Sinbad Provides a Pertinent Medical Lesson

We're taking a break from all things medical the last two weeks of December. Hopefully these videos will make you smile and as a bonus, each post will have a book/gift card winner drawn from the subscribers/followers list. So, sounds like a great time to start subscribing and following!

Check back frequently and often to see if you've won. Address must be e-mailed to jredwood1@gmail.com by 12/31/2011 to claim.

Today's winner is: Dianna Benson who subscribes via FeedBlitz!

Now enjoy the video! I love Sinbad and he provides a good medical lesson.

Holdman Christmas Lights

We're taking a break from all things medical the last two weeks of December. Hopefully these videos will make you smile and as a bonus, each post will have a book/gift card winner drawn from the subscribers/followers list. So, sounds like a great time to start subscribing and following!

Check back frequently and often to see if you've won. Address must be e-mailed to jredwood1@gmail.com by 12/31/2011 to claim.

Today's winner is: Nancy Lynn Jarvis who follows via Networked Blogs!

Now enjoy the video. This has been one of my holiday favorites.

Ever Had a Day Like This?

Hope everyone had a great Christmas! Any funny stories out there? Best gift?

I have one. My 9 y/o daughter came up to me, "Santa is so rude."

"Why?" I ask.

"He put my cookie back in the bin."

"Ummm..."

How about you?

We're taking a break from all things medical the last two weeks of December. Hopefully these videos will make you smile and as a bonus, each post will have a book/gift card winner drawn from the subscribers/followers list. So, sounds like a great time to start subscribing and following!

Check back frequently and often to see if you've won. Address must be e-mailed to jredwood1@gmail.com by 12/31/2011 to claim.

Today's winner is: Diane J!

Now enjoy the video!

Christmas Morning Disaster!

We've been enjoying some holiday fun. I certainly hope your Christmas morning does not go like this. I loved this video and I hope you enjoy it too.

But before we have Christmas fun, our next winner is: km.weiland@.... who subscribes via FeedBlitz! 

Remember, you must e-mail me your address by 12/31/2011 to jredwood1@gmail.com. 

Now, please remember to check those fish Christmas morning before the children come down to see them.



Hope you all have a Merry Christmas!

A Social Network Christmas

We're taking a break from all things medical the last two weeks of December. Hopefully these videos will make you smile and as a bonus, each post will have a book/gift card winner drawn from the subscribers/followers list. So, sounds like a great time to start subscribing and following!

Check back frequently and often to see if you've won. Address must be e-mailed to jredwood1@gmail.com by 12/31/2011 to claim.

Today's winner is: Leila Rose Foreman who follows via Networked Blogs.

Now enjoy the video!

Christmas Fun

We're taking a break from all things medical the last two weeks of December. Hopefully these videos will make you smile and as a bonus, each post will have a book/gift card winner drawn from the subscribers/followers list. So, sounds like a great time to start subscribing and following!

Check back frequently and often to see if you've won. Address must be e-mailed to jredwood1@gmail.com by 12/31/2011 to claim.

Today's winner is: twobellesandabook!

Now, enjoy the video. Love this because I'm a dog lover.

Up and Coming: Drawings Galore!!

Over the next two weeks, Redwood's Medical Edge is celebrating all those who subscribe and follow. On my regular post days (Mon, Wed, and Fri) I'll be drawing names from these lists for prizes. All you have to do is subscribe or follow!

I'm really humbled that so many of you are keeping track of things here and finding the information useful. I have great things planned for January that I know you'll enjoy but I think it's good to take a step back and just... well... be thankful for all that you've given me.

So, check back frequently and often to see if you've won!!

Many blessings to you this Christmas Season... Jordyn

Author Beware: The Law-- HIPAA (3/3)

Today, I'm concluding my three-part series on the HIPAA law. I'm going to focus on how I've seen it violated in published works of fiction.

Situation 1: A hard-nosed journalist makes entry into the hospital and begins asking the staff about a current patient. One nurse pulls him aside and gives him the information. This is a clear violation of HIPAA. All media requests will go through the public relations office. For any information to be released, the patient needs to give their permission.

Situation 2: A nurse on duty calls her friend and notifies her that another victim involved in a crime spree that her sister was a victim of is an inpatient at her hospital. Again, unless that person has provided direct care to the patient or the patient gives their consent for the information to be released, the nurse is in violation of HIPAA. However, the author of this particular ms handled it well. At least she had the character divulge that she could get in "big trouble" if upper management found out what she'd done. Think back to Brittney Spears in part one of this series.

Situation 3: Small town high school mascot falls ill on the field during a football game and is rushed to the hospital. A paramedic takes him to the ER. When the paramedic's wife arrives, she inquires about his condition. The paramedic/husband tells her what the doctors found. Again, the wife is not providing direct medical care to the patient. This paramedic has violated the patient's HIPAA rights by divulging this information to his spouse. Now, I understand, in small towns-- this information may "leak out". A better way for the author to have handled this would have been to have the wife of the fallen mascot tell this woman what his diagnosis was. HIPAA doesn't apply to family members and they can willingly share information with who they wish. That may not make the patient very happy--- ahh... another area of conflict!

Have you seen HIPAA violations in works of fiction that you've read?

Author Beware: The Law-- HIPAA (Part 2/3)

Situations involving minors can be an easy way to increase conflict in your manuscript. Here is an easy area to use.

Minors presenting to the ED for evaluation of a pregnancy or STD related complaint.

Here's a set-up. Mother brings her 14 y/o daughter in to "get checked for pregnancy". Okay, great. Already we have inherent conflict. After all, if the daughter was in agreement about allowing her mother to know this information, they could have done a home pregnancy test and matter solved.

At times, parents will bring their children to the ER thinking that, because they've signed them in as a patient and they're the parent, we'll have to do as they ask and they'll learn the information that way.

This isn't the case. Will we do the pregnancy test? Maybe. The patient has to be willing. Will we relay the pregnancy test results to the parent? If the 14 y/o patient says "no" then we will not.

