Going To Sleep Is Free, But

Administrators, there are Six Sigma specialists already at your hospital

• Categories: Medical errors
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Six sigma. Lean six sigma. High reliability organizations. Hospital administrators seem to drool over this stuff. Many are willing to go out and spend lots of money on six sigma consultants to come in to their hospitals and integrate the buzz words.

What many hospital administrators don't realize (or conveniently forget) is that anesthesiology is a six sigma specialty within medicine. That is, there are fewer than six mishaps per million events. That safety attitude is ingrained in us from the first day or residency. We live and breath six sigma and evidence-based medicine.

So, hospital administrator, the next time an endocrinologist comes to you with a plan to give insulin to non-critically ill, non-diabetic patients with a blood glucose over 120 right before their general anesthetic and the entire group of anesthesiologist says 'I don't think that's a very good idea,' pause, take a deep breath, and listen to what they have to say.

Six sigma is a way of thinking. Six sigma trumps three sigma any day of the week.

Transfer Password Wallet Entries to iPhone

• Categories: iPhone, Software
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I've been a long time user of Password Wallet from Zelznick Scientific Software. A password manager with 448-bit keys, it can launch url's and autofill usernames and passwords. Love it.

This morning they announced the availability of Password Wallet for iPhone. I purchased and installed it right away. It's slick, so I thought I'd post some screenshots. After exporting my selected Password Wallet records to Safari as a bookmarklet, I synced my iPhone with iTunes. I next went to that bookmarklet:

After entering my (correct) password I saw:

Selecting one of the records yielded (username and password erased, of course).

The Latest In Controlling OR Heat Loss

• Categories: Anesthesia Tips
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Keeping patients warm in the operating room can be a challenge. On call two weekends ago I had an 'Aha' moment--give them knit caps! Below is the protype--a scullcap made from 6 inch stockinette.

[note: this photo was taken with an iPhone!]

Tool of the Trade: Lidocaine

• Categories: Anesthesia Tips
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Dr. Wes' post on the proper way to inject lidocaine got me to thinking about how I do it and I think I have some tips to share, too. I inject lidocaine in people's back while they're in labor, in their groins, necks, and arm pits when I do blocks, and of course in their hands and arms when I place IV's. (I inject it into their IV's, too, but there's no trick to that, really.)

When I have time, I like to add about a one fourth volume of bicarbonate to the lidocaine I'm injecting. (This doesn't work with bupivicaine as it will cause it to precipitate out.) I've testing this on myself, on nurses in labor, and in patients in labor and I am convinced this removes most of the burning sensation that comes with injecting lidocaine.

After having selected my injection site and cleaned it (with alcohol, betadine, chloraprep, duraprep, etc.) I wait for the prep to dry so that the prepping agent doesn't cause any stinging. I place a drop of lidocaine on the skin and insert the needle through the drop of lidocaine to make contact with the skin (after warning the patient, of course). This works, not because it numbs the skin under the drop (you need a eutectic mixture of local anesthetics for that) but because it caries some lidocaine in on the tip of the needle. I inject while inserting the needle intradermally. You should inject slowly, advance slowly, and see a skin wheal if it's truly an intradermal injection. This is easiest on horizontal surfaces but can also be done on a vertical surface like a back. In my opinion the wrong way to do inject lidocaine is the way tuberculin skin test are often placed: jab in the tiny needle (ouch!) inject the antigen quickly (ouch!).

When I watch trainees inject lidocaine I often see them stop to aspirate to make sure they're not in a blood vessel. This is unnecessary a) if you keep the tip of the needle moving and b) because the total dose of lidocaine in the 3cc syringe is not enough to cause toxicity even if injected intravascularly. We now return you to your regularly scheduled programming...

Give Me $200 Off My NEXT iPhone

• Categories: iPhone
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People at the hospital gleefully point out to me that my iPhone is now $200 cheaper than when I bought it ten weeks ago. I'll tell you what I'd like more than a $100 rebate now: A $200 rebate on my next iPhone (you know, the one with 3G wireless).

