Category Archives: General

Final Answer: What The Heck Is It #1

Alright, here’s the final answer to the xray I posted last Friday. This patient was using a ThermaCare Menstrual HeatWrap by Pfizer. It was applied to her back, though, for relief from back pain. It was not apparent during the trauma activation exam, even with clothes off, until we logrolled her to examine her back.

Each pocket in the wrap contains a granular mixture of activated carbon, iron powder, salt and a few other ingredients. When the wrap is removed from its vacuum pouch it heats up to 104F (40C) and stays hot for up to 8 hours. The iron shows up on xrays. The regular pattern is a giveaway that this is not some other problem (stones, drug pouches in the colon).

Bottom line: Remember, conventional xrays collapse a 3D space onto a 2D image, so you can’t tell how deep objects are (anterior to posterior). This is another reminder to be thorough when examining your patient. They can hide things anywhere!

Disclaimer: I do not have any financial or other interest in Pfizer Inc.

What The Heck Final Answer

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Your Comments

I’d like to thank everyone for their comments. An unregistered user just left a comment on a post on local wound exploration that I published 6 months ago. It poses a good question and I don’t want it to get lost in the archives. Click here to see the old post. I’m going to do a post next Wednesday entitled “The Art of Local Wound Exploration” that should answer everybody’s questions about this.

And so far, no one has figured out the weird pelvic xray below.

Michael

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What The Heck Is It? #1

Here’s a perfect item for April Fool’s Day, although it is for real. The xray below was a pelvic image obtained during a trauma team activation. I’m not going to give you any more information than that. 

You’ve got until Monday to figure out what’s doesn’t belong and give me an answer in the comments. I’ll post the full story and answer then.

What The Heck #1

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Reporting Unsafe Drivers: Part 2

So what should you do if you encounter a patient that really shouldn’t be driving? First, encourage them and/or their family to self-report. If that fails, familiarize yourself with the laws of your state (or province). 

In the US, 11 states have mandatory reporting laws for certain conditions that would impair driving. Forty have some type of reporting system for phsyicians and other health professionals. Many allow anyone to report. However, a few stipulate that they may release your name to the driver or that you must have their permission to report. This is essentially the same as not allowing you to report.

Unfortunately, only 29 states hold you harmless from civil or criminal suit if you choose to report. I suspect it would be a tough sell convincing a jury that a patient’s inconvenience is more important than protecting them from an unsafe driver, though. I doubt such a suit would go anywhere.

So brush up on the laws and procedures in your state and decide what is in your patient’s (and the public’s) best interest. Then do the right thing.

A sample of my compiled report of US state reporting laws is shown below. Click it or this link to download it.

To read Part 1 of this article, click here.

Sample state driver license laws

References: 

  1. Physician’s Guide to Assessing and Counseling Older Drivers 2e. NHTSA / AMA, 2010.
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