Most states have laws surrounding minors that issues related to pregnancy or STD's is protected information and can only be released to the patient. Depending on the state, the cut-off is 13 or 14 years. This is different from us giving information about a follow-up culture for strep throat.

I've had parents call back for test results. I had a step-mother call for pregnancy test results on a patient. Nope, can't give you the information.

Another area is that minor patients can sign themselves into the ER without parental consent for these matters as well. Generally, for all other conditions, we have to make attempts to get the parent on the phone for verbal consent witnessed by two individuals.

What do we do?

As healthcare providers, we really do try and facilitate open dialogue between the parent and child. We'll sit with the 14 y/o daughter privately and go over why it would be best for her to share this information, regardless of the results, with an adult.

Can you think of other healthcare situations involving minors that could be high areas of conflict?

Author Beware: The Law-- HIPAA (Part 1/3)

Several months ago, I was watching a local TV news station when a nurse manager was being interviewed about the fact that you could look up ER wait times on the Internet before checking in. That's a whole other can of worms I won't get into today but the problem with her interview was that the camera shot included her standing next to their patient tracking board in which you could clearly see the last name of the patient, their age, and their medical complaint.

I almost fell out of my chair. This was a clear HIPAA violation and that ER manager should have known better than to be standing anywhere near that board.

Each time you visit the doctor's office or sign into the urgent care or emergency department for treatment, you should be given a paper that outlines your rights under HIPAA which stands for the Health Insurance Portability and Accountability Act. It basically outlines rules on how to deal with a patient's "protected health information" or PHI.

What this boils down to for the bedside clinical worker falls into a couple of areas and I'll give some examples below.

1. I should be providing direct care to a patient or should have provided recent care in order to look up their chart. Some of you may remember the healthcare workers that were fired for accessing Brittney Spears medical information. They were likely fired under this provision.

2. I can't share any specific information (name--never, age, and complaint) listed together in areas where other's could become aware of the patient's visit. This would include areas like social media (a big no-no). When cases are presented at medical conferences, generally all patient information is blacked out (say on x-rays). And the patient is only spoken of in general terms. Such as: 16y/o presented to the ER for evaluation of neck pain. Now, across the USA for one day, probably several patients presented with this complaint so how do you know which one it was?

3. I shouldn't be sharing patient information with my spouse unless he has provided direct care to the patient as well. Therefore, since my husband is an accountant, I can't say--- "Oh, by the way our neighbor's daughter was seen for a broken arm today in the ER." Unless I've asked the mother specifically if it's all right that I mention this to my husband, I have violated that patient's rights by sharing that information with my spouse. Working in pediatrics, I've been in the situation often and don't mention the visit at all when home.

4. Requests for information about a patient from the media generally go through the public relation's office. This tends to happen more off hours, a reporter will get through to the ER desk and begin to ask questions. Most, if not all hospitals, are very firm that all media inquiries go through public relations. This allows them to control the message.

5. Patient information cannot be given over the phone unless specified by permission. This is why, when you fill out those HIPAA forms at your doctor's office, they generally ask who they can talk to and what kind of information they can share. Perhaps you don't want your husband to know why you were at the OB's office. A caveat to this is giving information to your personal physician who is following up on your ER complaint. We will generally give specifics for this because they are providing your follow-up care.

Next post I'll talk specifically about HIPAA and minors.

Up and Coming: Author Beware--- The Law

This week at Redwood's Medical Edge I'm doing an Author Beware series on healthcare privacy laws. Boring? Hardly... everyone remember how several staff members got fired for looking into Britney Spears's medical records?

http://www.mtv.com/news/articles/1583480/medical-workers-fired-looking-at-britney-spears-records.jhtml

Exactly...

I'll be covering the most common authorly violations of the HIPAA act I see in manuscripts. You'll definitely want to avoid these or have your characters suffer some repercussions if they violate this law.

Looking forward to your thoughts and comments.

Jordyn

ED Issues: Cop versus Nurse

My brother works in the next county over as a deputy sheriff. I always say a writer is blessed if they have a law enforcement officer and a medical person in the family. That helps cover a lot of manuscript issues. My brother does patrol so, at times, he'll bring a person in custody to the ER for drug testing. After a frustrating interaction with the ED staff, I'll get an irate call from him, "Why did the ER do that!" Most often, it has to do with making him wait.

Personally, I have a great respect for the police and know their time is valuable as they would rather be on the road than stuck in the ER. Most areas of conflict come up when we don't understand the other's work. ER nurses get upset with the floors when they don't take an admission quickly because we can't stop what walks into the department even if we close to ambulances. The floors think the ED didn't do enough of an evaluation and left too much for them to do. Nearly every agency that receives and hands-off people to someone else has sources of conflict-- this is guaranteed.

When my brother called to complain about how long he'd had to wait for his prisoner to get his lab work, I immediately wanted to defend the ER workers.

These are the first things I thought.

1. The prisoner is a low priority. We're going to take care of sick patients first. The higher the acuity in the ER, the longer the wait time is likely to be. We have to save lives first.

2. Confusion on what needs to be done. I remember this from my adult ER days. We're not drawing blood or doing drug testing on prisoners every day. Since it's not something done often, there are likely questions on the proper procedure. We're going to want to make sure it's done correctly, particularly if it goes to court. The delay could be the staff actually researching how to handle the situation (what tubes to put the blood in and what paperwork to fill out).

3. The prisoner has a babysitter. I know that's a horrible term for a police officer. Generally, a police officer cannot leave someone who is in his custody. So, as the ER staff, we know there's an extra set of eyes on that person and we will worry less about something happening to them.

What other sources of conflict do you see? Have you written a scene with a mix of ER and law enforcement?

Medical Question: Flu and Pregnancy

Bonnie asks:

My question has to do with one of my characters who gets a deadly form of influenza (swine and avian flu combined) early in her pregnancy. She winds up in the ICU. She survives but then discovers she’s pregnant. She worried about the baby.

