Archive for February, 2011

Compression Ultrasonography of the Lower Extremity With Portable Vascular Ultrasonography Can Accurately Detect Deep Venous Thrombosis in the Emergency Department Ann Emerg Med. 2010;56:601-610

[I’m still reading the EM literature fairly avidly, i’m just not posting quite as much as I did]

I’m a bit of an ED USS fan. For the simple things. Keep it simple and we’ll not cock it up. I promise.

Some in the radiology are (understandably) concerned about letting us play around with the higher frequencies. I agree, lots of these concerns are genuine but some are just nervous titters over who own which turf.

Every other specialty in the hospital seems to get free (mainly unaccredited) reign with the USS machine. In EM there’s a lot of work going into this so it’s kind of an inevitability that we’ll be waving an USS probe at you in the near future.


DVTs are dull and largely uninteresting. But some of them are probably important. Not nearly as many as we think mind you, but definitely some of them. There is a movement towards abandoning imaging anything below the knee for DVT. If you look you’ll find them, it just seems that they don’t mean anything.

The radiology dept. in our place seem to be mainly doing this.

This study sought to prove that we can do this (very simple, come on admit it…) imaging study as well as the radiology techs can do it with very little training.

This place had 60000 patients a year and 60 docs (of note we see 78000 a year and have about 25!) of whom 45 docs did the enrolling. Most were middle-grades with some (but not much DVT) USS experience.

The enrolled everyone who they had enough concern to  order an USS in the radiology dept.

They did a 2-point compression exam (femoral and popliteal only) and compared this with the radiology exam (proximal limb only but not a 2-point compression).

And they got the same results (about 25% were positive overall) as the radiology dept did.

[They actually did better as the ED called one scan +ve that the radiology called -ve yet it turned +ve when they repeated it a week later!]

I think this is pretty compelling stuff. If we can finally grow the balls to stop worrying about below knee DVTs (unless there’s some other reason to worry about them) and get some basic, universal USS training and culture going in the ED (which the college are pushing for pretty well, even if Northern Ireland isn’t quite on the ball yet) then we can make this whole thing a lot less hassle for both us and our patients.

How I remember

So I’m somewhere between Leixlip and Clonsilla, on my way into town to meet Simy and Morsies. I’ll be waiting for them in Connolly station when the 1108 enterprise gets in

And I remember.

I remember leaning on the metal barrier at Auckland airport waiting for Simy and Morsies to arrive. Me on the other side of the world waiting for my family to come visit.

I’m not even sure if I’m weeping cause I’m happy or cause I’m sad.

As the train pulls into Coolmine I’m sitting here in the single seat behind the toilet trying to wipe away the tears so I don’t freak out the other commuters

What’ll I be like when I’m waiitng for God in my doting eighties, catching sight of digitised memories and silently weeping in the corner.

After Virtue – 1

If i’m ever at a loose end in trinity of an evening I tend to wander into the library and slowly work my through Alisdair Mcintyre’s After Virtue. It’s been about 4 months now and i’m only on chapter 4 so it may take a while.

Last night while waiting for a lecture by this guy I came across a fascinating bit in chapter 4 about the origin of the word moral.

According to Mcintyre there was no word in Latin appropriately translated as moral till we translated one backwards into latin.

There is a latin word moralis that is linked (but not the same) as our word moral. But even moralis is another invented word (from Cicero) to translate the Greek word ethikos.

Here’s where the distinction from our word moral comes in: Ethikos is taken to mean “pertaining to character” and was understood as

a set of dispositons to behave systematically in one way rather than another. To lead one particular kind of life

The very idea that we could abstract “the moral of the story” from the character of the person is such a new idea that we had to invent a new word for it.


Bird stealing bread

About 10 days ago now someone pinched a couple of bags of coal from our back yard. In the middle of the night when we were sleeping.

This made me notice a few things:

1) i felt a sense of fear and violation and mistrust. Why would someone steal my coal? I started to suspect my neighbours just because they could see into my garden.

2) a move towards increasing security around the house. I got a lock and put it on the back gate, I’m a bit more cognisant about whether doors are locked. This is faulty on two levels. One – it’s closing the door after the horse has bolted and two – the way we do security makes us feel more secure but I doubt it really stops much.

3) it made me consider the idea that a peaceful society depends not on law or security but on a willingness to live peacefully (or a reluctance to steal) from one another.


Suffering Presence – 6

Hauerwas quotes from some folk called Gliedman and Roth in a book called the unexpected minority. They suggest that perhaps it may be better (or more useful) to view those with disabilities as being an oppressed minority rather than those with a medical condition.

Not that they don’t have medical reasons for their disabilities but that they suffer more from social exclusion than they do their “medical defect”.

We (as a society) don’t want to see our treatment of those with disabilities as social exclusion because then we’d know we have to do something about it. When we keep it under the banner of medicine then we can happily exclude them without burden to out consciences


It takes a lot to laugh it takes a train to cry

We’ve been working our way through 3o Rock over the past number of month and it’s only just dawned on me that it uses all the same comedy techniques as the Simpsons except with real people.

Kind of real people.

This link shows some good examples. (they wouldn’t let me embed it)


February 2011