ACED it!

This post is inspired by the fresh rhythm of the posts over at protecttheairway.com...

The patient's chief complaint: ankle pain.

Patient was seen here one week ago and ran out of ACE bandages. Patient walked to the ED in 30 degree weather in the middle of the night in the icy cold, winter, to obtain ACE Bandages, risking slipping on cold icy sidewalks to do so. Patient is WEARING a perfectly good ACE bandage.

When patient is asked if they would like the ACE bandage applied by the doctor, patient states, no thanks, I will just take that and go... It was too expensive up at the pharmacy.

When questioned by the doctor if the patient went to their followup visit at the ortho clinic, patient states, I was never told to go there....

Net cost to taxpayer: 400 plus dollars for ED visit for ACE bandage which was also available free of charge at orthopedic follow up clinic.

Net cost to patient: nothing but a stern lecture in the middle of the night.

Dinosaur Orthopedics: Snow day at AMNH

OK, so it snowed on Friday

here is a picture of the cemetery on my way to work (which reminds me to do a good job each day....) ! I was pretty excited, not because of all the bundling up New Yorkers have to do,


but because of the snow. WOW. It was cold. That's why special ear warmers were invented. Mostly, however, I went around wishing I had a balaclava on. So, the weather was cold enough that indoors activities were more appealing. So, the order of the day was to go up to the American Museum of Natural History and check out the dinosaurs!



Now,these dinosaurs got me thinking about orthopedics, of all things. Just have a look at the size of the head on this one, for example.
I began to wonder why there were so many varieties of neck and head and vertebral structural variation in the dinosaurs.Was variation in bony structure accompanied by variation in underlying neural structure?

Take for example the tortoise, which is a well adapted species, living hundreds of years. For example, one of the tortoises found by Darwin recently died in 2006. The tortoise has as it's main adaptation a bony armor, which forms the shell, basically preventing it from exposure to trauma, which is life threating in humans, for example, who have an expsoed cervical spinal cord and walk upright (making them liable to fall and undergo head trauma). Ironically, however, the cause of death in one 154 year old tortoise kept in a British Fort was an accidental fall! So much for that hypothesis!

So, I began to think, which dinosaur species was least likely to require a head or c spine CT? Is this a possible candidate?

The whole concept of the Ottawa Ankle rules was very intriguing when applied to dinosaurs and vertebrate skeletons. If you are evaluating a dinosaur in your ED, can it hop three steps unassisted before you scan it's massive ankle? How do you put a C collar on a beast of this size?

Take the camel or giraffe. They have the longest skinniest bones, highly vulnerable to long bone fractures, and a C spine which also places it at great risk. Cerebrovascular disease in a camel, therefore, would appear to make a camel fall down and injure many bones... How can this possibly be adaptive other than the whole reaching for high leaves and seeing your prey from far away arguments?

Altogether a very interesting afternoon, for anyone interested in orthopedics, the dinosaur exhibit is well worth your time.

New Year's Retrospective

So, I was just looking through some pics, and thought I would put up some cool pics here that I snapped over the last 6 months in NYC. The first one (above) is of Santa riding the L train. It was a very festive Christmas holiday!


Next we have the shot taken from the roof of one of the hospital buildings, I think it is Fierman, in which John discovers the meaning of the word "ph" in an elevator... It stands for penthouse.

Every city has it's own peculiarities with respect to floors. In Ireland, I was constantly miffed by the fact that the ground floor was not the first floor, and what I thought should be the third was actually the second. Here in New York I have had to grasp a whole new vocabulary... mezzanine, lower level, and Sabbath elevators. I determined that it takes approximately 3 minutes to get to the top of one of the twelve story buildings in my hospital if you get stuck in the Sabbath Elevator.

In any case, one of the perks of New York is the rooftop scenery. New Yorkers love their rooftops! Here is an example of the rooftop at the Met, with art from confiscated sharps at the airline security checks...

I ventured north to Boston and saw some trauma backboards being used for a more relaxing purpose, a parkbench, and quite the ham that I am, had to take a photo op...

While in Boston, there was a competition to carve several thousand pumpkins on the Commons. Apparently there is a competition between towns in Mass. to have the most carved pumpkins. Jack o'Lantern turnout was an estimated 24,000 plus pumpkins! As well as some cool rowing on the Charles!

Thinking back to summer, it feels like just yesterday when I was hanging out on the piers on the Hudson...

And watching the sunset on Fire Island...


I even got to take a trip to California and catch a California sunset! and enjoy good times with the cat, grandmother, and fire...