What are the possible dangers to the baby?

Heidi says:

The flu is actually more dangerous to the pregnant woman herself than to the fetus. Most women and healthcare providers delay preventative and treatment of the flu because they fear possible effects on the baby. More women in their third trimester of pregnancy die of the flu, than anything else including accidents and domestic violence.

Untreated flu symptoms that can and usually do send pregnant woman to the ICU include such things as high fevers, dehydration, and viral infections. The effects on the fetus include an increase in still births, brain damage, premature birth, and spontaneous abortion. Woman early in pregnancy are at greatest risk for spontaneous abortion. This would be the case for your patient. Treatment of the flu (antiviral's), is the best thing for this patient, the benefits greatly outweigh the risks.

I encourage all pregnant patients to get the flu shot and to call their health care provider immediately for flu like symptoms. Tamiflu and Relenza work best when given within the first 48 hours of flu symptoms. Always your best defense is a good offense, get your flu shot.

***********************************************************************

Adelheideh Creston lives in New York. She is former military and married military as well. Her grandmother was a WAVE and inspired her to become a nurse. Heidi spent some time as a certified nursing assistant, then an LPN, working in geriatrics, med surge, psych, telemetry and orthopedics. She’s been an RN several years with a specialty in labor and delivery and neonatology. Her experience has primarily been with military medicine, but she has also worked in the civilian sector.

Heidi is an avid reader. She loves Christian fiction mysteries and suspense. Though, don’t recommend the gory graphic stuff to her… please. She enjoys writing her own stories and is yet unpublished. 

Nurse Assisted Deliveries: Heidi Creston

Babies come when they want to, not necessarily when we want them to. Every labor and delivery nurse and OB provider are well aware of this fact. Nurse assisted deliveries happen daily.

The primary reasons for nurse assisted deliveries are:

1. Physicians are over extended.  They have more than one patient delivering at one time or are  covering OR and/or ER as well as OB.
2. They are not on site due to office hours.
3. Precipitous Deliveries (baby comes quickly).

Labor and delivery nurses are specially trained to monitor and keep close observation on a patient's status in order to notify the OB provider in a timely manner. Most patients are kept on continual electronic fetal monitoring. The pattern on the fetal strip provides information concerning both fetal and maternal status to include how soon delivery may be.

Sterile vaginal exams or cervical examinations to monitor dilation is another skill that L&D nurses are trained to perform. Nurses also educate their patients to report any signs of increased pressure.

It is always preferable for the OB provider to be present for the delivery, due to the increased risk to the patient (possible birth complications such shoulder dystocia), but in the event the provider does not make it, labor nurses are trained to deliver.

The L&D staff will make every effort to contact the provider, they will stop any measures taken to induce labor (turn off pitocin, instruct patient how to breathe thru contractions), provide support, and set up for delivery.

If the delivery is imminent, the nurse will guide the patient in her delivery, guiding the head, checking for nuchal cord. A nuchal cord is when the  umbilical cord is around the neck.  In some cases the cord can be untangled by hand.  Tight cords need to be reduced, clamped and cut.

Nurses also must be careful of other body parts being entangled by the cord as well. Delivery of the body is usually rapid once the head and shoulders are out.

If there are no complications with the infant, nurses will usually leave the baby on the mother’s chest with an uncut cord for 3-5 minutes. Nurses do not attempt to deliver the placenta, but if the placenta delivers spontaneously they place it in a container for the provider.

After delivery, if the provider remains unavailable, the nurse will clean the perineum and assess for tears and bleeding. Given the situation (excessive bleeding) the nurse may restart the pitocin, give a dose of methergine or hemabate, provide continuous fundal massage, and or perform a vaginal sweep. Upon arrival of the provider, the nurse will give them a full report.

Although most deliveries are uneventful, there are many things that could go fatally wrong with the delivery itself or during the post partum period. These include but are not limited to: malpresentation (ie: breech, compound limbs), cord prolapse/cord accidents/nuchal cords/body cords, placental abruption, and post partum hemorrhage.

******************************************************************************
Adelheideh Creston lives in New York. She is former military and married military as well. Her grandmother was a WAVE and inspired her to become a nurse. Heidi spent some time as a certified nursing assistant, then an LPN, working in geriatrics, med surge, psych, telemetry and orthopedics. She’s been an RN several years with a specialty in labor and delivery and neonatology. Her experience has primarily been with military medicine, but she has also worked in the civilian sector.

 

Heidi is an avid reader. She loves Christian fiction mysteries and suspense. Though, don’t recommend the gory graphic stuff to her… please. She enjoys writing her own stories and is yet unpublished.

Up and Coming

Hey all! Hope you have had a great week. Anyone holiday shopping? Finished yet?

Seemingly, I have survived my first week post shoulder dislocation. Last Sunday, I asked people to post in the comments section cause of said injury and I would pick a winner today. Well, congratulations, Sandra Ardoin, who said: If it was like my brother's dislocation, someone (who had no clue what they were doing) was trying to teach you judo.

That made me laugh out loud. So, Sandra is the happy winner of a $15.00 Visa gift card and a book of her choice. I'll give her a few options. Sandra, send your address to me at jredwood1@gmail.com and we'll figure out what book you'd like to read.

The real cause of my injury--- a cable machine push-up. First exercise on the second rep. My trainer dude was nearly as white as I was and though I do appreciate his offer to pop my shoulder back into place... unless you are in the ED with Fentanyl in your pocket... please stay away from my dangling arm.

This week:

Monday: Heidi Creston talks about nurse-assisted deliveries. She's a stellar OB RN. I know, because she's been a great eye for my character's OB issues.

Wednesday: Medical question concerning influenza and the possible complications for a pregnant woman. I'll also be over at Christian Mama's Guide discussing all things pediatrics.

