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Author Archives: WhiteCoat

A False Alarm

Cup of Coffee

There aren’t too many times that the staff gets the giggles when a patient’s monitor shows ventricular tachycardia. Normally, there is a flurry of activity while everyone wheels a code cart into a patient’s room ready to deliver lifesaving shocks. So when the new nurse was halfway through her second day working in the ED, she couldn’t believe how calm the staff was when the cardiac monitor began alarming in Room 8. Room 8 was Clarence. He had dementia and was a transfer from the nursing home for mental status change. When Clarence arrived by ambulance, he seemed just like the same old Clarence they’d seen dozens of times in the ED before. Toothless smile. Southern drawl to his speech. Always wanted coffee – cream no sugar. A lot of times staff would try to avoid putting Clarence on a cardiac monitor because the monitor would often give false alarms when they were attached to him. But the paramedics stated that Clarence had some PVCs on the way to the emergency department, so the triage nurse dutifully attached EKG leads to Clarence’s chest. About 20 minutes later, Clarence’s monitor showed ventricular tachycardia. “BLEEP BLEEP BLEEP BLEEP BLEEEP” went the alarms. One nurse and the secretary looked at each other, smiled, and shook their heads. The new nurse looked quizically about the department, obviously wondering why no one was running to bring the crash cart into Clarence’s room. The charge nurse started to get up from her chair, then sat back down and continued charting. “Mary, can you go and check on Room 8 for me?” “Um … sure,” said the new nurse as she walked briskly into Clarence’s room. Thirty seconds later, Mary came back to the nursing station with a stunned look and a red face. “Everything OK in there?” asked the charge nurse. “Well … yes,” she said as she regained her composure. “It seems that the only thing going fast in that room was Clarence’s hand under the sheets.” “Welcome to the team. You’ll get to know these patients as well as we do in no time. As for Clarence, I’ll take care of him. A nice cup of coffee — cream, no sugar — usually breaks his ‘ventricular tachycardia’ fairly quickly.” “But did he have a pulse?” asked one of the doctors. Mary smirked. “I’m kind of a … new … nurse. Maybe you could help me check that?” The doc smirked. “See, you’re going to fit in here just fine.” ———————– This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on Dr.WhiteCoat.com, please e-mail me.

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Sites to Download Free Pictures

Antique Camera

Getty Images has earned a reputation as a copyright troll for demanding hundreds to thousands of dollars in licensing fees and penalties from bloggers and other web sites that use a Getty photo without a license. Getty uses a search engine that scours all of the pictures on the internet looking for copyright infringers, then sends off demand letters to anyone flagged in its system. At least one law firm has fought back, suing Getty to get a court declaration that Getty’s tactics should not apply to thumbnail images.  The article contains a copy of the lawsuit if you happen to get a letter from Getty and want to sue them. Most people won’t have the desire to fight one of the demand letters and will instead just pay Getty Images what one person labeled as an “extortion fee” to settle the case. I completely acknowledge and agree that photographers deserve to be compensated for their work. But copyright laws make exceptions for use of copyrighted materials (including pictures). For example, if I created the changes at the right to parody of Getty’s iStock licensing model where it costs $45 (three “credits” costing $15 each) to download one picture, the transformative changes I made to Getty’s logo would fall under the “parody” exception of copyright law. In addition, under US Copyright law, words and short phrases such as names, titles, and slogans and typeface are not subject to copyright. Even if you choose to pay Getty’s outrageous licensing fees, you’ll need an attorney to decipher Getty’s license. For example, as some of the 16 restrictions on use of its images, Getty states that licensees may not … 5. incorporate the Content in any product that results in a re-distribution or re-use of the Content (such as electronic greeting card web sites, web templates and the like) or is otherwise made available in a manner such that a person can extract or access or reproduce the Content as an electronic file. *** 12. use or display the Content in an electronic format that enables it to be downloaded or shared in any peer-to-peer or similar file sharing arrangement; Since anyone can right-click and download an image from a blog post, by including a Getty image in your blog, you are violating Getty’s terms of service. As part of the license, Getty demands that … You agree to indemnify, defend and hold iStock, its affiliates, its Content providers and their respective directors, officers, employees, shareholders, partners and agents (collectively, the “iStock Parties”) harmless from and against any and all claims, liability, losses, damages, costs and expenses (including reasonable legal fees on a solicitor and client basis) incurred by any iStock Party as a result of or in connection with any breach or alleged breach by you or anyone acting on your behalf of any of the terms of this Agreement. In other words, if Getty alleges that you have breached any of the terms of its license agreement, you give Getty permission to sue you for damages and you agree to pay all of the damages plus pay for all of Getty’s attorneys’ fees. Finally, Getty requires you to acknowledge that YOU HAVE READ THIS AGREEMENT, UNDERSTAND IT, AND HAD AN OPPORTUNITY TO SEEK INDEPENDENT LEGAL ADVICE PRIOR TO AGREEING TO IT That’s an awful lot of risk and expense to go through just to put a picture on a blog, isn’t it? Violate their restrictive and confusing licensing agreement and Getty can sue you and make you pay the fees of the lawyers that are suing you. Since Getty has already demonstrated its penchant for filing lawsuits ...

