Friday, July 27, 2007

EMR sign

Stat consult called. Rush in to see patient. On the floor I can't find any of the nurses by the patients room. Instead they are all at the nurses station trying to enter things into the EMR. I ask for the patients vitals and find out that they are in the computer. The computer doesn't let anyone log on. (passwords have to be changed every so often and now it has locked up the system, good old HIPPA), I ask the nurse what she thinks the vitals might be but she explains that they are taken by the nursing assistant and then entered into the computer. I try to find the assistant and luckily she has them written on the back of a napkin but she is not sure whose is whose.

Finally we get the computer up and running which lets me access the patients history and progress notes. The patients history is : "waiting to be transcribed". Interestingly, all the JACHO forms are there. I did find the vitals.

I am so glad that we have EMRs to help save lives, just whatever we do, make sure there are lots of napkins!

Saturday, July 21, 2007

Green gas

The other night on call we were discussing the current issue of carbon emissions and global warming. My friend was conversing while drinking a diet coke. As he opened the can, out went a fiss of carbon dioxide. I though, well there goes some carbon into the atmosphere. Then I thought, how was that carbon dioxide put into the can? Well, energy was used to run the compressor to get the carbon dioxide from the air and then to put it back into the car. So, next I wondered just how much carbon dioxide in the atmosphere is from the carbonated beverages? About the time that I was doing this I burped, which had some more carbon as a by product of my own metabolism breaking sugars into CO2. It was about this time that the OR was ready and I had more important things on my mind.

Friday, July 13, 2007

Quicke's Edema

Intense swelling of the uvula (caused by ranting!) . Slowly my week of call is ending. I often am puzzled by the meaning of emergency. This is a result of having to answer emergency calls in the middle of the night. My favorite is the call that comes in at 2:00 am from the patient who can not sleep. I try my best not to say "I know the feeling".

Even when it is not that busy at night I find that I am always tired. It is the anticipation that any minute that I might have to rush in. I can't imagine what it must be like to be a fireman, police officer or EMT. How do they ever sleep on those long shifts? Well, off to sleep hoping that it will be quiet. Long live EMTALA!

Friday, July 6, 2007

Black line finger

This is the black impression that occurs on the middle finger due to constant pressure from a pen.

CMS has now required that anesthesia document in their records when the pre-operative antibiotics were given. The main problem, anesthesia is not who are giving the antibiotics! They are given in the holding room. So again we have anesthesia having to run around to find that information and document it rather than taking care of the patient.

Often when going to the floor to see a patient in the hospital, I am amazed as I can't find any of the nurses. When I ask where they are, the answer is usually in the back doing charting. I understand now why there is a nurse shortage, there is not enough of them to do all the paperwork. When I asked JACHO and CMS representatives about the amount of paperwork, the answer was "to improve patient care".

I would rather have the nurse take care of my patients than their chart.

Thursday, July 5, 2007

A Detroit city employee has filed suit against the city because of her co-workers perfume (,2933,288130,00.html). She is using the Americans with Disabilities Act as the basis for her suit. Already, her co-worker has had to stop using an air freshener which makes me wonder if the real victim of the case is the co-worker who has had to deal with the plaintiff's B.O.

I digress. What constitutes a disability? I hate people chewing with their mouth open and cracking gum, in fact it makes me sick to my stomache. Does this mean I can sue any business that I enter if they do not make people chew politely? Or, can I just have disability benefits?
Detroit already has enough problems with all the lawsuits against the city busses and their inability for fire problem drivers due to union lawsuits.

How do we fix the slippery slope that has become the American with Disabilies Act? The Sweeds have a solution. They focus on not what you can't due but rather on what you can. If you can't do your job because of perfume, go find a job you can.

Tuesday, July 3, 2007


MMOB (Minding my own business) seems to be the factor most often implicated in major trauma presenting to the emergency department. had a recent post describing how the British are removing "Accident" from the legal lexicon of automobile crashes. Their comment was that this action was part of the continued need to always find someone to blame for everything. For our trauma cases, the person MMOB is always the victim to SD (some Dude).

I am hoping to find the reformer of this current attitude and write MYODF (my own D**** fault)!