Friday: Cop versus Nurse. Always a fun time in the ER when the police bring in a prisoner. Good way to add conflict to your ms.

Anyone else typing in a sling? Have a great week...

Jordyn

Pediatric Controversies: Immunizations 3/3

I'm concluding my three part series on one area of pediatrics that causes a lot of controversy. Immunizations.

Why don't people choose to immunize their children? I would say a large majority of these parents would claim a concern about Thimerisol (covered in Part One) and the much talked about but unsupported risk that there is a link between autism and the MMR vaccine (covered in Part Two). This link is not supported by the medical research.

Some people choose not to vaccinate because they're possibly suspicious of western medicine or in general prefer herbal or homeopathic remedies. 

Another reason? I think it's because we largely don't see children suffering or dying from these illnesses that we vaccinate against. People who lived during times when polio was a known affliction in the US probably had a different opinion about vaccinating against polio.




H1N1/Widipedia

 An interesting thing happened early in the fall of 2009. H1N1, otherwise known as the "swine flu" made an outbreak. It affected a large number of people but the pediatric population, particularly late elementary through early high school, had some very serious complications. Several children nationally required mechanical ventilation (a breathing machine) to save their life. Several children died.

There is a vaccine for H1N1. In fact, it's been included in the regular flu vaccine this year and last year. However, in 2009, distribution came a few months after the outbreak. The interesting part? It was scarce because so many people wanted it for themselves and their children. They didn't want them to die from the swine flu. Most people don't see children ill or dying of the diseases we routinely vaccinate against. The immediacy of the experience is lost.

If you have chosen not to immunize, I hope you've taken the time to research the diseases and their complications. Choosing not to immunize is a risk as well. How does this play out in fiction?

Let's say a 6 month old child presents to the ED with high fever and a rash and has never been immunized. Now, we as the ER staff have to worry about all those diseases the child is not protected against. This may set the child up for additional lab tests and procedures. Parents aren't generally happy when we explain why we have to add these other tests. This is an excellent way to add conflict.

What are your thoughts about immunizations? I'm happy to post any dissenting, well-articulated opinion in the comments section. No derogatory remarks please. I know this issue has a lot of passion on both sides.

Pediatric Controversies: Immunizations 2/3

How many of you have heard the name Dr. Andrew Wakefield? His uber-small, sample study that linked childhood vaccines to autism was retracted by the British Medical Journal. Why is this important? This study fueled the fire for many people choosing not to immunize. But really, what harm is it not to immunize your child against common childhood diseases? You can read about this retraction and the impact it has by following this link: http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html

I want to introduce a concept to you. It's called herd immunity. I can already see index fingers flying up, scratching a few temples. Cows? She's talking about cows? This girl has lost her mind-- been working too many 12 hour shifts.




Malibu56/Photobucket

Let me explain. Herd immunity is the number of immunized individuals in a group (be it people or cows). It affords certain protection if the "herd" is largely immunized. Let me paint a scenario for you. Take a population of 100 people. Now, 99 of them are immunized against measles. There is a measles outbreak in the next town five miles over. Measles is highly contagious. What's the chance of measles taking hold in this community where 99% of individuals are immunized? What if the herd immunity in that town was 80%. What are the chances then?

In this scenario, the likelihood of measles taking hold in the community where 99% of people are immunized is low. Dr. Paul Offitt, in his book, Deadly Choices, states that likely 95% herd immunity will protect a community against measles. In 2008, the following states all had immunization rates <70%: Washington, Vermont, Idaho, Montana and Nevada. The likelihood of a measles outbreak taking hold in those state is high.
In the article above concerning Dr. Wakefield, it lists some of the ramifications of people choosing not to immunize.

"The now-discredited paper panicked many parents and led to a sharp drop in the number of children getting the vaccine that prevents measles, mumps and rubella. Vaccination rates dropped sharply in Britain after its publication, falling as low as 80% by 2004. Measles cases have gone up sharply in the ensuing years."

The 95% herd immunity for measles seems to hold true.

"In the United States, more cases of measles were reported in 2008 than in any other year since 1997, according to the Centers for Disease Control and Prevention. More than 90% of those infected had not been vaccinated or their vaccination status was unknown, the CDC reported."

But really, what's the problem with a case of measles? Why did they invent that vaccine anyway? You can read more about measles infection on the following links but one possible complication of measles infection is encephalitis (1:1000 measles cases). I was a little shocked by that number. Encephalitis is an infection in the brain.

1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002536
2. http://kidshealth.org/parent/infections/lung/measles.html

The main concern with measles is that it is highly contagious. There is no "cure" once a case is contracted, merely symptomatic support. Measles is very concerning if a pregnant woman contracts it. Read the following:

"If you're not immune to rubella and you come down with this illness during early pregnancy, it could be devastating for your baby. You could have a miscarriage or your baby could end up with multiple birth defects and developmental problems. Congenital rubella syndrome, or CRS, is the name given to the pattern of problems caused when a baby is born with the virus."

I think the following paragraph lends support to the point of having high herd immunity when it come to measles.

"Rubella has become quite rare in the United States, thanks to a very successful vaccination program. Before the rubella vaccine was developed in 1969, a rubella epidemic in 1964 and 1965 caused 12.5 million cases of the disease and 20,000 cases of CRS in the United States. In contrast, between 2001 and 2005, there were a total of 68 reported cases of rubella and five reported cases of CRS. And in 2006, there were just 11 reported cases of rubella and only one case of CRS."

Here is the link for these quotes: http://www.babycenter.com/0_rubella-german-measles-during-pregnancy_9527.bc.

How often do you hear this side when it comes to the immunization debate? What good is this for fiction? I talked to a pediatrician in our area and asked him what his current rates of immunization were. He stated he was lucky to have 50% of his kids immunized. Some of those children are now women of childbearing age. I think it would be easy to add as a pregnancy complication for any story. What about a measles outbreak?

What do you think?

