What’s the Diagnosis #16
A nursing home patient is brought by ambulance with a cough. Nursing home staff believe the patient may have aspirated lunch 30 minutes ago. The patient’s workup is normal except for his EKG which is shown below (you can click on it for a much larger/printable version). What’s the diagnosis? What needs to be done with the patient? Does it make any difference whether this was a new finding or an old finding? I’ll provide the answer in the comments section in a couple of days. (Source: WhiteCoat's Call Room)
Source: WhiteCoat's Call Room - April 3, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: What's the Diagnosis? Source Type: blogs

Healthcare Update — 04-01-2013
This case report is entirely bizarre. Patient gets awarded more than $800,000 after visit to doctor resulted in incorrect diagnosis of cancer when the patient really had pneumonia and caused patient to have amputation of her foot. A trial was held on the case four years ago with a verdict in favor of the doctor, but the judge declared a mistrial because Washington State jurors were referring to the plaintiff’s Japanese attorney as “Mr. Miyagi” and were making other racist comments against him. Then, the article notes that the doctor had been disciplined by state regulators for making “erroneous diagnoses” and for...
Source: WhiteCoat's Call Room - April 1, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Dear Diary
My gosh. I actually get angst when I haven’t posted for a few days. Actually, I have angst for other reasons, but not posting just adds to the angst. So what’s been happening lately? First, the poor WhiteCoat children are having trying times in their love lives. Oldest daughter WhiteCoat found out from a member of her track team that her boyfriend of 6 months was cheating on her. Another member of her track team was apparently going around and telling everyone that she had a “secret boyfriend” and was also telling everyone the sordid details of the interactions she was having with her “secret ...
Source: WhiteCoat's Call Room - April 1, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs

Healthcare Update — 03-25-2013
This study showed that in more than 4 of 5 obese children, the subcutaneous fat layer was too thick for an IM injection one quarter of the way down the thigh. In nearly 1 of 5 obese children, the subcutaneous fat layer was too thick three quarters of the way down the thigh. In those patients, the study suggested injecting the calf. I suppose the manufacturer could be forced to make autoinjectors with longer needles, but then non-obese patients would theoretically risk getting a bone marrow injection of epinephrine. How good are emergency physicians at dispositioning psychiatric patients when compared to psychiatrists? Not ...
Source: WhiteCoat's Call Room - March 25, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Grand Rounds Snoop Dog Style
I happened to catch on Twitter a web site where people could search up their Twitter names and get their tweets translated into gangsta talk. Probably not something you should read at work or in church, tho … yo. So I tried it with some other sites. I can’t decide which is more amusing. A newspaper story about a crime? A court opinion? A medical article? Press Ganey’s web site? Note at the bottom of the page the type of “Regionizzle Symposium” they have in 2013. Or a WhiteCoat post? Wanna be an instant YouTube sensation? Have someone video you doing a grand rounds translated by Gizoogle. (Sour...
Source: WhiteCoat's Call Room - March 24, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs

Who Should Sign Death Certificates?
I happened to read an article in the Columbus (Ohio) Dispatch where Ohio coroners are complaining because some doctors, including emergency physicians, are refusing to sign death certificates listing a patient’s cause of death. The coroners are concerned because they are being “burdened” with hundreds of extra cases every year that they must handle. And if other doctors don’t sign off on the cause of death, sometimes it takes two months for them to examine records, wait for test results, and make a final ruling on a patient’s death. The treating physicians reportedly use the excuses that they ...
Source: WhiteCoat's Call Room - February 28, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Medical-Legal Source Type: blogs

Healthcare Update — 02-27-2013
Knowledgeable and honest. Yeah, that’s me. Study shows that doctors wearing white coats were most likely to be judged by patients as being the “best” physicians. Doctors wearing scrubs were also more likely to be highly rated. Of course my widespread appeal could also come from my stunning good looks or my debonaire personality … Interesting dilemma. A patient in Washington DC called an ambulance at 1:26 AM when he was having trouble breathing. Just so happens that it was New Years Eve and about 25% of the entire DC firefighting force had called off sick that day. An ambulance arrived 30 minutes later and the patie...
Source: WhiteCoat's Call Room - February 27, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Reader Poll
So I had a problem with a patient and family recently and I’m looking for solutions from everyone who reads this blog. An elderly patient who lives at home with his wife, his son, and his son’s family was brought by the ambulance to the emergency department for “not feeling well.” As I attempted to get more of a history about the patient’s symptoms, the discussions angered the family. “When you say that you don’t feel well, what do you mean?” “I’m sick! That’s why I came here so you could tell me what’s wrong.” “But I don’t understand...
Source: WhiteCoat's Call Room - February 22, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs

