What the scallop is MDOD?

I propose a contest:
Since I have no friggin' idea what "M.D.O.D." stands for, I want some suggestions.

I went back through the very first posts and 911doc does not explain his chosen acronym. I'm guessing one of the 'D's stands for 'doctor' - pretty clever, huh? I figure as a contributor, I have a right to know. If the actual revealed meaning is lame-ass (as I suspect), we need something good. Put on your creative hats and help me out. Try not to suck.

The Hooters / Queer-Eye / Cabana-Boy Nursing Home

I forgot what I had learned about this chart in neuroanatomy in medical school but was able to find it on a google search. I think that as men age the sex-drive areas are replaced by a 'desire to take a good bowel movement' area, but that lesson is for another day.

Please do not yell at me but really, if I need to be in a nursing home at some point I would prefer to be shot. The reasons are legion and I'm sure there are some good nursing homes out there but I have yet to find them. The patients we routinely receive from these facilities are either sent in for nothing or sent in near death. So with this in mind, I am looking for a venture capitalist to fund the "Hooters / Queer-Eye Nursing Home". Since, as a nation, we are extremely uncomfortable with death and no longer take care of our parents in their dotage, I think the following is a better solution.

The only requirement to be placed in this nursing home is that you sign and agree to a 'comfort care only- Do Not Intubate - Do Not Resuscitate' order. But oh, the comfort!

The nursing home will be divided into a male and female wing. On the male side Hooter's girls, or their equivalent, will provide all meals and assistance. They will be expected to deal with a moderate level of leering, sexual innuendo, and butt-pinching. They will be paid well and allowed to slap the hands of the offending pinchers while telling them how naughty they are. The men can watch football all day long on huge high-definition televisions and eat and drink and smoke and play cards to their heart's content.

The ladies wing will be run by young homosexual men with a flair for fashion and interior decorating. The ladies can get their hair done, their nails done, and gossip all day. The fine young male pseudo-nurses can plan all the social events and make helpful hints regarding the latest fashions etc... Ladies, please flesh-out this concept as I am crippled with the kind of brain pictured above and can not comprehend much about the female perspective (thanks in advance).

CPR will not be performed correctly but may be requested by either the male or female residents for a time period not to exceed five minutes. When I close my eyes for the last time I think seeing a buxom young thing astride my chest, with her gravity defying cleavage moving in rhythmic motion ( and with just a hint of perspiration on her red rosy cheeks), will allow me to believe, if only for an instant, that I am headed for paradise.

This is where I want to die.

AS AMMENDED THANKS TO RESPONSES FROM THE LADIES: This should perhaps be the "Hooters / Pool-Boy / Queer-Eye" nursing home. Keep the queer-eye lads for decorating and social events. Pool or cabana boys for the ladies side. That would work. Thanks to RadGirl and MOW and others for this suggestion.

Musants

Musants are musings and rants. I just made that up.

From time to time I come up with great ideas, and while dealing with a resident (they sometimes shuffle through the ED on a rotation) I came up with this idea. We have dummies and test manikins for everything from intubation to breast exams to CPR. But with today's technology, we could produce the following, with the help of the Disney imagineers, which would give the new resident a quick overview of the ED in a short period of time, and help them learn how to deal with a typical patient.


1. Grumpy old man manikin that continuously tries to fall out of bed, and wants a more comfortable pillow.


2. GI bleed manikin, that continuously spews foul fake stool all over the bed and floor, all the while yelling "you're killing me, you're killing me"


3. 18 year old girl manikin that reeks of alcohol, vomits xanax pills, and curses about the boyfriend who just "doesn't realize what he has thrown away"


4. Old man #2 manikin, that doesn't speak at all, except for saying "you tell him momma" when you ask about his history.


5. Young female manikin that continuously rubs her entire abdomen, discharging fake pus between her rubber legs repeating " there's no way I could be pregnant".


As an aside this is for you prospective "clients", also known as patients: It's not a spider bite, that cold won't "turn into pneumonia", you don't need antibiotics for your cold, there are 200 individual products over the counter for your symptoms, if you smoke two packs a day you don't have "asthma", and for the last time I don't care what you ate at Luby's two weeks ago (unless you ate arsenic), and finally, you didn't "just move into town" if I look in the records and your were here 6 times over the past 4 months.