Pediatric Controversies: Immunizations 1/3

I'm going to focus on aspects of the pediatric immunization controversy that could easily be a whole novel in itself (and has been), but can add layers to novels that have a pediatric character or perhaps you want to add conflict to an issue that involves a child.

Issue based novels that are preachy typically perform poorly. It has to be about characters first. A novelist who does this well is Jodi Picoult. There is generally a central issue in her novel but the characters are likely why you keep reading.

One of the largest areas in pediatrics that is a main source of controversy and angst amongs parents is whether or not to immunize their child. Much of this stems from the fear that there is a link between autism and vaccines, particularly the MMR vaccine. Thus far, no credible scientific study has proven a link between autism and any vaccine.



67cupchamps

Let's start by talking about thimerosal. Thimerosal is a preservative that contained mercury that was added to vaccines. This additive has largely been removed from immunizations since 2001. It can still be found in some influenza vaccines so if you're concerned, ask your healthcare provider about it.

However, did you know that since thimerosal has been removed from vaccines, rates of autism have continued to rise? I'm going to list some articles that talk about this revelation. Is it known among parents that this is the case? I'm not convinced.

Check out these resources:

1.http://journals.lww.com/neurotodayonline/Fulltext/2008/02070/Removing_Thimerosal_from_Vaccines_Did_Not_Reduce.6.aspx

2.http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/UCM070430

3.http://leftbrainrightbrain.co.uk/2010/09/thimerosal-in-vaccines-did-not-cause-an-autism-epidemic/

Unfortunately, the power of celebrity is over-riding sound medical study and research in some cases. Millions in research dollars have gone to disproving and have disproved many of these vaccination myths. The question to ask now is whether or not we should continue to investigate these myths or put these limited dollars into research that actually supports the autism community in finding a cure.

Not immunizing your children has risks as well. We'll be talking about this next post.

How can this add conflict to your novel? What if a child died from a disease that he could have been protected against but the parents chose not to immunize? Would that parent have guilt? Would the medical team caring for the child place blame on the parent? What are your thoughts?

I am very interested in comments, however, I know there is a lot of passion on both sides of this debate. So, keep it respectful and curse word free and it will stay posted-- even if you disagree.

Dislocations and Immunizations: HUH?!?

Normally, I post the upcoming week on Saturday but I had a wee issue with a shoulder dislocation yesterday and was in a slight drug haze after the fine ER doctor put said shoulder into place.

I don't know... I think since there's a lot of writers that follow this blog, I should do a book/gift card give-away for whoever leaves the best reason for the cause of the shoulder dislocation. Best comment wins and I'll decide next Saturday. Who's in to win!!

Plus, I'm loving Tim Tebow's winning streak and this is another cause to celebrate.

This week, since I'm already injured, I thought I'd tip my toes into a hot lava on controversy. The myths that surround immunizations. I know this is dangerous territory as both sides of the issue have passionate people that think they have the right opinion. I'm giving the medical perspective which I feel gets muted in the news by other activists.

I'm interested in comments... just keep it clean and respectful and it will stay up. Looking forward to hearing your thoughts and concerns.

Have a great week!!

Forensic Issues: Bruising

On every crime show where a murder has occurred, there's usually a big scene with the medical examiner asserting time of death or determining the time of an injury. In pediatrics, this becomes important when we look at timing a child abuse injury so we can place who was with the child during the suspected event.

The question is, can bruising give an exact time for the injury?




http://orthopedics.ygoy.com/

 Bruising happens when an object comes into contact with the skin, and the small capillaries underneath break open and cause bleeding. Generally, patterned shaped bruises are more suspicious for intentional injury. For something to make a pattern on the skin, it generally needs speed or velocity to imprint the pattern onto the skin. For instance, it is far different if I tap you with a belt versus swinging and slapping it down.

Point blank, bruising is not a good way to determine time of injury. Bruising is influenced a lot by the individual person. Are they on blood thinners? Do they normally heal quickly? Age factors influence speed of healing as well. Bruising can give a time frame but color of bruising is also open to interpretation. Here's one set of guidelines.

Color of Bruise
Red-- swollen/tender: 0-2 days
Blue/Purple: 2-5 days
Green: 5-7 days
Yellow 7-10 days
Brown 10-14 days

As you can see, 48 hours is a large time frame. In the case of pediatrics, imagine the potential of how many people could have come into contact with an infant.

Interesting bruising fact: Bruises generally heal from the inside out. If you watch a bruise you have, you'll notice they become lighter at the center as healing progresses.

Did you think bruises could give an accurate time frame for injury?

Aortic Injuries: Part II

Dr. Edwards concludes his series on anuerysms today with a look at abdominal aneurysms.

The last blog in this series discussed problems with the upper (thoracic aorta) and how the condition known as a dissecting thoracic aorta can mimic heart attacks and be rapidly fatal if the wrong medication (a clot dissolving drug, for example) is given.  This time we’re looking at the abdominal section of the aorta.



www.health-news-blog.com

 By far the most common emergency condition involving the abdominal aorta involves a ruptured aneurysm. An aneurysm means a ballooning.  Abdominal aortic aneurysms, however, do not develop suddenly.  They rupture suddenly, but the underlying problem—the development of a large bulging section—occurs slowly over years.  We know that hypertension is a risk factor for this, but there are most likely hereditary factors as well.  Typically the aneurysm begins in a person’s forties, fifties, sixties or later, and is often present, usually undetected, for ten years or more before reaching the dimensions (usually greater than 4 cm in diameter) where sudden rupture may occur.    

Many, if not most, AAA’s remain asymptomatic and never rupture.   If a physician discovers one on physical exam or finds one incidentally in the course of performing an ultrasound or a CT scan for an unrelated condition and the AAA is less than 4cm, the patient can be followed by repeat ultrasounds every six months or so.  When and if the AAA reaches 4 cm, then consultation with a vascular surgeon is in order to consider a prophylactic graft procedure.

