but it looks like they are looking at the aortic arch. It would be nice to be able to see the CT images without leaving the operating room table. Will iPad's become standard OR equipment?
2.23.2010
The Multidisplinary Team
It has been shown several times that having an intensivist in an ICU is associated with better outcomes. However, they shouldn't get all the credit. Taking care of the critically ill is never for one person alone to do. At least one of factors for the better outcomes is due to having a multidisciplinary team making rounds, at least according to the Archives of Internal Medicine. So, next time you see a crowd of folks making rounds in the unit, just realize that they are making a difference.Arch Intern Med. 2010;170(4):319-320.
2.17.2010
Check & Double Check
Visit msnbc.com for breaking news, world news, and news about the economy
I have to say that the video doesn't mention that small things can easily be lost in the retrocardiac region. I have heard that some centers don't even count the 7-0 prolene needles because they are so small, and easily lost. While the patient may have numbness, AFAIK there is no way that a bulldog clamp left in that area could cause hand numbness.
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2.16.2010
Laparoscopic Surgery Not Better For Surgeons
While there are many benefits for patients of minimally invasive surgery, it is not at all ergonomic for the surgeon. I know some surgeons that argue that using the Davinci robot system is the safest way to avoid it. However, not all surgery will be done that way as that is a 2 million dollar device. In the meantime, the wrist can certainly be affected by the reptitive motion of laparoscopy.More
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2.15.2010
Vscan Portable Sono
The applications of ultrasound in medicine are expanding quickly. One example is in critical care monitoring where it is rapidly gaining acceptance for determination of fluid status in a patient. Now GE is releasing their Vscan sono. At a price of $7900, it should allow it to reach the bedside in more ICU's. It has such features as an hour of battery life, portability, and a USB dock to download images. Until the iPod Touch gets an ultrasound app, this may be as portable as it gets.More
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9.28.2007
Noncardiac Surgery Guidelines
From The NY Times:
The nation’s two leading heart groups issued new guidelines yesterday about what should be done for patients with heart disease before they undergo surgery on other parts of the body.
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The nation’s two leading heart groups issued new guidelines yesterday about what should be done for patients with heart disease before they undergo surgery on other parts of the body.
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9.21.2007
Traveling Patch
From WebMD:Researchers have developed a skin patch that prevents the curse of many trips abroad: travelers’ diarrhea.
In a study of more than 150 travelers to Mexico and Guatemala, the novel vaccine cut the risk of moderate to severe diarrhea by 75%. Those who did get sick had a shorter, milder course of illness, says researcher Herbert DuPont, MD, director of the Center for Infectious Diseases at the University of Texas School of Public Health in Houston.
The patch releases a low level of the toxins of E. coli that causes Traveler's diarrhea. This stimulates the immune system of the patient. Then, when they are infected by the bacteria, they already have some preformed antibody which is protective. Neat, huh?
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Keep the Lunch, Lose the Box
From San Jose Mercury News:
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The state's public health department asked parents Thursday to toss certain Chinese-made lunchboxes potentially containing dangerous levels of lead - the same ones it distributed in a campaign to promote healthy eating.
The department distributed more than 350,000 of the canvas lunchboxes, only to find out that at least three that were tested in a batch of 56,000 contained "significant" levels of lead.
I think this is an argument to brown bag it.Medicine Tag
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8.31.2007
Diana's Death- Looking Back
From CBS News:
Glamorized in life, Princess Diana continues to be scrutinized 10 years after her death.After I watched this clip on the CBS News, I was in awe at the horrible care that the Princess had received. I had heard it was the custom to send the Doctor out to the scene of the accident in Europe, which is not usual in the states. An anxious trauma patient needs to have hemorrhagic shock excluded long before any sedation is even considered. They used up their "golden hour" long before she ever got to the hospital. Her care is a good argument for "scoop & run" in these types of situations.
An early-morning traffic accident in a Paris tunnel killed Diana's companion, Dodi Al-Fayed, and the driver of their car. But Diana was conscious after the accident and did not appear to be seriously hurt. In truth, she was bleeding internally.