Now I feel better.

BOOYAH!

Once in a while good things happen to good people. How to explain then our recent honor of being chosen "Doctor('s) of the Month" over at Addicted to Medblogs? However one might explain it we are honored and must thank our good friend MedblogAddict for her hard work in putting this together. WARNING! Rated R (at least).

God Bless Crazy Parents

One subject I could post on every day is crazy names. We got 'em. No, I'm not talking about 'Shithead' (pronounced 'shi- thaid') so please don't comment that you've heard this one, or 'Oranjello' or 'Lemonjello' or 'Wasserman Positive Illigitemate Jones' or 'Sy Phillis' or 'Nosmo King' or 'Neveah' (heaven spelled backwards which to me means the oppositte of heaven so really, WTF??), or whatever. Heard it all. What I have never seen is a youngster with a middle name of "Machinegun", but I met him yesterday.

I love this name. Little Billy Machinegun Smith will likely be a huge badass, and if he ever plays sports his name will never be announced over the PA system without his middle name being accented. He will have thirty tattoos by the age of 18 and chew nails and spit bullets. If you are going to do this to your child, THIS is how to do it. "Machinegun". That kicks ass! Props.

"Credentialed" to Check Poo

PICTURED IS ONE OF THE OLD TESTS THAT WAS ONLY 96% SENSITIVE ETC...

In their infinite collectivist wisdom, a committee composed of paper-nurses and paper-doctors decided to do away with the old standby poo-checking card used for decades without accidental death or decaptitation, and get a fancy-schmancy super poo-checking-can't miss tubette that will not be fooled by, say, goat's blood in someone's ass or something.

Seriously, we do, occasionally, check stool for blood with the whole finger-in-the-bottom thing and it used to be a quick and dirty (pun intended) little exercise that no one liked but would tell us immediately if someone had blood in their stool and then we could fashion our treatment based on the knowledge that somewhere in the patient's GI tract was a bleeding "something".

Much to my surprise the other day I got the old 'letter in the box' on official hospital stationery. During one of my busy shifts I had needed a stool check for blood and had taken the super fancy can't miss tubette into the room and got some poo and mixed it up in the fluid and the test was positive and I wrote it in the chart as such. It didn't change my management of the patient while they were in the ER.

The letter was signed by one of our super power-through-paper folks and it kindly informed me that I was not 'credentialed' to run the poo-check test. Gotta go take a 6 hour course now on finger-angle, lube application, tubette maintenance, and proper form filling-outedness. Call me if anyone gets sick.

More Bread and Butter

After working all day last week, my mom called at 2am.

She's frail, 83 yrs old and had an ACB this summer. After 3 months in rehab, she had been back at her retirement center for 5 days.

"I'm just weak" she said. (We all love those octogenarians who are "just weak")

I told her to push her "I've fallen and I can't get up" button and I'd meet her at the ER.

When I got there, I didn't understand why there was so much activity around her...then I saw her EKG! I post it since I thought it was a great tracing.

The cardiologist came in and put a temp pacer in her (they wouldn't let me do it....I LOVE to do those), and she got a permanent pacer a couple of days later.

She's back at the rehab and doing well.

No HIPAA concerns, her name is removed, Mom thinks the internet is a bunch of tubes, I have power of attorney, and all of her friends are dead.

Welcome erdoc85

I had never met a Texan until I met erdoc85 during a project we collaborated on some years ago. Some of the work we did together spurred further research, the results of which have gone on to improve the quality of care provided by those on the front lines of Emergency Medicine. I am proud to say that recent research from the NIH is, well, a direct offshoot of our research. Please see the video below if you are curious.

Americans are fond of saying that everything is big in Texas though, being from the barren reaches of the Ukraine and remembering well the days of the CCCP I have never really understood this. erdoc85, however, educated me on the uniqueness of Texas to the American psyche, and on the proper use of the term "bullshit". erdoc85 is boarded in Emergency Medicine and currently practices in the United States in a hospital near you. Welcome old friend.



Study: Multiple Stab Wounds May Be Harmful To Monkeys

Blame Canada!