Unlike what happens with the thoracic aorta where a tear develops and blood channels inside the vessel wall, the AAA actually ruptures through the entire wall of the aorta and the patient can rapidly die from blood loss.  Time is very much of the essence.

The classic presentation of a ruptured AAA will be a patient in their seventies or eighties with a long standing history of hypertension who has the acute onset of severe lower back or possibly flank area pain which may or may not extend around to the front of the abdomen.  The pain is severe and a fair percentage of the time it is accompanied by a fainting episode and low blood pressure.  In some ways the pain mimics that of a kidney stone, though I have personally seen two patients with a ruptured AAA that came in complaining of feeling constipated. 

The diagnosis can be picked up by ultrasound or CT, but in a good number of cases, you can actually palpate a pulsatile mass in the abdomen.  Emergency providers must keep a high index of suspicion for the presence of a ruptured AAA in any elderly patient with abdominal pain.   If you don’t think about it, you can easily not consider it until the patient is crashing, and then it’s often too late.  In general, though, it must be said that the mortality rate is very high even if the physician does everything right.

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Frank Edwards was born and raised in Western New York.  After serving as an Army helicopter pilot in Vietnam, he studied English and Chemistry at UNC Chapel Hill, then received an M.D. from the University of Rochester.  Along the way he earned an MFA in Writing at Warren Wilson College.  He continues to write, teach and practice emergency medicine. More information can be found at http://www.frankjedwards.com/.

Diabetic Emergency: Dianna Benson

Dianna's back for her monthly guest blog. Today, she covers EMS care for a diabetic emergency.

EMS 4 diabetic emergency at 123 Fox Street, at 123 Fox Street on TACH Channel 12

I stuff the rest of my sandwich into my mouth and gulp down some water as I rush out of the fast food joint to hop into my ambulance. As my partner signals RESCOM (dispatch) we’re en route to the above (sample) call, I speed our ambulance down the road, lights and sirens.

I won’t discuss the full assessment and treatment we’d perform on a diabetic patient, but if you want clarification or further explanation for your fictional writing needs, please ask me.

On scene we find first responders assisting an unconscious male sitting slumped over in a Target bathroom.

“His blood sugar is 12,” one of the firefighters tells me. “He works here and his co-workers say he takes insulin daily.”

“Sir?” I say to the patient. “Can you hear me?”

No response. His eyes are half open. His pupils are dilated and sluggish.

My partner and I insert a line (IV), and push one 25g AMP (ampule) of D50 (dextrose 50% in water). I attach him to our cardiac monitor via a 12-lead (ECG patches), and assess his heart rhythm and all his vital signs. He’s in normal sinus rhythm and all his vits are within normal range; however he’s slightly tachycardic (heart rate too high), but an elevated HR is the body’s defense to survive a hypoglycemic episode (low blood sugar).   

“Sir?” I place my hand on his shoulder. “Hey, buddy, talk to us.”

The patient remains unresponsive, so my partner and I push another 25g AMP of D50.

Via a glucometer, we test his BGL (blood glucose level). It’s now 43. We’re headed in the right direction, but the patient is still unresponsive. We administer 1mg of glucagon IM (intramuscular injection).

“Sir?” I squeeze his hand. “I need you to talk to me. Okay?”

He stirs, his eyes attempt to focus. We load him onto our stretcher and wheel him inside our ambulance. Within a few minutes, he stares at me. “Where am I?”

“You’re in an ambulance, sir. I’m EMT Benson.” I finish retaking his BGL again. It’s now 98 (within normal limits). “Do you know what happened?”

He nods. “Yeah. It happened again. Twice this week. Stupid blood sugar.”

Can you tell me your name?” I ask, even though I know his personal information via his co-workers. I start this line of questioning to assess the patient’s mental status.

“Bob.”

“Okay. Bob, what’s your birthday?”

“Ah…February 3, 1972.”

“Uh-huh. Gosh, Bob, my math is horrible. How old does that make you?”

“Thirty-nine, but don’t tell my girlfriend. She thinks I’m thirty-one.”

I laugh. “I won’t say a thing, but you may want to tell her yourself soon, what do you think?”

“You’re probably right.” 

“You take insulin, I hear. Did you take any today?”

“45 units, early this morning.”

“45, huh? Have you eaten anything today?” I note the time is twenty minutes past noon.

“Two graham crackers.”

“You need to eat more than that, you know? Especially after 45 units. Breakfast is the most important meal of the day. Promise me you’ll eat breakfast everyday.”

He nods as he smiles at me. 

I radio the hospital. “Wake Med, EMS 4 en route with pt (patient) initial BGL 12, then 43, now 98. We’ve given 2 AMPS of 25g D50, and 1 mg of glucagon. Initially pt was unresponsive, now A&O times 4 (alert and orientated times 4). Vitals within normal limits. ETA 2 minutes.”

“ED room on arrival. Wake Med out.”

“EMS 4 out.”

*****************************************************************************

After majoring in communications and enjoying a successful career as a travel agent, Dianna Torscher Benson left the travel industry to write novels and earn her EMS degree. An EMT and Haz-Mat Operative in Wake County, NC, Dianna loves the adrenaline rush of responding to medical emergencies and helping people in need, often in their darkest time in life. Her suspense novels about characters who are ordinary people thrown into tremendous circumstances, provide readers with a similar kind of rush. Married to her best friend, Leo, she met her husband when they walked down the aisle as a bridesmaid and groomsmen at a wedding when she was eleven and he was thirteen. They live in North Carolina with their three children. Visit her website at http://www.diannatbenson.com 

Up and Coming

Happy Thanksgiving Week!!



http://www.theholidayspot.com/

I hope it is blessed and a time of joy spent with your family.
Here are the festivities I have planned at Redwood's this week.

Monday: Dianna Benson's monthly EMS post. Her focus is diabetic emergencies.

