From the monthly archives:

December 2008

Carbon Monoxide Poisoning

I’ve had many patients come in with carbon monoxide concerns, but this story was really depressing.

Carbon monoxide is an odorless byproduct of combustion, and can be lethal. It firmly binds to hemoglobin molecules in your blood stream and makes it impossible for oxygen to bind. As a result, oxygen cannot get delivered to the vital organs. The process can be gradual, and clearly deadly.

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The Doctor Rants

I’m not one to rant excessively, I’ll leave that to the professionals like White Coat, but after a particularly painful night shift, I have something to get off my chest. When I walk into a patient’s room, there are a couple of phrases I don’t really want to hear anymore:
#1. In answer to the question–What seems to be the problem? Some seem to think the funniest thing in the world is to say is “I don’t know, you’re the doctor.” Perhaps I’m just getting cantankerous, or maybe it’s because I’ve heard this joke about 8 million times already, but come on. The evil doctor in me wants to just look right in their eyes and say, “I’ve got it, you’ve got skin failure!” and walk right out again. I’ll let you know if I try this one.
#2. Another opening line I sometimes use is “Hello, I’m the ER doctor, how are you?” Naturally, this question brings out the Don Rickles in many patients, and they of course answer with, “Not very good, why do you think I came here?” Oy.
#3. My least favorite response by far, is when I go in to see a patient with a non-emergency problem and the patient says, “It’s about time.” Wow. It takes a lot of willpower not to get snippy at these times, especially since I practically run from room to room. I have considered a few sarcastic comebacks to this, but I bet my satisfaction scores would suffer. One option, “Gosh, I’m so sorry, what time was your appointment again?”

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If you have sudden death, do it while skiing

We recently had a patient who suffered a cardiac arrest and was under CPR for quite some time, but regained spontaneous circulation and was brought in with decent vital signs.  His mental status on arrival was very poor, however.  He ended up getting treated with induced hypothermia, meaning he was chilled down with ice packs, and cold IV fluids.  Despite the general consensus that he would do quite poorly, he ended up making a relatively dramatic recovery.  I can’t say I’ve had much personal experience with this, but the data looks promising, and the American Heart Association is recommending it now.  Would love to hear about more of these cases.  As for me, if I have a cardiac arrest, I hope I’m skiing at the time.

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Doctor burn out

Here’s an excellent example from ER Stories of why ER doctors burn out and want to change careers.  Of course with this economic meltdown, maybe not so much. . .
 
 

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Heath Ledger raises sleeping pill use concern

Q

I use sleeping pills frequently, but after Heath Ledger’s death  earlier this year, I am concerned.  What can I do?

A

Insomnia is a huge problem, affecting one in six Americans.  While sleeping pills have a role in treating insomnia, there are some major downsides and generally, their use should be limited.  The concept of proper “sleep hygiene”  is gaining traction in this country, but is under-utilized.  What it means is that all steps to ensure a proper night’s sleep should be taken prior to relying on medications.  Having a regular schedule during the day and a reasonable bedtime is important.  The sleeping environment should be dark, quiet and a comfortable temperature.  The bed should be used for sleeping, not as a surrogate office, TV area, or dining table.

Alcohol is used by many to help them get to sleep, but in fact, it can degrade the quality of sleep substantially, and it should be avoided within 6 hours of bedtime.

Caffeine products should be avoided after noon.

Exercise has been shown to benefit sleep substantially, so that can be added to the list of why we should get our daily exercise.

Clearly, there are situations which can negatively impact your sleep, and from time to time, many people may need a sleeping pill.  At that point, it is reasonable to speak with your doctor about sleeping pills.  However, you generally should not be on sleeping pills long-term, and you should make sure that you follow prescription directions closely.

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