A short film from my side of the debate is clickable below. Hey Michael Moore, I hope you have to get your penis-lengthening surgery in Cuba you idiot (he suffers from what is commonly known as 'turtle-penis').

I'm a Freakin' Psychic and Al Gore Knows It!

Dear Readers: This is the third Al Gore-referencing post in a week or so... something is very wrong with me. Somehow this "bucket of warm spit" is all of a sudden a freaking scientific and public policy genius? Combine this with the earth heaving from the college football mess and I'm building a bomb-shelter out back. I do apologize but this is more amazing to me than the guy who came to the ED yesterday with a three month rash, itching, chest pain, a boil on his butt, a dermatologist who was treating him appropriately, and, as it turned out after a full cardiac workup, only needed a prescription for benadryl.


Serendipity? Psychic powers? You be the judge. If Tony -freakin'-Robbins were locked in a room with Al Gore he would pop a gun in his mouth within an hour. Yeah, I know the last sentence has an indeterminate reference and it's on purpose because I really don't know whether Tony would kill Al or himself or do the whole murder-suicide thing.


NOTE: VIDEO PULLED FROM YOUTUBE 10/17/07 BUT SHOULD BE CLICKABLE HERE. SUMMARY FROM MEMORY. "I'M AL GORE AND WE SHOULD HAVE NATIONAL HEALTH CARE BECAUSE I WON AN ACADEMY AWARD AND A NOBEL PRIZE AND I'VE GOT TO FIND A WAY HIT THE TRIUMVARATE AND WIN THE MISS AMERICA CONTEST."

Hello National Health Care

The only thing puzzling about this story is that people are puzzled. Just as an afterthought perhaps the Brits can form a committee to pass some laws to force the dentists to make this right. Let's send them Al Gore... he won a Nobel prize and all.

Vacations: Blessing and Curse

Well, got back from vacation last week. Went to a city out west with bright lights , gambling, great restaurants and always something to do. Played 4 rounds of golf with friends and spent time with my wife on our anniversary. Rode around in limos. But the thing that sucks with my(our) job, is that any time we take vacation, we cram all the shifts of a month into 3 weeks. So I get an intense reminder of how great it was to not work, and how horrible I feel at 3:00 a.m. physically and mentally. Vacations make it hard to go into the room and keep my patient satisfaction scores high by looking interested about a 19 year old's penis drip. They make it difficult to deal with the codes and unexpected deaths (had one today). Vacations make your heart sink when you return that next Monday to several already waiting to be seen when you get there at 7:00 a.m.

I guess the best solution to prepare me would either be to not take vacations ( won't work, because I do love drinking white Russians, smoking a fat cigar, and sharing good times with family and friends) or plan B: to stay up all night the last night of vacation, hire several people to yell and bitch all night and complain about stupid things, pipe in the smell of pus, beer, poop and feet, and kick me in the balls. Then I would be prepared to come back to work.

It Just Warmed My Heart the Other Day...

I was working at my new BCH (Big County Hospital) when a dirt bag came up to the nurses station and started bitching because he wasn't getting his pain medicine fast enough and it wasn't Demerol and he just couldn't be ignored anymore, blah, blah..At that time we had, oh, 120 something pts in the dept...

One of my now favorite new nurses just looked up and said "Sir this isn't MacDonalds, you don't get to have it your way. We'll get to you as soon as we take care of the really sick people here. Please feel free to leave anytime you wish"

Lord, I thought I'd died and gone to Heaven!! Or at least had been transported back a couple of decades in time... Just thought I'd share.

The Earth Has a Fever or Something

So Al Gore won the Nobel Prize. The earth has a 'fever'. Now there are lots of things to worry about but I'm not worried about this for many reasons which are detailed here.

Here's what worries me... college football. When the season starts with Michigan losing at the big house to Appalaichan State and South Florida is a top five team and Kentucky beats L.S.U. and Stanford beats U.S.C. and Nebraska sucks ass then the earth is spinning out of control. Something needs to be done quickly! Al Gore, please help.

Read and Laugh. Thanks Panda Bear.

Kudos to Panda for this.