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Healthcare Update — 10-21-2014

More healthcare related news from around the web on my other blog at EP Monthly Let’s call the first part of this post the Ebola Chronicles Treating one Ebola patient would wipe out the ICU in an average-sized hospital and may even bankrupt some smaller facilities. Most states won’t even allow disposal of waste from Ebola patients. Then there’s the Ebola patient in the US you didn’t know about. Doctor infected with Ebola while working for the WHO in Sierra Leone was treated in Emory Hospital’s biocontainment unit for the past 6 weeks. Now is “well on his way to a full recovery.” Baylor Medical Center in Texas requires that patients knock on glass door and answer Ebola screening questions before being allowed in emergency department. Clipboard idiot walking alongside Dallas Ebola patient Amber Vinson and directing people in hazmat suits grabs hazmat trash bag and discards it, then boards the flight — with no hazmat gear. Were he and his clipboard quarantined after touching waste from the Ebola patient? Of course not. The only conclusion we can make from this scenario is that clipboards must prevent Ebola. Vomiting is now an actionable offense. California’s Southwestern College evacuates and institutes quarantine after student who flew on same airplane as Amber Vinson gets sick and vomits in class But vomiting and dying … not so much. Patient on Nigeria flight to JFK vomits and dies. Officials give corpse a “cursory” exam, declare he does not have Ebola, then whisk him from the airplane. Nothing to see here, folks. Move along. Move along. Don’t look now … actress Tori Spelling quarantined in hospital with symptoms of Ebola. Well, she did have a fever and an “uncontrollable” cough, but she was hospitalized for bronchitis. That reminds me. I have symptoms of Ebola, too. My muscles are sore … after I worked out yesterday. Just wait until flu season hits. And finally, the lawyers are already figuring out ways to profit from Ebola, suggesting that hospitals may have liability if they miss a diagnosis of Ebola. Now back to regular news … Buying insurance on the Obamacare exchange? Last year’s enrollment period began October 1. This year, you can enroll and find out how much your rates have increased … on November 15, 2014 … after the elections. This strategic timing can only mean that rates are set to skyrocket. If they were trending downward, the elected officials who voted to pass Obamacare would be using that fact in their campaigns. Want to see the names of the numbskulls who voted for this abominable law? Roll call of Senators who voted for Obamacare (a party line vote by Democrats) Roll call of House members who voted for Obamacare (pretty much a party line vote by Democrats as well) Did I mention that elections are a couple of weeks away and that many of these people want to be re-elected? More on the microbiome. Stress and shock may really cause a heart attack – by affecting the bacteria present in arterial walls. The stress hormones released during sudden stress may cause the bacterial biofilm over the arterial walls to dissolve, causing placques within the walls to rupture. In the future, managing bacteria within an arterial plaque (carotid arteries typically have Pseudomonas growing inside) may be just as important as managing a patient’s cholesterol. What happens to all the kids who are sent from schools to the emergency department for psychiatric evaluations? In 92.2% of cases, they’re sent home, and in half of those cases they aren’t even given psychiatric follow up. The study notes that only ...

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Healthcare Update — 10-13-2014

