tag:blogger.com,1999:blog-11360009.post2842552367143696683..comments2023-10-02T06:01:07.043-05:00Comments on The-Paris-site: If You Do, Or If You Don't....2/6fac_phttp://www.blogger.com/profile/07837459359891180522noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-11360009.post-56254835042883362082008-02-06T10:39:00.000-06:002008-02-06T10:39:00.000-06:00Newest thing I've seen is doing CT's to rule out f...Newest thing I've seen is doing CT's to rule out fractures on extremities. Usually you do this when the plain films show no break but the patient continues to have pain a few days afterwards. Now they are doing it in the ED every time they don't see an obvious break on the films.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11360009.post-82845518540578211402008-01-23T08:18:00.000-06:002008-01-23T08:18:00.000-06:00BTW, thanks for printing my all time fave Fqar Sid...BTW, thanks for printing my all time fave Fqar Side cartoon!!!! All it needs is "Radiology" over one door and "X-Ray" over the other! LOL!!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11360009.post-35859069760726569502008-01-23T08:15:00.000-06:002008-01-23T08:15:00.000-06:00Well the problem will only be solved by capping me...Well the problem will only be solved by capping medical malpractice suits. Like the slick shysters will let that law pass! Until it does...or heck freezes over, CT all belly pains for possible appy...still better than cutting them open to find a healthy appendix!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11360009.post-59228476941347556342008-01-22T12:33:00.000-06:002008-01-22T12:33:00.000-06:00I could have held back a couple...but why bother. ...I could have held back a couple...but why bother. An upright film would indicate if it had ruptured, but little else. My concern would be a CT on every bellyache that walks in the ER. <BR/><BR/>We rapidly create an excessive standard of care by our own over-reactions to the possiblity of litigation.<BR/><BR/>We are creating a situation in which a single payer reimbursement will be inevitable. And the government does so well in social programs.....Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11360009.post-55383020080466975992008-01-22T08:47:00.000-06:002008-01-22T08:47:00.000-06:00Interesting, it took you one whole sentence to men...Interesting, it took you one whole sentence to mention CT. <BR/>Agreed, this is a surgical case until otherwise determined and only physical exam or xray imaging would be of sensitivity sufficient to declare this. Think back 50 years ago, I know you may be too young, but try. No CT. Went on physical exam and standard xray(low sensitivity). Rule of thumb used, if 50% of appendectomies aren't normal, your not doing enough surgery. Think this would fly with your insurance company or Medicare today? More to the point, walk out in the parking lot and look for the Parasitic Plaintiff's attorneys and run this by them. Either way, CT scans have simply become "standard of care" and if not done will be critical in cross examination.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11360009.post-39564748697686892452008-01-21T18:29:00.000-06:002008-01-21T18:29:00.000-06:00RLQ pain x2days, 14,500 WBC, 101 temp,and rebound....RLQ pain x2days, 14,500 WBC, 101 temp,and rebound...a touch more history, and probably a CT. How was the onset of pain...after eating? Characteristics? Assuming the rebound was at McBurney's point.... <BR/><BR/>He'd be a surgical service referral, and the surgeon would make the call. Depending on the CT...if he'd eaten anything...the surgeon might hold until the AM and bump into the first slot...but that's <B>his</B> decision.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11360009.post-45760689354382360932008-01-20T12:12:00.000-06:002008-01-20T12:12:00.000-06:00Ok, lets explore. 21 year old WM presents to ER wi...Ok, lets explore. 21 year old WM presents to ER with right lower quadrant pain for 2 days. Today has fever to 101 degrees F. Perfectly healthy all of his life, on no medications and no allergies. Saw his Doc 2 days ago and was placed on Cipro. It is Friday night and his local Doc is not on call. You are the ER doc. Physical examination reveals stable vitals with temp to 100 degrees F after one dose of Tylenol.Exam is normal except for rebound tenderness in the Rt. lower quandrant of the abdomen. The general surgeon on call happens to be in the ER seeing the 3rd patient of the night and planning to take yet another patient to the OR for emergency cholecystectomy. CBC ordered shows a WBC of 14,500 with a left shift and UA is normal. ESR is elevated to 30. You are in a level 1 trauma center. Oh, by the way, this young man is the son of the local trial attorney who loves to sue doctors. Your turn.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11360009.post-19324652320072745802008-01-20T08:40:00.000-06:002008-01-20T08:40:00.000-06:00This is not a good time to try and sell a hospital...This is not a good time to try and sell a hospital or hospital company. They must buy some time and the best way to do that is to declare a "study". Don't really have to do a thing...just look at stuff. Buy a few capital items that you have to buy anyway to keep the locals off your ass and be attractive later when the market is better. Paris...do not be diverted by the B.S...if it looks like a duck, quacks like a duck, then it's probably a duck (quack, quack!)Anonymousnoreply@blogger.com