Americal College of Emergemcy Physisians = the College of Liberal Academic American Emergency Physisicans (the CLAAeP)

Hey ACEP. I'm done. No more dues for you. When you open your convention with a Media personality who cites the Veteran's Administration Health System as a glittering jewel of what can be achieved if we would only get ourselves on board with socialized medicine, when you create rules that take 5 minutes out of every lecture so the speaker can disclose any financial relationships they might have with 'evil' drug companies, and when my dues go to support such nonsense rather than advancing and protecting the agenda of the majority of the physicians in the college, well, you guys really are just a bunch of pointy-headed academics operating in your own vacuum. See you later. Much later. Scratch that. Never.

You can't even get some refreshments to us between lectures, but here you make an exception and let the evil drug companies and medical device companies and Team Health (that evil monster and perennial whipping boy for disgruntled ED docs) do it for you. You are part of the problem. You are patronizing and paternalistic in the extreme. You believe that only your small set of 'smart doctors' are able to fix the problems of the obviously mentally inferior unwashed masses of patients and that the best way to fix the problems is to form the 800th committee of the college to form resolutions to make resolutions in the future to address the problems. No responsibility for the patients, no, they can't handle it. We should do it all because, gee, we are all so smart. ACEP, you guys suck.

Bread and Butter

Vital signs my friends. Vital signs. If I had not looked at this young man's vital signs I would have let him sit for a while with his chest pain. After all he was an 18 year old without trauma. What's the worst it could be? The nurse did document a pulse of 140 but somehow triaged him to a low category. I saw the pulse rate and went back to see this young man who was looking quite ill.

Now the dogma is that you never want to diagnose a tension pneumothorax by Xray but that is in fact what happened here. Without trauma it was not apparent to me to even think about it and he was maintaining his oxygen saturations. I did suspect a pneumothorax in this tall thin kid who smoked but I did not expect this.

As you can see from the first film there is a very clear looking right lung field. The busy-looking hilar area on the right near the middle is his right lung, fully collapsed, and, if you look closely you can see the trachea deviated into the left lung field.

As soon as I saw the Xray we moved him to a critical bed and I stuck a 14 angiocath between the 4th and 5th ribs on the right. There was no dramatic rush of air so I think this was early tension, but when I put in the chest tube (seen clearly in the mostly re expanded left lung apex) I did get a nice rush of air.

Concerningly, this young man's lungs do not appear normal after the chest tube so suspicion is raised for an underlying undiagnosed disorder like alpha 1 antitrypsin deficiency. Vital signs people. 18 year olds with chest pain sometimes have a life threatening cause and we can not miss them.

Don't Crash Your Car Outside a Big City

Big surprise. People think that this is due to lack of funding and certainly when we give stuff away for free money becomes a scarce. Wow. The reality also is, as we have stated here, that specialty surgeons (and trauma surgeons in particular) are in short supply. Besides that, due to the litigation climate and the demands on their time they would face being the one or two guys in town that do trauma, they absolutely do not want to practice in rural areas. Sometimes the best they can do outside a trauma center will not keep them out of court. Result? They leave for the big city. Go figure. Article citation below...

Transfer of trauma patients to appropriate emergency care often falls short.
The Wall Street Journal (10/3, D1, Landro) reports on a dangerous gap in emergency care, the lack of resources to transfer patients to the hospital best equipped to deal with them. Noting that "[t]rauma from injuries including accidents, falls, and violence is the leading cause of death for Americans under the age of 44, claiming more than 140,000 lives and permanently disabling 80,000 people annually," the Journal finds that "only one in four lives in an area served by a coordinated system to transfer patients to designated trauma centers from less-equipped hospitals, according to the American College of Surgeons, which sets standards for trauma care." And, "only eight state trauma systems met nationally recommended preparedness levels in a study by the federal government after the Sept. 11, 2001, terrorist attacks." The Journal adds that "[w]hile some progress has been made, many states remain woefully unprepared, trauma experts say." Furthermore, although "[e]fforts are under way to develop a national trauma system to ensure referral of severe injuries to qualified centers...funding is tight," with "the federal government...provid[ing] only about $34.1 million to help develop statewide trauma systems." In addition, the areas at "highest risk are...rural areas, where nearly 60% of trauma deaths occur even though such areas account for only 20% of the population."