HC Update 6

See more medical news from around the web at my other blog at EP Monthly. _________________ NEW SITE SPONSOR! Need to renew your BLS, ACLS, or PALS certificate? You can get your certificate the SAME DAY by taking an online course and passing the online test at Pacific Medical Training. By clicking on THIS LINK, you’ll also get a 15% discount on the course fees. That’s a $25 savings for your ACLS recertification! _________________ Straight out of Men in Black. UC Davis researchers have discovered that they can erase certain memories in mice by using flashes of light. China is cracking down on pharmaceutical price fixing. Some company executives received prison sentences of between 2 and 4 years for their actions – although unfortunately those prison sentences were suspended. Government department heads are also being investigated since they are responsible for and must be punished for law violations committed by their subordinates. Even the cats were amazed. 18 year old woman who had habit of chewing on her hair goes to doctor with abdominal pain and malnourishment. Rushed to surgery where a 9 pound hairball was removed. Yes, you read that correctly. A nine pound hairball. Like she had a baby Cousin Itt inside of her. The Limits of Friendship. How many friends can an average person realistically have in their social circle? Based on human brain size … about …. Oh go on and read the article. The discussion is pretty interesting. Baylor University Medical Center reportedly at risk of losing all federal funding if it doesn’t submit an acceptable action plan regarding psychiatric patient elopement. CMS inspectors recently found six cases in which psychiatric patients walked away from the hospital’s emergency department before treatment concluded and determined that those “elopements” put patients in “immediate jeopardy” of their health and safety. The Netherlands has a slightly different way to treat patients with severe psychiatric problems: Euthanization. The rate of death by lethal injection for patients with severe psychiatric problems tripled from 14 cases in 2012 to 42 cases in 2013. Counting “terminal sedation,” euthanasia accounts for one in eight deaths in the Netherlands. But at least the patients in the Netherlands have insurance – just like us. No more curly fries for me for a while. Woman puts potato in her vagina after being assured by her mother that doing so would be a fail-safe contraceptive method. Turns out mom was right. Guys tend to run the other way when they see roots growing out of your hoo hah. Fortunately, doctors were able to remove the budding spud without surgery. And if anyone makes any Mr. Potatohead jokes, I’m going to be sick. I just know it. The hormones from birth control pills found in sewage found to cause feminization of of male minnows. This caused the number of minnows in the Ontario waterways to decrease to 1% of the usual population. As a result, the number of lake trout decreased – lake trout are the minnow’s main predator. Also as a result, the number of insects in the area began increasing – insects are the minnow’s main source of food. When estrogen was removed from the water supplies, all of the changes reversed. Wait a minute. Obamacare requires that birth control pills be provided at no cost. That must mean that the government wants less fish and more insects in our country. What effect has the Affordable Care Act had on employment in the US? Mostly negative, according to this paper from the Mercatus Center at George Mason University. It creates financial incentives for employees to work less. Part ...

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Better With Vomiting

A 3 year old was brought to the emergency department for persistent vomiting. He was seen in the emergency department a couple of days beforehand, was treated, and released. He still looked well-hydrated and the mom said that she had run out of the medication he had been given. So we looked in the old records to find out what medication he was given and found this entry for the history of present illness: Mother states he has had a fever of 101-102 for the last two days. He vomited this morning. He has drank some on the way here. She states he is acting better now. And all I could think of was the video below that is in one of my son’s saved video compilations.  I wasn’t going to link to it initially, but then, eh, it reminds me of college and I have a sick sense of humor. ***WARNING *** This video is disgusting. Do not watch it if you have a weak stomach or if you are drinking beer or planning to drink beer.

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Healthcare Update — 09-22-2014

More health care news from around the web on my other blog at EP Monthly.com _________________ This site is an AMAZON affiliate. Purchasing products through Amazon by clicking on THIS LINK will support this blog at no cost to you. Thanks! _________________ Woman undergoes colonoscopy and biopsied show that she has rectal cancer. She undergoes four operations to remove parts of her rectum. Five months later, the hospital notifies her that her biopsy specimens actually belonged to another patient and that she never had rectal cancer. Now she’s suing. Five most common presenting complaints at Kings County Hospital emergency department in Brooklyn: Headache, chest pain, pregnancy, limb pain, back pain. Vaccines are good? Of the 100 or so children who died from influenza last year, 90% did not receive an influenza vaccination. Vaccines are bad? 15 Syrian children die and another 50 children sickened after “bungled” measles immunizations occur. Medics may have accidentally used a muscle relaxant to reconstitute the powdered measles vaccine. Archaeologists uncover 700 year old skeletons in England. They were laid to rest holding hands and their fingers were still entwined together when they were found. Your children belong to US. Parents remove 5 year old son from British hospital after being refused proton beam treatment for his brain cancer. Take child to Spain to continue treatment in addition to obtaining proton beam therapy. Britain then issues an international arrest warrant against parents based on “explicit medical advice” that the child’s “life was in danger.” Interpol picks the family up in Spain’s Materno Infantile Hospital. North Carolina’s Fayetteville VA Medical Center converting to an urgent care clinic because the company with which it contracted “failed to staff the emergency department with “an adequate number of well-trained physicians.” Veterans at the facility have reported that there was no medical officer on duty at the facility and that there have been long waits in the emergency departments. And … taking a play from George Bush’s playbook … many veterans were told to just “go to the emergency department” for their health care while they were waiting months for their appointments with primary care physicians. One 69 year old veteran who was having heart palpitations with a rate in the 150s went to the VA emergency department at 3:30 PM and learned that there was no doctor there to evaluate or treat him. The put him into a monitored bed and left him there until a doctor could see him. The veteran and his wife were “scared by the lack of care” they received. Let that quote sink in for a second. They have insurance yet they were scared because had no medical care. Another example of how medical insurance doesn’t mean a thing if you don’t have the medical providers willing to provide medical care in exchange for the insurance. More importantly, the couple noted that nurses in the emergency department were “turning many veterans away and telling many to return at 8 p.m., when a doctor would be on duty.” If true, the Fayetteville VA Medical Center is violating federal EMTALA requirements. If a patient comes to an emergency department seeking medical care, the patient must receive a medical screening examination to determine whether an emergency medical condition exists. I won’t hold my breath waiting for news of the investigation of these incidents. Chinese patients increasingly violent when they are unhappy with the treatment from their doctors. In September, 2011, a calligrapher in Beijing, dissatisfied with his throat-cancer treatment, stabbed a doctor seventeen times. In May, 2012, a woman attacked a young nurse in Nanjing with a knife because ...