Wednesday: Dr. Edwards returns to conclude his series on aortic injuries. Great info here! I'll also be over at Christian Mama's guide talking all things pediatrics. Hope you'll check it out. http://www.christianmamasguide.com/

Friday: I'm going to start a post series on Forensic Issues. These will pop up every now and then. The focus on this piece is bruising and is it good to use for time of injury/time of death.

Many blessings to you this week... Jordyn

Author Beware: Seasonal Illnesses

One thing to keep in mind when you're writing a novel is that some illnesses are seasonal. So if your book covers an obvious time of year-- say the summer. It may behoove you as an author to be aware of the illnesses that are and aren't around.

Croup: AKA laryngitis. Used to be seasonal but we typically see it year round. No time restrictions needed here.



fyi.utah.edu

RSV: The leading viral cause of bronchiolitis typically starts in late fall, early winter and lasts approximately 20 weeks. This is what healthcare professionals happily (maybe?) term "respiratory season". It means gowns, gloves and masks need to be worn for patient's that present with cough and fever. Another fact to keep in mind.


Influenza: Influenza is truly a respiratory illness and not a gastrointestional (GI) one. You know an author has thoroughly checked their facts when they have a summer illness with vomiting and diarrhea and don't call it influenza. This is why flu shots are given Sept-Nov... to help prevent the transmission of this illness.

Keep seasonal illnesses in mind when you're writing a novel that occurs during a specific time of year. It may behoove you to ask if that contagious illness you're killing off your characters with would actually occur during your time frame.

Have you used a contagion, known or "created" in your novel?

The Curious Case Of Typhoid Mary

We've all heard sick people exclaim, "Watch out, I'm typhoid Mary today!" over concern of how many people they could potentially infect.

I happened to be reading the book, Deadly Choices, by Dr. Paul Offitt which is a non-fiction book that talks about the effects of the anti-vaccine movement on public health. I happened to come across the true story of Mary Mallon AKA Typhoid Mary.

Mary Mallon was a cook. In 1906 she was hired by New York banker Charles Warren for the summer as he vacationed with his family in a rented home on Oyster Bay, Long Island. During that summer, six of eleven people in the household became ill with typhoid fever. Since typhoid fever is spread through food and water sources, the homeowners feared they wouldn't be able to rent the property again unless the true source was discovered so they hired private investigators to look into possible causes.

All roads led back to Mary Mallon and she was approached to give samples of her blood, urine and feces to look for the bacteria. To say Mary Mallon was a cooperative patient would be like saying the Tasmanian devil was a soft furry bunny. She had to be brought against her will to the hospital and though sources don't explicitly say, I'm gathering she didn't easily give up the specimens they wanted.

Salmonella typhi was found in her feces and Mary Mallon became the first identified healthy carrier of  salmonella typhi. This was very hard for her to understand. How could she possibly be causing these illnesses if she herself was asymptomatic? In order to prevent her from infecting others, she was quarantined to a small cottage on North Brother Island from 1907-1910.

In 1909, Mary sued the health department for unlawful imprisonment but lost. In 1910, after a new health commissioner came to power, she was released under her promise that she would never take work as a cook again.

January 1915, Sloan Maternity Hospital in Manhattan suffered a typhoid outbreak. It was traced back to a cook, Mrs. Brown, who was really Mary Mallon working under a pseudonym.

She was quarantined for the remainder of her life from 1915-1938. She spent a total of 26 years in quarantine.

The case of Typhoid Mary brings up several interesting issues. One being, what power should the state/government hold for the health of a population? I'm curious as to your answers as we'll be looking at this more when it comes to religious and philosophical exemptions to vaccines.

Barber-Surgeons

Have you ever wondered about the origin of some symbols? How about the infamous barber pole? Are you familiar with the role of the barber-surgeon? If you write historical fiction spanning the 13th through the 18th century, you may want to familiarize yourself with their function.




aj_da_barber

The practice of medicine was separated from the practice of surgery. Medical practice was generally carried out by those who went through a university program whereas surgery was considered more of a trade.

The characteristic red and white barber pole with the brass bowl symbolized the basin used to collect the blood during blood-letting and the red and white stripes represented the blood and dressings. This represented members of the Barber-Surgeon Guild until 1745.

To learn more about barber-surgeons, check out these references:

1. http://en.wikipedia.org/wiki/Barber_surgeon

2. http://unusualhistoricals.blogspot.com/2009/01/professions-barber-surgeon.html

3. http://www.sciencemuseum.org.uk/broughttolife/people/barbersurgeons.aspx

4. http://www.barberpole.com/artof.htm

Would you have been comfortable going to a barber-surgeon?

Up and Coming

This week at Redwood's Medical Edge:

Monday: Barber-Surgeons

If you're a historical novelist, knowing about the combined role of the barber-surgeon could be important. Hair cut and splenectomy in one stop shopping!

Wednesday: The Curious Case of Typhoid Mary. Interesting story and conflict builder. What power should the government have over protecting the population from disease?

Thursday: I'll be over at the WordServe Watercooler on the topic of publication. http://wordservewatercooler.com/

Friday: Author Beware: Seasonal Illnesses.

How are your Thanksgiving preparations coming along?

Jordyn

Top Three Most Popular Posts: #1

I'm so blessed that it's been such a great first year for this blog. I owe it to all of you and your interest in how to appropriately injure, main and kill your fictional characters. Thanks to everyone who follows and subscribes and even the lurkers who peruse by....

It isn't surprising to me that this remains the most popular post of all time here at Redwood's Medical Edge with nearly 1000 page views. This myth continues to be perpetuated in books and TV.

Medical Myth: Head Injured Patients Need to Stay Awake

I love the series Dexter. If you're unfamiliar with it and you're a writer, I think it's a great exercise in intricate plotting techniques. However, it is violent, so proceed with caution. The general premise is that Dexter works for Miami Police as a blood splatter specialist. In his free time, he's a serial killer, but only kills those that the justice system doesn't put away. This show is also good study for the sympathetic villain.

