You Can't Silence Us

Old School

A few of my readers have commented on how they enjoy practice pearls, so I thought I would go ahead and share a simple one. This particular pearl is not just for medical people, it will work quite well for those of you who are not in the medical profession. In the medical profession, a lot of time is spent training people in the latest, greatest technology- the newest medication, the latest technique, the wow factor, but sometimes, it is the old school method that works best. I recently had the chance to teach a young doctor this exact lesson.

Lacerations

We had a woman that entered the emergency room who had cut off the last quarter inch or so of the tip of her finger with a pair of scissors while attempting to cut open an Amazon package, of all things. In so doing, she had also managed to nick the artery, and blood was pulsing out of the end of her finger. She had the presence of mind to bring in what she thought was the tip of the finger (what she brought in wasn’t the finger) and she was attempting to control the bleeding herself, but wasn’t succeeding.

The doctor looked at it and suggested we perform a digital block and attempt to stitch off the artery and suture the wound closed. That was going to be a bear to do. Instead, I suggested that we try something a bit more old school. I took a large emesis basin, filled it with ice, a little water water, and a bottle of Providone. I told the woman to place her finger in the basin and keep it there until the cold became painful. This concoction does three things:

  • The ice numbs the area
  • the Providone cleans the wound (there is a risk of infection if you don’t)
  • the ice also constricts blood vessels and is great at controlling bleeding

She spent about 15 minutes with her hand in that basin, and this stopped about 80% of the bleeding. I pulled her hand out, cleaned the finger with a couple of gauze pads (4×4), then had her hold one against the tip of her finger using her thumb. After about 5 minutes of that, we still had some bleeding, so I soaked a gauze pad with tranexamic acid (TXA) and placed it against the wound. That stopped the rest of the bleeding. I dressed the wound, and we sent her home.

Esophageal Varices

Just as you can get varicose veins in your legs, you can get them in your esophagus as a result of cirrhosis of the liver and the resulting portal hypertension. I was working in the ED one night when a patient began vomiting large amounts of blood. I’m not talking about what most people would think are large amounts of blood, but what a nurse who works in the ED thinks are large amounts of blood. It looked like this:

We were under the gun: if this bleeding didn’t stop, we were looking at a dead patient. I inserted an NG tube to suction out the blood, and the doctor and I came up with a plan. Using a piston syringe, I would push about 100 ml of ice water into the tube, let it sit for about 30 seconds, then suction it back out. I repeated this about 5 or 6 times, and each time, the amount of blood that came out with it was less. I was forced to stop after that 5th or 6th time, because the cold must have been irritating to her heart, as evidenced by the fact that she began having short runs of ventricular tachycardia. For that reason, anyone trying this, I would recommend placing the patient on a cardiac monitor and keeping a close eye on on their heart rhythm while doing this.

Ice- it’s quite useful in emergency medicine, but it isn’t used much any more in emergency medicine because it doesn’t have the sexy feel of the latest, greatest advances in medical technology, but it is still damned effective. Sometimes old school is still the best way to go.

People who have read this post: 271
By Divemedic, ago

No Posting Today

My Father in law needed some help throwing sod in his yard today, so I wound up spending the day helping him with yard work. I have told the in-laws not to do that sort of work, but to call me instead. They fall quite often, and I don’t want them getting hurt.

I spent about 8 hours throwing sod and working in their yard. It was 95 degF today, so I am spent.

Family comes first. Let’s see what we can do tomorrow.

People who have read this post: 79
By Divemedic, ago

Kids Acting Like Kids?

The so- called “teen takeover” trend expanded this past weekend when a large group of “teens” headed to Clearwater Beach and immediately began attacking people before it ended with gunshots. The police chief had this to say:

Deputy Chief of the Clearwater Police Department, Michael Walek, held a press conference around 8:30 p.m., where he said the incident was organized through social media and that it happened because of a “bunch of kids acting like kids,” claiming that this kind of incident would not happen again. 

Kids shooting each other is actung like kids? That’s because it’s “teens”

People who have read this post: 524
By Divemedic, ago

Why I’m Not Libertarian, pt 27

This is where the Libertarian Party is now.

If you don’t support rioting to protect illegal immigrants, you’re a tyrant, according to the Libertarian Party.

The term is peaceably assemble and petition the Government for a redress of grievances. Rioting, blocking others from traveling, committing violent acts and arson, are not peaceable or a petition.

I just can’t be a libertarian. I like classical liberal or perhaps Lockean liberal better.

People who have read this post: 326
By Divemedic, ago

Taxation for Profit

Ever since DeSantis came out with his proposal to virtually eliminate property taxes, by social media feeds have been absolutely overrun with people screaming about how towns will go bankrupt and have to shut down police, fire, and roads. It is so pervasive and widespread, it’s like a chorus. They are also being misleading.

I want to use my town as an example. For a reminder on how Florida does property taxes, you can read this old post from a year ago. Where I live is a town with 3500 people living in about 900 households. Our only commercial property consists of a convenience store and a single diner. Of those households, nearly a quarter of them (18%) pay less than $200 a year in non-school taxes.

Town revenue breaks down like this:

  • 29% of revenue is from ad valorem taxes, with almost half of it (14% of the total revenue) being from ad valorem taxes on homestead property.
  • 29% of revenue comes from fees for services (fees for water, sewer, trash, and other city services)
  • 20% from state and federal funding
  • 10% from shared taxes with the county
  • 10% from utility taxes
  • 2% miscellaneous sources

Keep in mind that the town LOVES my neighborhood, because the people in it comprise only 1/10 of the town’s population, but pay about 25% of all ad valorem taxes. Another 18% pay nothing, or nearly so. The governor’s plan would increase homestead exemptions to $250,000 (from $50,000 currently) in the first year, then to $500,000 the second year, meaning no one would pay taxes on any home until its value was more than $500,000, except for school taxes, which would remain unaffected. A complete loss of ad valorem taxes on homestead property would mean the city would face a loss of 14% of their revenues. What would have to be cut? Let’s look at the town budget. This is where the town budget goes:

  • 33% to the Police department
  • 29% to Administration, Finance, Legal, Legislative, and Planning
  • 22% to Public Works and solid waste
  • 10% to the library
  • 2% to Code Enforcement
  • 3% to Historical Preservation, Cemetaries, and Special Events
  • 1% to parks and recreation

It seems to me that the town is pretty top heavy in administration, the library is an extravagance, and I would argue that a town of 3500 people doesn’t need 15 police officers. I would cut the library, and I would cut the police and admin budgets by 10% each. That takes care of most of the cuts you need right there.

  • Will a small town with almost zero crime miss a single cop being cut from the budget? Likely not.
  • Likewise, the library just isn’t as important as it used to be in the age of the Internet. Certainly not important enough to take money from residents, and taking the homes of those who won’t pay.
  • and seriously, a third of the city budget being administrative overhead?

The town has 50 employees, with 15 being law enforcement officers. Granted, 20 of the town’s employees are seasonal or part time, but that seems like a heavy dead load for a town of 3500, where a fifth of them aren’t paying any taxes at all.

Since 2020, the town’s total revenue has increased 250%, but the population has only increased by 6%.

Losing ad valorem taxes on homestead property isn’t just doable, it’s the only way to curb the bloat. Towns are treating these massive windfalls from taxation like a teenager who just found his dad’s credit cards.

People who have read this post: 337
By Divemedic, ago