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Battling diarrhea with … yeast

Recently-published meta-analysis shows that the yeast Saccharomyces boulardii has “clear beneficial effects” on children with acute diarrhea. Pooling of 22 studies showed that duration and amount of diarrhea was significantly reduced in children who took the supplement. Interesting back story to the discovery of Saccharomyces boulardii: The yeast is found on the skin of lychee fruits. French scientist Henri Boulard discovered Saccharomyces boulardii in the 1920s after noticing that natives of Southeast Asia were chewing on the skin of lychee fruits in an attempt to control the symptoms or cholera. You can purchase Saccharomyces boulardii from Amazon without a prescription. Saccharomyces boulardii is related to another yeast – Saccharomyces cerevisiae – which is found on the skin of grapes and plums and is used in brewing beer and baking. Antibodies to Saccharomyces cerevisiae are often seen in patients who have inflammatory bowel disease such as Crohn’s disease and ulcerative colitis, suggesting that Saccharomyces cerevisiae may play a role in bowel inflammation. Then I begin wondering whether the link between beer and “beer belly” may be related to more than just the alcohol and the extra calories in the beer.

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Healthcare Update — 09-12-2014

Need certification or recertification in BLS, ACLS or PALS? Don’t wait for the next course to be offered at your hospital. You can get same-day certification with an entirely ONLINE course NOW at Pacific Medical Training. If you sign up for training through this link, you’ll get a 15% discount on the cost of the course at checkout and you’ll be able to download your certificate of completion as soon as you pass the online test. ———————— 40 year old father/husband went to emergency department two days after feeling nauseous when he ate breakfast. Reportedly had cardiac symptoms, including chest pain. Was in the emergency department 4-5 hours, during which time no cardiac enzymes were ever ordered, and then released. Two days later, clutches his chest and dies from heart attack. Jury awards family $4 million. Good news: Chinese researchers discover new way to kill cancer cells by injecting the metal gallium into the arteries supplying the tumors. Bad news: In rabbit studies, the metal somehow finds its way into the heart and lungs and forms deposits there. $62 million medical malpractice award to patient who goes to Winthrop University Hospital for endoscopic removal of an ectopic pregnancy, developed complications from an unnoticed bowel perforation, then developed sepsis that eventually required amputation of both legs. In addition, the high doses of antibiotics she was receiving caused her to lose her hearing. When a front page story about the patient ran in the newspapers during trial, the hospital’s attorneys requested a mistrial, stating that the plaintiff “should be thankful the doctors were able to save her life.” Not really a good argument to use. In the end, the plaintiff and her attorney were happy that “justice was served” and someone in the comment section to the article suggests that everyone “remember this case the next time you find yourself asking why a Tylenol in the ER costs you 30 bucks.” Ohio jury awards patient and husband $1.2 million when patient had persistent pain after undergoing partial hysterectomy and physician didn’t order CT scan to diagnose perforated bowel until the patient was “critically ill.” By the time the complication had been diagnosed, she had developed respiratory distress syndrome and now requires a walker to help her walk. Remember how the government is making elderly patients pay for more care when they’re admitted as “observation” versus fully admitted? Then they came up with the “two midnight” rule, where providers had to predict whether a patient would need to stay in the hospital for two midnights – and then sign an attestation to that effect. The government won’t give “prior authorizations” for admissions, so providers are left to guess whether the government will retrospectively consider an admission appropriate, and anything deemed as “unnecessary” care is considered fraudulent when the government is billed for it. End result? Community Hospital Systems pays $98 million to settle false claims allegations. “The United States alleged that from 2005 through 2010, CHS engaged in a deliberate corporate-driven scheme to increase inpatient admissions of Medicare, Medicaid and the Department of Defense’s (DOD) TRICARE program beneficiaries over the age of 65 who originally presented to the emergency departments at 119 CHS hospitals. The government further alleged that the inpatient admission of these beneficiaries was not medically necessary, and that the care needed by, and provided to, these beneficiaries should have been provided in a less costly outpatient or observation setting.” Several emergency physicians and emergency nurses were “whistleblowers” in the case. When a hospital wants to admit you as an “observation” status, keep criminal investigations and settlements like this in mind. One ...

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