WSJ Video: The Skinny on Stents

Christopher White, chief of cardiology at New Orleans’s Ochsner Clinic talks about the present and future of the cardiac stents.

Link via WSJ Health Blog.

What to do if you lose a guide wire during central line placement?

I was discussing central line placement complications with medical students a few days ago. Some of them are illustrated with horrifying details in the NEJM.

"What should you do if you lose a guide wire during central line placement?", I asked.

"We could use a strong magnet to pull it out", one of the students suggested.

Well, not really.

You should call interventional radiology immediately and the radiologist will extract the wire under fluoroscopic guidance by using another wire to hook up and pull out the lost one.

A few examples of different approaches to extract lost guide wires are listed in the British Journal of Anaesthesia.

We have published free illustrated step-by-step procedure guides to central placement with and without ultrasound. The guides are available as web pages and Windows Mobile/Palm downloads.

References:
Central Line Placement: A Step-by-Step Procedure Guide with Photos
Loss of the guide wire: mishap or blunder? British Journal of Anaesthesia, 2002, Vol. 88, No. 1 144-146.
Lost guide wire during central venous cannulation and its surgical retrieval. Kumar S, Eapen S, Vaid VN, Bhagwat AR. Indian J Surg 2006;68:33-34.
Image source: Wikipedia, public domain.

Further reading:
Lost Guide Wire. Radiology Picture of the Day.
A Big Time Mistake. Ten out of Ten: My experiences as an ER doc, 02/2008.

Improper placement of the central venous catheter - case one and case two from the Annals of Emergency Medicine

Updated: 02/09/2010

Dr. Charles' Blog Goes on Hiatus with Memorable Final Thoughts

I have enjoyed reading The Examining Room of Dr. Charles for years. He writes one of the best literary sites in the medical blogosphere and not surprisingly is the most famous Dr. Charles according to Google. Dr. Charles started his blog on Blogger.com, published a book and moved his site to Science Blogs about a year ago. Since then, his style of writing has been somewhat different and focused more on current events rather than what I think he does best -- telling compelling (if fictional) patient stories. I will stay subscribed to the feed in case he decides to bring his blog back online one day. In the meantime, somebody else took over his old blogspot URL which is sad since the blog archives seem to be lost.

Here is Dr. Charles himself:

"And If I were to make a few final requests they might be the following. Watch the swallows flying before sunset. Save the planet. Cook a meal with someone you love, and drink too much wine while you're doing it. Please don't vote for another Bush or Edwards. Support health care courts and malpractice reform. Bring your doctor a tomato from your garden, assuming you like him. Cancel you cable, buy a hammock, and get a library card. Use more basil. Beware of people selling unproven cures. Lie on your back and watch for shooting stars. Go to the beach in the off-season. Fight for justice. Fight for truth. Never take for granted the blessings of good health. Help those who are sick. And remember that you don't need things to make you happy, and that life is a bittersweet flash of a firefly at night."

Image source: Tirau Sunset, Essjay NZ, a Creative Commons license.

Updated 07/08/2009:

After a two year hiatus, the talented medical blogger Dr. Charles is back, "reopening the examining room" http://bit.ly/igKWW

Funny Ads: "Hello, I'm a Mac... And, I'm a PC"

A 7-minute collection of 15 short video ads showing the cool Apple Mac Guy vs. the loved-by-everybody PC Guy.

Update 02/04/2008: The compilation video was deleted but the individual clips are still available on iTube.

Related:
Is Obama a Mac and Clinton a PC? NYTimes, 02/2008.

Updated: 02/04/2008

Medicine 2.0 -- A Blog Carnival About Web 2.0 and Medicine

Medicine 2.0 is a weekly blog carnival which collects the most interesting posts about Web 2.0 and Medicine.

A blog carnival is a blog event similar to a magazine dedicated to a particular topic. It is published on a regular schedule, often weekly or monthly. Each edition of a blog carnival is in the form of a blog article that contains links to other blog articles on the particular topic (source: Wikipedia).



Video: Using the Web 2.0 write up in Wikipedia this video is to help teach educators about Web 2.0 tools, by JuTechTips.

Image source: ScienceRoll.com, a Creative Commons license.

Confessions of a Rock Star and DVT Victim plus Ten Tips for Survival

Ian Anderson, the front man of the famous British rock group Jethro Tull shares his experience of developing DVT while travelling between 3 continents in 2001:

Confessions of a DVT Victim and Ten Tips for Survival

"But something didn't feel right with the leg - a deeper and more sinister feeling than just the dodgy knee - so, after a brief discussion with a worried hotel doctor, I took myself off to a Sydney hospital and insisted on an ultrasound scan to determine that, hopefully, no clot was present. Alas, the scan showed a huge and life-threatening clot stretching from just above the ankle to the upper thigh, just below the groin."

A new study by the World Health Organization (WHO) shows that the risk of developing deep vein thrombosis doubles after traveling for just four hours.

Comments from Twitter:

@AllergyNet (Dr John Weiner): Blood clots x3 higher on long-distance flights than the general population http://goo.gl/Tk45Z - Wear those stockings to Australia! Would you believe, I've got tickets to see JT in Melbourne in April, he prob should have a shot of anticoagulant plus the stocking!

References:
Thrombosis risks double after 4-hour travel: study. Reuters, 06/2007.
Image source: JethroTull.com
More information: Ian Anderson Interview, 2003 on YouTube.

Secret to Long Life: Take It Slow, Don’t Have Many Kids and Enjoy Cold Water (If You Are a Whale)

211 and 115-year-old whales?

According to the NYTimes, the secret to long life is to "Take It Slow, Don’t Have Many Kids and Enjoy Cold Water", that is if you are a whale:

"Eskimo hunters killed a bowhead whale off the coast of Alaska last month and began to chainsaw their way into its blubber. They stopped when the saw hit the tip of an old harpoon lodged deep inside the whale. Historians identified it last week as part of a bomb lance, a harpoon manufactured for only a few years in the late 1800s in New Bedford, Mass. Whalers probably fired it at the bowhead around 1890, when the whale was probably a teenager, and it carried the harpoon for the next 115 years before finally being killed by a modern one."

References:
Take It Slow, Don’t Have Many Kids and Enjoy Cold Water. NYTimes, 06/2007.
Image source: Wikipedia, public domain.