Your History Can Haunt You

• Categories: News
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A cardiologist in San Diego is accused of striking a patient during a heart cath:

Dr. Maurice Buchbinder, a prominent cardiologist, and Scripps Memorial in La Jolla are under federal investigation because he allegedly hit a patient several times during a procedure at the hospital, physicians and health officials have confirmed.

Having been called to the cath lab on several occasions to intubate his patients I can say that this report does not surprise me and is completely consistent with past behavior (though he never struck anyone in my presence). I'm quite sure he refrained from striking me only because of my size and ability to fight back.

Nothing can stand between me and my bluegrass

• Categories: Anesthesia Tips
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On call at the hospital today. The work is done and we're getting ready to order Chinese food. Time for some computer work and bluegrass. But wait! The hospital has decided to block XM streams!

Thank you iTunes: Bluegrass Radio 128 kbps 100 Percent Pure Acoustic Bluegrass

Life is good (again).

Got Aperture, Want To Upload to Picasa? Think Ubermind.

• Categories: Software
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I just found a nice plugin for Aperture which automates uploading photos to Google's Picasa Web Album site--Aperture to Picasa Web Albums. My unfrozen caveman anesthesiologist review? Grrr. Upload easy. Good. Grrruh.

Dr. Anna Poe of New Orleans Not To Be Charged

• Categories: News
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Grand jury refuses to indict Anna Pou

Four civil suits are pending so her legal ordeal isn't over yet. As I understand it, the burden of proof in a civil suit requires only that the plaintifs version of the facts is 'more than likely' to be true (ref).

Safety Tip: Nerve Block Needle Disposal

• Categories: Anesthesia Tips
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I most commonly use a 2 inch B-bevel insulated needle for nerve blocks. It is often not convenient to dispose of the block needle right away after completing the block, so I started placing it in the barrel of the empty syringe from the plunger side and holding it in place with by depressing the plunger. Like this:

Safer for myself and my assistant (when I have an assistant).

Dark Chocolate Proven Healthy, Again

• Categories: Medical Articles, Data
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JAMA: Effects of Low Habitual Cocoa Intake on Blood Pressure and Bioactive Nitric Oxide

With a change of roughly 3 systolic points and 2 diastolic points I'm not going to stop taking my Prinivil just yet.....

Muslim First, Doctors Second

• Categories: Politics
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The news that several Muslim physicians were allegedly involved in the UK and Scotland bombing plots did not surprise me as much as it did some others. It made me think back to a conversation I had with a Muslim anesthesiology resident shortly after September 11th.

This resident physician was from Iraq, was a doctor in Saddam's army , surrendered to Canadian troops during Gulf War I and was granted political asylum in Canada. He was very well trained and was a wonderful resident to work with--good work ethic, felt responsible to his patient, a pleasure to teach, a natural in many respects. I'd like to think we became friends during those years. In fact, he gave my an anesthetic for my own appendectomy.

We'd had several conversations about Islam previously and I asked him what he would do if Grand Ayatollah al-Sistani instructed all Shia Muslims to kill Americans? Without even a pause he answered 'I would do it.' Muslim first, doctor second.

Swapping 3G SIM Card Into Activated iPhone Fails

• Categories: Technology
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Having settled on giving my wife the iPhone I wanted to see if I could insert her 3G SIM into the already activated iPhone so that her cellular number wouldn't change. No joy. I saw a brief message about it being the wrong SIM (even though the SIM cards appear identical on the outside). The device worked, but I had no cellular signal strength indicator or carrier name.

What I've done instead is set her original number to forward calls to her iPhone number when it's off.

The OTHER London Car Bomb

• Categories: Humor
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Surveillance camera's in London have captured video of what looks to be another car bomb attempt near central London. This one used a Volkswagen rather than a Mercedes.