Dear Diary
I hate the movie Pitch Perfect. Actually I like the movie itself, but my kids won’t stop singing the frigging songs. I have heard the songs from that movie in my sleep for months now. The latest thing that my kids have taken to doing is re-enacting the “cup” scene where Anna Kendrick sings You’re Gonna Miss Me When I’m Gone using a cup. Before school in the morning, “you’re gonna miss me when I’m gone.” At night after dinner, it’s a chorus of “you’re gonna miss me when I’m gone.” Without a doubt I am NOT going to miss that damn song when it...
Source: WhiteCoat's Call Room - February 21, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs

The Book and its Cover
When you work in an urban hospital, sometimes it’s difficult not to become jaded. There are certain neighborhoods that generate a disproportionate number of patients for some emergency departments. Meth is rampant. Marriage pretty much nonexistent. More bars than there are restaurants. Domestic abuse frequent, but prosecutions rare. Police know people more by their street names than by their real names. South Heights was one of those neighborhoods. The emergency department frequently treats South Heights kids who are neglected by their parents. I’ve seen young South Heights kids with seizures from cocaine. Now ...
Source: WhiteCoat's Call Room - February 19, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update 02-18-2013
Some hospital CEOs just don’t like being questioned. When one hospital chief of staff led some other physicians in questioning the manner in which a hospital was being run, hospital CEO Bruce Mogel allegedly had black gloves and a gun planted in the doctor’s car. Then someone called 911 and reported that someone was driving down the street waving a firearm. The doctor was arrested in the hospital parking lot and was strip searched at the jail. The doctor sued. During depositions, a witness alleged that the CEO claimed “People do not know how powerful I am.” Now a jury has found the hospital liable for $5.2 million....
Source: WhiteCoat's Call Room - February 18, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

The Last Patient of a Long Night Shift
By Birdstrike M.D.   My first night shift in a stretch of 7 was almost over.  It was 6:15 a.m. and I had to keep moving otherwise the minute I would stop, my eyelids would drop like two ton shades and I’d fall asleep.  That never makes for a good drive home after a night shift. “Got time to see one more?” asked Jenny the nurse. “Do I have choice?  The door-to-doctor time storm-troopers would have it no other way,” I grunted back, eye lids drifting closed. “Febrile seizure,” it said. Good, this should be quick and easy, I think to myself.  We’ll give some Tylenol, reassess in 30 minutes and this b...
Source: WhiteCoat's Call Room - February 17, 2013 Category: Emergency Medicine Doctors Authors: Birdstrike Tags: Uncategorized Source Type: blogs

It Didn’t Feel Like A “Win”
By Birdstrike M.D.   My kid and I are outside in the front yard blowing bubbles, enjoying the blue skies and 70 degree weather when she says, “Cool Daddy! Look, there’s a police car coming down the street. Oh, cool! I think he’s coming to see us!” Uh, oh, I think to myself. Despite my kid’s excitement, I know that rarely does anything good come delivered by a policeman. My wife is inside, my one kid is with me and my other is inside, so they’re not coming to give me some tragic news. Or are they? My parents….my siblings….is everyone okay? Why is a sheriff pulling into my driveway? I exhale for a minute...
Source: WhiteCoat's Call Room - February 16, 2013 Category: Emergency Medicine Doctors Authors: Birdstrike Tags: Guest Posts Medical-Legal Source Type: blogs

Are You Better Than 83% of Radiologists?
Fascinating study about missing obvious findings on CT studies, based on another study about selective attention. In the cited study, 83% of radiologists missed the abnormal findings on the first CT image. Don’t ruin it for anyone else, but how many of you caught all the abnormalities on the CT scan below? For those who aren’t used to looking at chest CT scans, I included a fairly “normal” CT chest cross section (except for the small nodule) at approximately the same level on the bottom for comparison (credit here). Abnormal CT (Source: WhiteCoat's Call Room)
Source: WhiteCoat's Call Room - February 15, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Medical Studies Source Type: blogs

Mending
Surgery went uneventfully, I think. Don’t remember much of it because of the dang Versed. While walking back to the outpatient surgery room, I never thought what big business surgeries are for hospitals. The outpatient surgery floor had a long curving hallway of identical rooms, one after another, all with freshly-made beds, blankets folded neatly on top of the beds, and patient belonging bags draped over the blankets. Walking by the rooms, it was almost like having the same picture flashed in front of my face over and over again. After I got settled in the room and started watching the news on the flat screen TV in ...
Source: WhiteCoat's Call Room - February 15, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs