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Sight; Mental images of gangrene. Taste; The guys at Caribou put vanilla in my coffee this morning. I loathe flavored coffees. Touch; Open-toed shoes that I have apparently outgrown since last summer. I have them off my feet under the desk. Smell; Someone in Customer Service smells like pee.
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February
16, 2000 Bite wounds: Don't let your patients leave with the wrong impression BY J**** R. H***** MD, JD, CLINICAL INSTRUCTOR OF SURGERY, DEPARTMENT OF EMERGENCY MEDICINE, UNIVERSITY OF I*******, COLLEGE OF MEDICINE AT P*****; AND J*** G. Z*******, MD, JD MPH, LLD (HON), ADJUNCT PROFESSOR OF LAW, G********* UNIVERISTY LAW CENTER, W********* D*, AND ASSOCIATE PROFESSOR OF PREVENTATIVE MEDICINE, UNIVERSITY OF M****** SCHOOL OF MEDICINE, B********, M*. Bites and stings from various types of animals are common in the emergency department. While allergic reactions to insect stings are probably the most common problem we see from bites and stings, there are other significant potential problems. We also commonly see bite wounds from humans, dogs, cats, and various other animals that have a high risk of infection, loss of function, amputation, and even death if not promptly and correctly treated. Because of this risk of adverse outcomes, bite wounds represent a significant area of malpractice risk for emergency physicians. Appropriate management and follow-up care can minimize complications and reduce the emergency physicians' malpractice risks. Human Bites Case No 1: Stupid Drunk Old Man v. United States. In Stupid Drunk Old Man, the plaintiff alleged that he had been negligently diagnosed and treated for a human bite wound on the middle finger of his right hand. The injury ultimately required a partial amputation of the finger, a complication that the plaintiff alleged was the result of negligent diagnosis and treatment of his injury. There were three components to the patient's claim. First, he alleged that the emergency physician at the Big Unnamed Veterans Hospital (the "VA" Hospital) failed to properly diagnose and treat his injured finger. Second, he alleged that he medical staff, in general, "failed to properly instruct him as to wound care upon discharge." Finally, he alleged that, as a result of the physicians negligence, he developed a GANGRENE INFECTION and a portion of this finger had to be amputated. The court's recitation of the facts was quite detailed. The plaintiff, a 41-year-old male, made arrangements to meet his ex-wife for dinner. While waiting for his wife, the plaintiff, "for reasons unknown," decided to pass the time in a local tavern. While in the bar, he had several drinks and struck up a conversation with an unknown woman. Upon leaving the bar alone, he encountered his new acquaintance on the street. Some sort of altercation ensued in which the plaintiff suffered an injury to the distal end of his right middle finger. (Skipping more inane uninteresting parts of the case for your pleasure.) ...On this second visit, the Stupid Drunk Old Man was seen by Dr. Paid Alot, an orthopedic resident at the time. The patient told the resident that "he had been in a fight a few days earlier and had been struck on the finger." He also said that "he had been drinking and could not recall exactly how he had injured his finger." Dr Paid Alot examined the finger and found it to be "grossly discolored, swollen, and full of foul-smelling parulence [sic]." The patient was admitted and prepped for irrigation and debridement of the fracture. The operating surgeon's report indication a preoperative and postoperative diagnosis of "infected open tuft fracture of the right long finger." The wound was packed open, and the patient was given antibiotics. The following day, a dressing change revealed "widespread infection" and the patient was taken back to the operating room for an amputation of the middle and distal phalanx of the finger. The subsequent pathology report noted a massive streptococcus infection and gangrene." The patient underwent numerous postoperative irrigations and debridements of the stump due to persistent infection. After the amputation, the medical record for the first time mentioned a diagnosis of a "bite" or "human bite." At trial, Stupid Drunk Old Man's vocational rehabilitation expert testified that, due to his injury, Stupid Drunk Old Man had to give up working as a waiter (his previous occupation) and take a lighter type of work at 50% decrease in wages. In addition, according to the expert, plaintiff would ever again be able to work as a waiter because of the physical appearance of his hand. The court took note that Stupid Drunk Old Man's rehabilitation expert's failed to make note of some important facts: numerous previous injuries due to fights, drug dependency, failure to cooperate with physical therapy, and a previous felony conviction on a drug charge and third-degree assault. ...The court concluded that it was not negligent for Dr. First Doctor to See Stupid Drunk Old Man to conclude, given the information available to her, that the patient had suffered a gunshot wound, rather than a bite. ....The court also concluded that it was negligent for Dr. First Doctor to See Stupid Drunk Old Man to fail to prescribe antibiotics and this negligence was the proximate cause of the plaintiff's injury. The patient's $20,000 in damages was reduced to $10,000 because his own negligence contributed to the adverse outcome. And that's only one case out of this paper. There's cat bites and hog bites and no antibiotics anywhere. I don't have the energy to type anymore. But this FASCINATED me. Hopefully it wasn't too droll, or too routine for anyone who deals with things like this on a daily basis. I love my job sometimes. What kind of drooling moron do you have to be to not notice "grossly discolored, swollen, and full of foul-smelling parulence [sic]?" Jesus Christ, Big Daddy and the Spook! Though, the doctor should have prescribed antibiotics because there was not definite cause that could be determined for the injury. Cover all your bases, including your own ass. Then the Stupid Drunk Old Man wouldn't be out spending someone else's $10,000, shuffling his bills around with three fingers. The mental image makes me snicker and I feel awful when I do, but this just leads back to taking blame for you own mistakes. Okay. I've got pictures of Casa and Back Fat. I'm having a moral dilemma, should I call Dr. Laura? I can't decide if I want to post them or not. You tell me. My humble apologies for not updating yesterday, Adam called me from home around lunch and told me he was sick. So I stopped and rented a few movies, Stir of Echoes, Chasing Amy, and Trainspotting. Adam had said he wanted to see Chasing Amy and Trainspotting again recently, and Stir of Echoes just came out. What I really wanted to rent was Death Car. It was wonderful, no one was in the store but me, so I traipsed around, trying to remember what it was that Adam had mentioned. Everytime I saw one of my favorite films I kept thinking to myself, "I have got to talk about this in today's entry." What a geek I am. I stopped myself from pulling out a pen and making notes. So, from what I can remember, which isn't much, see these films; Death and the Maiden Absolute Beginners Freeway Mr. Frost See, I told you I couldn't remember that much. And I wasn't even inebriated in an form. I'm so disappointed in my feeble little mind. So, the husband is sick, I couldn't even lure him into bed with the sultry whisper in his ear..."I've stopped sloughing." What man can resist that?!? Adam can. Although he made up for it this morning by standing in the shower having just turned off the water, bare assed and dripping, and telling me (paraphrased for younger readers) that I better just be waiting when he gets home tonight. I'll take that to mean that he's feeling a little better. I joined a few mailing lists and my first webring. I can tell you already that I was disillusioned enough to believe that anyone would respond to my first message out there. Which most likely could have been construed as pompous and self-righteous. Which I'm not. The topic just happens to get my back up. Guess what it is. Who Wants to Marry a Millionaire? People are just screaming sexist at the drop of a hat. Which makes me feel self righteous and I feel like screaming back... Men and women are not the same, physically or mentally. Celebrate these differences instead of finger wagging at anything that points this out. I love the fact that I am the owner of a vagina. God help anyone unhappy enough that they will get angry because people don't turn a blind eye to our differences. This does not include injustices based on sex race creed or religion. I'm talking about Miss America, commercials focused at women, men who enjoy looking at women, these are NOT sexist things. Sexism is being paid less on the basis of your gender. Sexism is a court siding with a man because the woman was wearing a short skirt and invited rape. Sexism is NOT "Who Wants to Marry a Millionaire?". Talk to me. Let me know what I should do, god knows I can't think for myself.
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