Had the accident occurred in the United States, Diana would have been rushed to a hospital. However, the French have a different system: They first try to stabilize the patient at the scene. Still, as CBS News correspondent Erin Moriarty reports, that difference doesn't explain the series of missteps and delays in Diana's medical care that experts say never should have happened.
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Skinny In Colorado
From MSNBC:
Coloradans are among the skinniest people in the nation, according to a new obesity report, but don't go celebrate with a slice of New York cheesecake.Colorado's waistline is expanding just like every other state's.Is is any wonder? With all of those outdoor activities in that state, I know why they are thinner out there. Between mountain bike riding, skiing, hiking and climbing, those folks never sit still out West.According to the Trust for America's Health, which compiled the report released Monday,Colorado has some of the lowest rates in the country of overweight residents, physical inactivity, hypertension and childhood obesity. Overall, it ranks as the leanest state in the study.
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8.24.2007
Stay On the Right Side
From CNN:
There's really no excuse for not having consulted the CT scan before starting the case. Still, it can be quite easy in the "heat of battle" to proceed on the wrong side. I remember as a first year resident on call, the OR called me at around 5 am as they were getting ready to prep the patient for surgery that day, and he was an early case. The patient was going for a combined carotid/CABG operation, but they didn't have consent for the carotid portion. When I asked which side I should consent them for, the patient didn't know, but the nurse insisted on the right carotid. I looked in the chart, and the nurse assumed that because the right side was 100% blocked, that was the surgical side. Wrong! She didn't realize that once a carotid is occluded, it can't be operated on, and it was really the left side, which was 70% occluded. Now that it was becoming an issue, I called the attending vascular surgeon at home, and confirmed with them which side was the operative one, as by the time they arrived, the patient would be under anesthesia, and draped with the surgical side of the neck exposed. While I hope that the surgeon would have known which was the correct side, I can easily envision things proceeding less than perfectly. Thankfully, this is my only surgical side story, and it was a save.
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An 86-year-old man has died three weeks after a surgeon operated on the wrong side of his head, and state health authorities were investigating whether the mistake contributed to his death.
The patient, whose name wasn't released, died Saturday. The state medical examiner was determining the cause of death, according to a spokeswoman for the state health department.
The man underwent emergency surgery at Rhode Island Hospital on July 30 to treat bleeding in his brain, according to a state report released Thursday.
There's really no excuse for not having consulted the CT scan before starting the case. Still, it can be quite easy in the "heat of battle" to proceed on the wrong side. I remember as a first year resident on call, the OR called me at around 5 am as they were getting ready to prep the patient for surgery that day, and he was an early case. The patient was going for a combined carotid/CABG operation, but they didn't have consent for the carotid portion. When I asked which side I should consent them for, the patient didn't know, but the nurse insisted on the right carotid. I looked in the chart, and the nurse assumed that because the right side was 100% blocked, that was the surgical side. Wrong! She didn't realize that once a carotid is occluded, it can't be operated on, and it was really the left side, which was 70% occluded. Now that it was becoming an issue, I called the attending vascular surgeon at home, and confirmed with them which side was the operative one, as by the time they arrived, the patient would be under anesthesia, and draped with the surgical side of the neck exposed. While I hope that the surgeon would have known which was the correct side, I can easily envision things proceeding less than perfectly. Thankfully, this is my only surgical side story, and it was a save.
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Minute Clinic Controversy
From MSNBC:
As far as I'm concerned, if it offers an affordable alternative to the overloaded Emergency Rooms, than it is a good thing.
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The growth of clinics in retail stores comes amid a shortage of family physicians that only promises to worsen.
Medical groups predict a shortage of 200,000 doctors in the United States by 2020. About 20 percent of Americans live in areas with a shortage of primary medical care, according to PricewaterhouseCoopers.
Wal-Mart operates 78 in-store clinics in 13 states, where the cost of a “get well” visit ranges between $40 and $65.
About half of those surveyed who visit Wal-Mart clinics have no insurance, according to spokeswoman Deisha Galberth. Another 15 percent said if there had not been a clinic, they would have gone to an emergency room instead.
As far as I'm concerned, if it offers an affordable alternative to the overloaded Emergency Rooms, than it is a good thing.
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