Wednesday, April 18, 2018

What is the worst way to combat school shootings?


Please read carefully because there might be a test.

A school district in Pennsylvania placed a 5 gallon bucket of rocks in each classroom two years ago. If locking and barricading the classroom door does not work, the students have been instructed to throw rocks at the would-be shooter instead of hiding under their desks.

According to a Buzzfeed story, the school superintendent for Schuylkill County believes the rocks serve as a powerful deterrent. He said, “If an armed intruder attempts to gain entrance to any of our classrooms, they will face a classroom full of students armed with rocks. And they will be stoned.”

Maybe it’s working. Since the arrival of the rocks, there have been no shooter incidents in any Schuylkill County school.

Wednesday, April 4, 2018

The decline and fall of the rectal exam



For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications.

As recently as two months ago, trauma surgeon Michael McGonigal blogging at The Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable for patients already traumatized and its yield is so minimal, he advocates doing it in only patients with spinal cord injury, pelvic fracture, and penetrating abdominal trauma. For a more extensive discussion of the topic, see Life in the Fastlane, an emergency medicine blog.

Monday, March 12, 2018

Can data in electronic medical records be trusted?

If the subject is respiratory rates, the answer is “No” according to a recent study. The authors reviewed the records of 28,500 patients over 220,000 hospital days and found recorded maximum respiratory rates “were not normally distributed but were right skewed with values clustered at 18 to 20 breaths per minute.”

The figure below shows maximum respiratory rates compared to heart rates which were normally distributed.
Reminder: Most sources say the normal respiratory rate of an adult ranges from 12 to 20 breaths per minute.

Thursday, March 8, 2018

More negative data about the nonoperative management of simple appendicitis

If you think I am the only one urging restraint in the adoption of nonoperative management of patients with uncomplicated appendicitis, you are wrong. A pediatric surgeon and a research fellow from Harvard and Massachusetts General Hospital have recently published their thoughts on the matter online in Annals of Surgery.

They call their opinion piece “Ulysses Syndrome” because they liken the fate of those undergoing nonoperative management to the “10-year ordeal filled with unexpected peril and ample misfortune” that befell Ulysses while attempting to go home.

Here are a few highlights.

Monday, March 5, 2018

How the public is misinformed about the outcomes of CPR

A survey of 1000 volunteer adults found 71% regularly watched medical television dramas, but only 12% said the shows “were a reliable source of health information.”

The participants were given some brief vignettes describing scenarios where CPR was administered—a 54-year-old who suffered a heart attack at home and received CPR by paramedics, an 80-year-old with a postoperative cardiac arrest in the hospital after surgery, and a post-traumatic arrest in an 8-year-old.

Those surveyed estimated CPR success rates at 57% to 72% and rates of long-term survival with neurologic recovery at 53% to 64%.

Monday, February 19, 2018

Perforated appendix not seen on CT scan

From an email received two days ago. Posted with permission and edited for length and clarity.

I came across your blog while looking for information on something puzzling that happened to my sister. I read the blog on CT scans and appendicitis* and went through all of the comments section. I couldn't find a case like my sister’s.

She has been sick off and on for the last two months. It began with what seemed like a bad stomach virus, fever, throwing up, diarrhea, gas pain, bloating, and stomach cramps. She brushed it off as a 24 hour type thing, stayed home from work a few days, and felt better but never returned to normal. She would have intermittent stomach upset and began to have weight loss. About 3 weeks ago, she went to see her GP who ran some tests (antibody tests, no CBC, chem 7 or normal work up) and diagnosed her with gluten intolerance.

Monday, January 22, 2018

"The Resident"

A new medical drama with the same old characters.

The show opened with the chief of surgery in the middle of a rather bloody open, not laparoscopic, appendectomy.

The circulating nurse started taking selfies with her phone; the anesthesiologist was distracted; the patient started moving; blood spurted all over the surgeon.


According to a nurse, the patient lost 2 liters of blood in 20 seconds.

What artery, other than the aorta, could he possibly have cut that would bleed so much? The chief of surgery just stood there. I yelled at the TV, “Put pressure on it for God’s sake.“

Finally, they started CPR and the surgeon seemed to be packing the wound.