In one episode, poor Dexter has been in a motor vehicle collision. He is dazed and is taken to the ER. The doctor says something to the effect of, "You have a head injury. You'll need to stay awake for the next several hours." Great.

Sleepiness post head injury is a classic set-up for pediatrics. Every day in the ER is a story like this. It's close to bed time. The children are running amok. Some child falls down, falls into, or falls off of something and hits their head. They cry their little heart out. After all, hitting your head hurts, a lot. After a good crying bout, they're sleepy. Parents first thought is, he must have a terrible head injury. Off to the ER.

Now, one, I want to make it clear. Getting your child checked in the ER for head injury is good and reasonable. However, we aren't all that concerned with sleepiness. What we are concerned with is how arousable they are from sleep. This is what we'll be monitoring every fifteen minutes to an hour if the child sleeps during his ED visit.

Level of consciousness is assessed as an indicator of an injury going on inside of the head. How arousable you are is the most sensitive indicator of level of consciousness. If the child falls asleep, and we are concerned about head injury, we'll try to wake them up every so often to assess their level of arousability. If we cannot wake them up, then we are concerned. It has to be more than a gentle nudge. You are really working to wake the patient and they won't respond. This is concerning.

Remember, things that are injured need rest. This is why we put you on crutches if you break an ankle. The brain rests by sleeping. It helps it to heal. If you're a subscriber to this myth, how long should we keep the patient awake? An hour? Two hours? A day? If you want a skewed neuro exam, try doing one on a sleep deprived patient.

For additional resources regarding this myth, check out the following:

1. http://firstaid.about.com/od/headneckinjuries/f/09_Waking_Heads.htm

2. http://familydoctor.org/online/famdocen/home/common/brain/head/084.html

Top Three Most Popular Posts: #2

Suspense novelists are a little consumed with finding ways to kill their characters. I'm guessing that's why this post by Kathleen Rouser was the second most popular post.

Plants: Poisons, Palliatives and Panaceas

Then God said, “I give you every seed-bearing plant on the face of the whole earth and every tree that fruit with seed in it. They will be yours for food.” Gen. 1:29 NIV

Shortly after the time Adam and Eve were forced to leave the Garden of Eden, because of their fall into sin, human beings most likely began looking for relief from pain and sickness. Perhaps by God’s guidance or by what seemed like coincidence, they found that there were certain plants that not only nourished, but also relieved symptoms or cured illnesses.

Throughout the ancient world healers emerged, whether as a medicine man, priest, wise woman or physician. They were brave enough to search by trial and error to find the right cure for each malady. These practitioners, whether spurred on by superstition or curiosity, had to figure out which plants healed... and which ones harmed. The line between healing and poisoning was often quite fine.

A few of the remedies the Sumerians used were made from licorice, myrrh, mustard and oleander. The Code of Hammurabi, originating during his reign (1795-1750 BC), regulated medical practice. There, apothecaries emerged, since the role of preparing medication was considered separate from that of the physician.



Poppy Plants

Around 1500 BC, the Egyptians wrote a dissertation on medicine and pharmaceuticals. Among many plant sources they derived their drugs from were castor seed, spices, poppy and acacia. They imported some ingredients due to the limitations of what they could grow. The Egyptians developed ways to dry, ground up and weigh these materials. Those that concocted medicines were called ‘pastophors’ and were members of a priestly profession.

Seventh century BC clay tablets have been discovered revealing that the Babylonians used many plants as pharmaceuticals including castor seed, thyme, peppermint, myrrh, poppy and licorice.

Various theories of diagnosis and treatment arose through the Greek and Roman civilizations. Pedanius Dioscorides, who lived from around 50-100 AD, wrote Materia Medica, which listed various materials with their medicinal uses and also Codex Aniciae Julianae. This text on herbals, listed many plants and how to prepare them through drying and extraction. Dioscorides, a surgeon to the Roman armies, shared a philosophy with another famous Roman medical man, Galen. They believed that each plant’s shape, color or other physical characteristics left a clue as to which body part or ailment it was meant to treat. By the 16^th century, this was foundation to one Christian viewpoint, which had expanded upon the Doctrine of Signatures, stating that it was the Creator who had marked each of these plants for their use.

During the Dark Ages, the Arab world and the monasteries of Europe, with their healing gardens, preserved much pharmaceutical knowledge.

Throughout history, many folk remedies, based on superstition, were supplemented with chants and rituals. Most often they missed the mark, perhaps imparting comfort if nothing else, considering man’s need to feel as though he is doing something! But apart from that, many plants continued to be used for healing and a large proportion of modern day prescription drugs are rooted in their derivatives. Some emerged to the forefront.



Cinchona Tree

During the 1600s, European Jesuit missionaries in South America sent a powder back home, derived from the bark of the cinchona tree. They’d been surprised to find out that the Native Peruvians knew how to successfully treat malaria, an illness spread by mosquitoes that has killed so many. In 1820, when French chemists extracted a chemical compound from the powdered bark of the cinchona tree, they called it quinine, based on the Peruvian name for the tree, quinquina.

William Clark and Meriwether Lewis took cinchona bark with them on their westward expedition. Lewis’s mother was an herbalist of some renown and imparted some of her knowledge to her son. While the men did not wind up contracting malaria, they found the bark useful for lowering fevers and as ingredient in poultices.

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Kathleen lives in Michigan with her hero and husband of 29 years. First, a wife and mother, she is “retired” after 20 years of home educating their three sons, who are all grown and have moved away. Since then, Kathleen returned to Oakland Community College to complete a Liberal Arts degree and a certificate of achievement in ophthalmic assisting. Last year the American Board of Opticianry certified her. Kathleen has been published in Home School Digest and An Encouraging Word magazines. She writes regularly for the local women’s ministry “Sisters” newsletter. She also contributes articles and author interviews to FavoritePASTimes.blogspot.com, a blog devoted mostly to historical fiction. Read about her fiction writing endeavors at: www.kathleenrouser.com.